Smoking epidemic in Europe in the 21st century

OBJECTIVE: To estimate smoking-attributable mortality in the long-term future in 29 European countries using a novel data-driven forecasting approach that integrates the wave pattern of the smoking epidemic and the cohort dimension. METHODS: We estimated and forecasted age-specific and age-standardised smoking-attributable mortality fractions (SAMF) and 95% projection intervals for 29 European countries by sex, 1950–2100, using age-period-cohort modelling with a generalised logit link function. We projected the (decelerating) period increases (women) by a quadratic curve to obtain future declines, and extrapolated the past period decline (men). In addition, we extrapolated the recent cohort trend. RESULTS: SAMF among men are projected to decline from, on average, 25% in 2014 (11% (Sweden)—41% (Hungary)) to 11% in 2040 (range: 6.3%–15.4%), 7% in 2065 (range: 5.9%–9.4%) and 6% in 2100. SAMF among women in 21 non-Eastern European countries, currently at an average of 16%, are projected to reach peak levels in 2013 (Northern Europe), 2019 (Western Europe), 2027 (Greece, Italy) and 2022 (Central Europe), with maximum levels of, on average, 17% (8% (Greece)—28% (Denmark)), and to decline to 10% in 2040 (range: 4%–20%), 5% in 2065 (range: 3.5%–7.6%) and 4% in 2100. For women, a short-term shift in the peak of the inverse U-shaped age pattern to higher ages is projected, and crossovers between the age-specific trends. CONCLUSION: Our novel forecasting method enabled realistic estimates of the mortality imprint of the smoking epidemic in Europe up to 2100. The high peak values in smoking-attributable mortality projected for women warrant attention

Future mortality in selected European countries, taking into account the impact of lifestyle epidemics

Conference of European Statisticians Joint Eurostat/UNECE Work Session on Demographic Projections Belgrade, 25-27 November 201

Future life expectancy in Europe taking into account the impact of smoking, obesity, and alcohol

Introduction: In Europe, women can expect to live on average 82 years and men 75 years. Forecasting how life expectancy will develop in the future is essential for society. Most forecasts rely on a mechanical extrapolation of past mortality trends, which leads to unreliable outcomes because of temporal fluctuations in the past trends due to lifestyle ‘epidemics’. Methods: We project life expectancy for 18 European countries by taking into account the impact of smoking, obesity, and alcohol on mortality, and the mortality experiences of forerunner populations. Results: We project that life expectancy in these 18 countries will increase from, on average, 83.4 years for women and 78.3 years for men in 2014 to 92.8 years for women and 90.5 years for men in 2065. Compared to others (Lee–Carter, Eurostat, United Nations), we project higher future life expectancy values and more realistic differences between countries and sexes. Conclusions: Our results imply longer individual lifespans, and more elderly in society. Funding: Netherlands Organisation for Scientific Research (NWO) (grant no. 452-13-001)

Past and future alcohol-attributable mortality in Europe

Although alcohol consumption is an important public health issue in Europe, estimates of future alcohol-attributable mortality for European countries are rare, and only apply to the short-term future. We project (age-specific) alcohol-attributable mortality up to 2060 in 26 European countries, after a careful assessment of past trends. For this purpose we used population-level country-, sex-, age- (20-84) and year-specific (1990-2016) alcohol-attributable mortality fractions (AAMF) from the Global Burden of Disease (GBD) study, which we adjusted at older ages. To these data we apply an advanced age-period-cohort projection methodology, that avoids unrealistic future differences and crossovers between sexes and countries. We project that in the future, AAMF levels will decline in all countries, and will converge across countries and sexes. For 2060, projected AAMF are, on average, 5.1% among men and 1.4% among women, whereas in 2016 these levels were 10.1% and 3.3%, respectively. For men, AAMF is projected to be higher in Eastern and South-western Europe than in North-western Europe. All in all, the share of mortality due to alcohol is projected to eventually decline in all 26 European countries. Achieving these projected declines will, however, require strong ongoing public health action, particularly for selected Eastern and North-western European countries

Future life expectancy in Europe taking into account the impact of smoking, obesity, and alcohol

Introduction: In Europe, women can expect to live on average 82 years and men 75 years. Forecasting how life expectancy will develop in the future is essential for society. Most forecasts rely on a mechanical extrapolation of past mortality trends, which leads to unreliable outcomes because of temporal fluctuations in the past trends due to lifestyle 'epidemics'. Methods: We project life expectancy for 18 European countries by taking into account the impact of smoking, obesity, and alcohol on mortality, and the mortality experiences of forerunner populations. Results: We project that life expectancy in these 18 countries will increase from, on average, 83.4 years for women and 78.3 years for men in 2014 to 92.8 years for women and 90.5 years for men in 2065. Compared to others (Lee-Carter, Eurostat, United Nations), we project higher future life expectancy values and more realistic differences between countries and sexes. Conclusions: Our results imply longer individual lifespans, and more elderly in society. Funding: Netherlands Organisation for Scientific Research (NWO) (grant no. 452-13-001)

Past and future alcohol-attributable mortality in Europe

We project (age-specific) alcohol-attributable mortality up to 2060 in 26 European countries by carefully assessing past trends and applying advanced projecting techniques. We used estimated sex and age-specific alcohol-attributable mortality fractions (AAMF) among the national populations aged 20-84, for 1990 up to 2016, from the Global Burden of Disease Study, whichwe adjusted at older ages. We applied age-period-cohort modelling and projection, and avoided unrealistic future crossovers and differences in age-standardised AAMF between sexes and country groups, by implementing different lower bounds and by enabling that current (stagnating) increases areturned into declines. We find that in 2016, age-standardised AAMF were substantially higher among men (10.1%) than women (3.3%), and were much higher in Eastern Europe (14.3%) than in Western Europe (8.2%) amongmen. From 1990 to 2016, age-standardised AAMF mostly increased in Eastern and North-western Europe, and then declined or stagnated; whereas in South-western Europe, AAMF mostly declined, albeit with decelerations, particularly among men. We project that in the future, AAMF levels will decline in all countries, and will converge across countries, but that for men, levels will be higher in Eastern and South-western Europe than in North-western Europe. For 2060, projected AAMF are, on average, 5.1% among men and 1.4% among women. In sum, the share of mortality due to alcohol is projected to eventually decline in all 26 European countries, and to converge across countries and sexes. Particularly for Eastern and North-western European countries, achieving these projected declines will require strong, ongoing public health action