Alcoholism is known to be greatly underdiagnosed in death certificates, a fact that biases in estimates of alcohol-related mortality. An autopsy series of 1658 cases (920 with natural cause of death and 738 nonnatural) was reviewed to evaluate the extent of this bias, and also to see how well different sources of information served as indicators of alcoholism when alcohol-related disease diagnosed at autopsy was considered as a gold standard. A stepwise logistic regression model adjusted by age and sex showed police reports of individual's alcohol usage and blood alcohol concentration (BAC) of > 2.9/1000 at autopsy to be the two most significant predictors of chronic alcohol abuse (p 2.9/1000), due to its high specificity, as particularly suggestive of chronic heavy drinking. However, it is wise to use these parameters only as an aid in decision-making, not as sole indicators of alcoholism. Deaths associated with chronic heavy drinking were frequent, 50.5% of the total series (male 56.4%, female 37.1%). For all but one age-group (male 45-64 years), however, death certificates mentioned alcohol-related diseases in less than half of these cases. Especially evident underdiagnosis was found for female and males 65 years and older. These results indicate that alcoholism is frequent in such a highly selected population as a series of forensic autopsies and suggest that estimates of prevalence of alcoholism based only on review of death certificates are to be considered with great caution.(ABSTRACT TRUNCATED AT 250 WORDS)
Based on the encouraging findings in part I of our study, and on the relevant research literature, several sociodemographic factors were added to the causal sequence proposed by the distribution of consumption model and corroborated by a statistical technique known as the analysis of linear structural relations (LISREL). The sociodemographic factors were added in two alternative fashions. Although neither approach proved to be significantly superior, the basic causal sequence identified in part I was maintained, and the sociodemographic factors were found to be intimately involved in the process that leads to alcohol-related morbidity and alcohol-related mortality in the general population. The findings are discussed with reference to their implications for prevention via public policy.
One of the major approaches to alcoholism prevention is referred to as the distribution of consumption model. This prevention model can be summarized as a causal model whereby the availability of alcoholic beverages has a direct causal effect on the aggregate level of alcohol consumption in the population and, in turn, an indirect effect on the incidence and prevalence of alcohol-related damage. This article summarizes an application of a statistical technique known as the analysis of linear structural relations (LISREL) to a set of Ontario data concerning alcohol availability, alcohol consumption and alcohol-related damage. Results substantiated the existence of specific causal paths consistent with the model. Several procedures for assessing the overall goodness-of-fit of the model suggested that it adequately fit the data. The results provide reasonable statistical evidence that government policies restricting the retail availability of alcoholic beverages will reduce the per capita rates of alcohol consumption and, in turn, reduce the level of alcohol-related mortality and morbidity in the general population.
The aim of this study has been to explore and compare the mortality of 100 female and 100 male alcoholics, admitted to a department of alcoholic diseases in 1963-69. The patients were early cases and mortality was studied during an observation period of 6-12 years. A total of 18 women and 16 men died. As compared with the general population, mortality was 5.6 and 3.0 times higher than expected for the women and men, respectively. Among the women a significant excess mortality was found for accidents, suicides, diseases of the respiratory system, and especially cirrhosis of the liver. Mortality among the men was significantly higher than expected due to suicides, diseases of the circulatory system, neoplasms, chronic alcoholism, and acute alcohol poisoning. The excess mortality from suicides found for both sexes was highest in the female group. Despite the hitherto rather small number of deaths in the two groups, the high frequency of cirrhosis of the liver among the women is striking.
High alcohol consumption is one of the major risk indicators for premature death in middle-aged men. An indicator of alcohol abuse--registration with the social authorities for alcoholic problems--was used to evaluate the role of alcohol in relation to general and cause-specific mortality in a general population sample. Altogether 1,116 men (11%) out of a total population of 10,004 men were registered for alcoholic problems. Total mortality during 11.8 years' follow-up was 10.4% among the non-registered men, compared to 20.5% among men with occasional convictions for drunkenness and 29.6% among heavy abusers. Fatal cancer as a whole was not independently associated with alcohol abuse, but oropharyngeal and oesophageal cancers together were seven times more common in the alcohol-registered groups. Total coronary heart disease (CHD) was significantly and independently associated with alcohol abuse, but nearly all the excess CHD mortality among the alcohol-registered men could be attributed to sudden coronary death. Cases with definite recent myocardial infarction were not more common in the alcoholic population. A combined effect of coronary arteriosclerosis and heart muscle damage secondary to alcohol abuse is suggested. Other causes of death strongly associated with registration for alcohol abuse include pulmonary embolism, pneumonia and peptic ulcer, as well as death from liver cirrhosis and alcoholism. Of the excess mortality among alcohol-registered subjects, 20.1% could be attributed to CHD, 18.1% to violent death, 13.6% to alcoholism without another diagnosis and 11.1% to liver cirrhosis.
There is a consensus that the large fluctuations in mortality seen in Russia in the past two decades can be attributed to trends in alcohol consumption. However, the precise mechanisms linking alcohol to mortality from circulatory disease remain unclear. It has recently been argued that a substantial number of such deaths currently ascribed to cardiovascular disorders are misclassified cases of acute alcohol poisoning.
Analysis of routine mortality data and of a case-control study of mortality among working-age (25-54 years) men occurring in the Russian city of Izhevsk, west of the Ural mountains, 2003-05. Interviews were carried out with proxy informants for both the dead cases (N?=?1750) and the controls (N?=?1750) selected at random from a population register. Mortality was analysed according to indicators of alcohol problems.
Hazardous drinking was associated with an increased risk of death from circulatory diseases as a whole [odds ratio (OR)?=?4.14, 95% confidence interval (CI) 3.23, 5.31] adjusted for age, smoking and education. The association with alcoholic cardiomyopathy was particularly strong (OR?=?15.7, 95% CI 9.5, 25.9). Although there was no association with deaths from myocardial infarction (MI; OR?=?1.17, 95% CI 0.59, 2.32), there was a strong association with the aggregate of all other ischaemic heart disease (IHD; OR?=?4.04, 95% CI 2.79, 5.84). Stronger associations for each of these causes (other than MI) were seen with whether or not the man had drunk very heavily in the previous week. However, associations also remained when analyses were restricted to subjects with no evidence of recent heavy drinking, suggesting that misclassification of acute alcohol poisonings is unlikely to explain these overall associations.
Taken as a whole, the available evidence suggests that the positive association of alcohol with increased cardiovascular disease mortality may be best explained as being the result of a combination of chronic and acute alcohol consumption resulting in alcohol-related cardiac disorders, especially cardiomyopathy, rather than being due to misclassification of acute alcohol poisoning. Further work is required to understand the mechanisms underlying the link between heavy alcohol consumption and deaths classified as being due to IHD (other than MI).
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The role of alcohol abuse in mortality was studied in an unselected population of over 10,000 46-48-year-old men in Malmö, Sweden. During follow-up of 0-6 years (mean 3 years) 199 men died. In 61 men (30.7%) death was alcohol related. A theoretical calculation of excess deaths in men with an alcohol-positive history yielded 78 deaths (39.2%). In the official cause of death statistics 10 of the deaths had been assigned alcoholic aetiology (5.0%). These estimates indicate that alcohol was the commonest underlying factor in death in this sample of middle-aged men. The number of deaths with alcoholic aetiology in official cause of death statistics should be multiplied by a factor of six to eight to arrive at the true alcohol-related death rate.