Corrao G, Ferrari P, Zambon A, Torchio P, Aricò S, Decarli A
Institute of Statistical and Mathematical Sciences, University of Milan, Italy.
Int J Epidemiol. 1997 Feb;26(1):100-9. doi: 10.1093/ije/26.1.100.
Since the mid 1970s, a striking reduction in alcohol-related problems has been observed in many Western countries. Liver cirrhosis mortality is considered to be a major indicator of alcohol-related problems in the general population. The aim of the present study is to describe liver cirrhosis mortality trends in European countries between 1970 and 1989.
This is a descriptive study on liver cirrhosis mortality in 25 European countries, and in four grouped European regions. A Poisson log-linear age-period-cohort model is used to clarify whether the recent trend in mortality represents a short-term fluctuation or an emerging long-term trend. In addition, a descriptive comparison between trends in per capital alcohol consumption and liver cirrhosis mortality is conducted.
In the whole European population and in that of Western and Southern Europe increasing period effects were observed until the second half of the 1970s followed by a decline in the next periods. In Eastern Europe the decline in period effects started in the first half of the 1980s, whereas in Northern Europe an increasing period effect was observed until the second half of the 1970s, followed by a stabilization. Similar trends were observed for per capita alcohol consumption. The age effect analysis showed a continuously rising effect in Eastern Europe, whereas an attenuation of the effect at around age 65 years was observed in Western Europe. Intermediate patterns were observed in Southern and Northern Europe. The birth cohort effect suggested that in the Western and Southern populations mortality could continue to decrease over the next decade, while in Eastern and Northern mortality is still rising and this will probably continue for the next decade.
The age-period-cohort analysis allows targeting of health care and prevention programmes based on future trends. Aetiological and prognostic factors act differently in Europe. A better understanding of the trends would require more detailed information on alcoholism treatment rates, alcohol habits, viral hepatitic infections and other factors involved in the aetiopathogenesis of the disease.
自20世纪70年代中期以来，许多西方国家与酒精相关的问题显著减少。肝硬化死亡率被认为是普通人群中与酒精相关问题的主要指标。本研究的目的是描述1970年至1989年欧洲国家肝硬化死亡率的趋势。
这是一项关于25个欧洲国家以及四个欧洲区域组肝硬化死亡率的描述性研究。使用泊松对数线性年龄-时期-队列模型来阐明近期死亡率趋势是代表短期波动还是新出现的长期趋势。此外，还对人均酒精消费量趋势与肝硬化死亡率进行了描述性比较。
在整个欧洲人群以及西欧和南欧人群中，直到20世纪70年代后半期观察到时期效应增加，随后在接下来的时期出现下降。在东欧，时期效应的下降始于20世纪80年代上半叶，而在北欧，直到20世纪70年代后半期观察到时期效应增加，随后趋于稳定。人均酒精消费量也观察到类似趋势。年龄效应分析表明，东欧的效应持续上升，而在西欧，65岁左右观察到效应减弱。在南欧和北欧观察到中间模式。出生队列效应表明，在西欧和南欧人群中，未来十年死亡率可能继续下降，而在东欧和北欧，死亡率仍在上升，并且可能在未来十年继续上升。
年龄-时期-队列分析有助于根据未来趋势确定医疗保健和预防计划的目标。病因和预后因素在欧洲的作用不同。更好地理解这些趋势需要关于酒精中毒治疗率、饮酒习惯、病毒性肝炎感染以及该疾病病因发病机制中涉及的其他因素的更详细信息。
