Trias-Llimós Sergi, Bijlsma Maarten J, Janssen Fanny
Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, the Netherlands.
Max Planck Institute for Demographic Research, Rostock, Germany.
Addiction. 2017 Feb;112(2):250-258. doi: 10.1111/add.13614. Epub 2016 Oct 28.
Understanding why inequalities in alcohol-related mortality trends by sex and country exist is essential for developing health policies. Birth cohort effects, indicative of differences by generation in drinking, have rarely been studied. This study estimated the relative contributions of birth cohorts to liver cirrhosis mortality trends and compared sex- and country-specific cohort patterns across eight European countries.
Time-series analysis of population-level mortality data.
Austria, Finland, Hungary, Italy, the Netherlands, Poland, Spain and Sweden; 1950-2011.
National populations aged 15-94 years.
We modelled country- and sex-specific liver cirrhosis mortality (from national vital registers) adjusting for age, period and birth cohort.
Birth cohorts (adjusted for age and period) made statistically significant contributions to liver cirrhosis mortality in all countries and for both sexes (P < 0.001), and more so among women (average contribution to deviance reduction of 38.8%) than among men (17.4%). The observed cohort patterns were statistically different between all but two country pairs (P < 0.001). Sex differences existed overall (P < 0.001), but not in the majority of countries (P > 0.999). Visual inspection of birth cohort patterns reveals birth cohorts at higher risk of liver cirrhosis mortality.
The inclusion of the birth cohort dimension improves the understanding of alcohol-attributable mortality trends in Europe. Birth cohorts at higher risk of liver cirrhosis mortality were born during 1935-49 in Sweden and Finland, around 1950 in Austria and the Netherlands and 1960 or later in Hungary, Italy, Poland and Spain.
了解性别和国家在酒精相关死亡率趋势方面存在不平等的原因对于制定卫生政策至关重要。出生队列效应（表明代际饮酒差异）很少被研究。本研究估计了出生队列对肝硬化死亡率趋势的相对贡献，并比较了八个欧洲国家的性别和国家特定队列模式。
对人群水平死亡率数据进行时间序列分析。
奥地利、芬兰、匈牙利、意大利、荷兰、波兰、西班牙和瑞典；1950 - 2011年。
15 - 94岁的全国人口。
我们对国家和性别特定的肝硬化死亡率（来自国家生命登记册）进行建模，并对年龄、时期和出生队列进行调整。
出生队列（经年龄和时期调整）对所有国家和两性的肝硬化死亡率均有统计学显著贡献（P < 0.001），女性的贡献（对偏差减少的平均贡献为38.8%）大于男性（17.4%）。除了两对国家外，所有观察到的队列模式在统计学上均有差异（P < 0.001）。总体上存在性别差异（P < 0.001），但在大多数国家不存在（P > 0.999）。对出生队列模式的直观检查揭示了肝硬化死亡率风险较高的出生队列。
纳入出生队列维度有助于更好地理解欧洲酒精所致死亡率趋势。肝硬化死亡率风险较高的出生队列在瑞典和芬兰为1935 - 1949年出生，奥地利和荷兰约为1950年出生，匈牙利、意大利、波兰和西班牙为1960年或之后出生。
