Major determinants of premature mortality in middle-aged urban males. Alcohol-related deaths and degree of participation in a preventive population program against alcohol and its complications.

The total, consecutive mortality in a population of 10,353 middle-aged males invited to participate in a preventive medical population program in Malmö was followed up 1.5-6.5 years, mean 4.5 years, after the time of invitation and analyzed in relation to participation or nonparticipation, forensic or in-hospital autopsy and possible intervention effects. The total mortality was twice as high in the nonparticipants as in the participants, and the death rate due to alcohol-related diseases was five times higher. There were no significant differences in other causes of death, including cancer and cardiovascular diseases. In the nonparticipants autopsied at the Forensic Department the proportion of alcohol-related deaths was 60.5%, compared with 10.0% in participants autopsied in hospital. A history of alcohol abuse was present in 45.2% of the total sample, and in 61.0% of the group autopsied at the Forensic Department. In participants with increased screening gamma-glutamyltransferase, mortality at 48-72 months' follow-up was lower in an intervention group in comparison with a control group matched for sex, age and gamma-glutamyltransferase. The results support findings that alcohol-related deaths, nonparticipation in a preventive population program, and intervention effects in a public health strategy against alcohol and its complications are major determinants of premature mortality in middle-aged urban males.