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Comparative analyses

Comparative analyses. Alcohol and suicide Nordic countries Norway – Sweden Sweden– France European Comparative Alcohol Study -ECAS. Alcohol and suicide: Nordic countries Hypothesis: differences in drinking patterns  strongest alcohol effect in FI, weakest in DK.

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Comparative analyses

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  1. Comparative analyses • Alcohol and suicide • Nordic countries • Norway – Sweden • Sweden– France • European Comparative Alcohol Study -ECAS

  2. Alcohol and suicide: Nordic countries Hypothesis: differences in drinking patterns strongest alcohol effect in FI, weakest in DK

  3. Finland 1932-1980. Alcohol=dotted, suicide=solid

  4. Norway 1931-1980. Alcohol=dotted, suicide=solid

  5. Denmark 1931-1980. Alcohol=dotted, suicide=solid

  6. Sweden 1922-1980. Alcohol=dotted, suicide=solid

  7. Estimated alcohol effect: DK & FI: not sign,NO & SE: sign

  8. Conclusions No support for the hypothesis. But: - Skog (Addiction, 1993: effect in DK, WW1), - Pia Mäkelä (Addiction, 1996: age-specific analyses in Finland)

  9. Comparative analyses • Alcohol and suicide: Norway – Sweden

  10. Conclusion

  11. Alcohol and suicide: Sweden - France • Heavy consumers in France and Sweden differ: in France: larger share with comon people • Lower acceptance for heavy consumption in Swedenmarginalisation Hypothesis: stronger alcohol effect on suicide in Sweden

  12. France 1930-1987. Suicide (solid), alcohol (dotted), unemployment (broken)

  13. Sweden 1930-1987. Suicide (solid), alcohol (dotted), unemployment (broken)

  14. Conclusion Support for the hypothesis: stronger alcohol effect on suicide in Sweden(10%/liter) than in France (3%/liter).

  15. European Comparative Alcohol Study – ECAS • Background • Aims • Research design • Results • Conclusions ECAS-report on the web:www.fhi.se/english/eng_health_ecas.asp

  16. Alcohol: a public health perspective Availability Consumption Harm Price Outlet density Acute Chronic Total consumption model

  17. The total consumption model an inventionof Northern Europe Does it apply to Southern Europe as well? ECAS

  18. European Comparative Alcohol Study – ECAS Funding 1998-2002 • The European Commission, DG V/F • Finland: Stakes • Sweden: Ministry of Health and Social Affairs, The National Institute of Public Health.

  19. Organisation • 12 researchers in Norway, Finland • and Sweden • Support staff at National Institute • of Public Health - Sweden • Collaborating partner in each • study country

  20. Purpose • Describe and analyse trends • and country differences in: • Overall consumption of alcohol • Drinking patterns • Alcohol-related mortality • Alcohol control policies • Study period • 1950-1995 in the EU member states

  21. Low Finland Norway Sweden Results pooled into 3 country groups according to consumption High • France • Italy • Portugal • Spain Medium • Austria • Belgium • Denmark • Ireland • Netherlands • U.K. • W.Germany

  22. Convergence in alcohol consumption—High consn. countries (Southern Europe)▀ Medium consn. countries (Mid-Europe) Low consn. countries(Northern Europe)

  23. Drinking patterns Lack of comparable data on drinking patterns ECAS survey in spring 2000 with 1000 completed interviews per country in: • Southern Europe: France and Italy • Mid-Europe: Germany and the UK • Northern Europe: Finland and Sweden

  24. ECAS-survey: drinking habits • Regular/daily drinking: lowest in Northern • Europe, highest in Southern Europe • Binge drinking: highest in Northern • Europe and the UK, lowest in Southern • Europe

  25. ECAS-survey: reported alcohol-related problems • Highest prevalence of problems in Finland and the UK • Volume of drinking and binge predict problems in all 6 countries • Weaker link between drinking volume and problems in France and Italy

  26. Mortality indicators • Liver cirrhosis mortality • AAA: explicitly alcohol-related mortality • Alcohol Dependence • Alcohol Psychosis • Alcohol Poisoning • Accident mortality • Suicide • Homicide • Ischemic heart disease (IHD) mortality • All-cause mortality

  27. Alcohol and mortality: cross-cultural perspective Consumption per capita and cirrhosis mortality in 14 European countries. Data for 1987-1995

  28. Alcohol consumption per capita and AAA-mortality in 14 European countries. Data for 1987-1995

  29. Alcohol consumption per capita and AAA-mortality in 14 European countries. Data for 1987-1995

  30. Alcohol and mortality: longitudinal perspective • Time series analyses separately for each of the 14 countries • Time period: 1950-95 • Input: alcohol consumption/capita • Output: mortality per 100' • How much does mortality change if alcohol consn/capita increases 1 litre? • Best way to assess public health effects of population drinking

  31. Results Increased alcohol consumption  • +cirrhosis or AAA in every country • +accidents, homicides and total deaths in half of the countries • +suicide in Northern Europe • 0 heart disease mortality • Stronger effect in Northern Europe

  32. Change (%) of 1-litre increase in alcohol consn/capita in low- medium and high consn countries (*p<.05)

  33. Summary and conclusions (1) Convergence in: • Per capita alcohol consumption, • Choice of beverages • Alcohol-related mortality • Number of alcohol policy measures

  34. Summary and conclusions, contd. (2) Large variations among countries in drinking patternswith respect to: • Regular/daily drinking • Intake per drinking occasion, binge drinking • Drinking contexts

  35. Summary and conclusions, contd. (3) Total consumption matters: • In all countries, a consumption increase  increased mortality from cirrhosis or AAA-mortality • Support public health perspective: more is worse • Modify: alcohol effect depends on drinking culture • No heart benefits at population level

  36. Summary and conclusions, contd. (4) Purchasing power and alcohol price affect overall consumption

  37. Comparative analyses: Conclusion -Choose countries that are similar to confirm a relationship - Choose countries that are dissimilar to detect cultural differences

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