Considerations about population-level alcohol-attributable mortality estimates

Carta al editor

Do Internet usage and education play a role in health inequalities? A study of the Spanish population aged 50-79

Socioeconomic inequalities in health persist in Spain. This can be explained, partly, by the interaction of multiple variables, including education and gender. The covid-19 pandemic intensified the potential impact of two critical factors on health inequalities: health literacy and the socioeconomic digital divide. This article explores these factors within the relationship between education and individual self-reported health status among a representative sample of the Spanish population aged 50-79. The main findings suggest that women report worse health than men, and that low-educated groups report worse health than their high-educated counterparts. Internet usage and having "adequate" levels of health literacy are associated with better health among the low-educated groups

Population age structure only partially explains the large number of COVID-19 deaths at the oldest ages

Background: To date, any attention paid to the age shape of COVID-19 deaths has been mostly in relation to understanding the differences in case fatality rates between countries. Objective: We explore differences in the age distribution of deaths from COVID-19 among six European countries which have old age structures. We do this by way of a cross-country comparison and put forward some reasons for potential differences. Methods: We estimate the distribution of deaths by 10-year age groups and the counterfactual age distribution under the assumption that all populations had the age structure of Italy. For this, we use 10-year age-grouped COVID-19 death counts and the corresponding population exposures for France, Italy, the Netherlands, Germany, Sweden, Spain, and China. Results: All included European countries experienced a high proportion of deaths at older ages. The relative proportion of deaths at ages above 90 years is lowest in Italy when compared to the other countries in the study despite Italy having the oldest population in Europe. Contribution: Population age structure seems essential for understanding COVID-19-related mortality, but other factors may play an important role, particularly at older ages in European populations

Impact of the COVID-19 pandemic on life expectancy in Madrid (Spain)

The coronavirus disease (COVID-19) pandemic is causing substantial increases in mortality across populations worldwide. According to the World Health Organization, by 22 May 2020, >325 000 confirmed COVID-19 deaths have occurred worldwide.1 The pandemic has overwhelmed health systems in many countries, potentially leading to increases in morbidity and mortality beyond the direct impact of COVID-19 infection. These increases in mortality, both direct and indirect, have the potential to cause stagnations or declines in life expectancy

Alcohol-attributable mortality in Europe:Past trends and their effects on overall mortality variations

Excessive alcohol consumption is a major public health concern in Europe. Differences in alcohol consumption levels and drinking patterns across European populations – and especially risky drinking behaviours among Eastern European men – could contribute to the substantial overall mortality differences observed across European countries, between the sexes, and over time. This thesis examined past trends in alcohol-attributable mortality in Europe and their effects on overall mortality differences. Differences across countries, between the sexes, and across birth generations (cohorts) over long periods of time were analyzed using demographic and epidemiological data and methods. Past trends in alcohol-attributable mortality were found to vary considerably across Europe: the levels were higher and the trends were more irregular among Eastern European men, and recently moderate declines have occurred in countries with high alcohol-attributable mortality. Moreover, differences across countries were found in the birth cohorts at highest risk of alcohol-attributable mortality. These substantial differences in alcohol-attributable mortality across countries, between the sexes, generations and over time can be related to differences in socioeconomic conditions and drinking cultures. Alcohol-attributable mortality had a large impact on overall mortality levels and trends, especially among Eastern European men. In 2012/13, alcohol-attributable mortality contributed around 20% to the life expectancy differences between Eastern and Western Europe, and at least 15% to the gender differences in life expectancy in Eastern Europe. These results suggest that the alcohol problem in Europe deserves further attention from society and policy-makers. Alcohol-related public health interventions can improve overall health while also reducing health inequalities across Europe

Healthy lifespan inequality: morbidity compression from a global perspective

Current measures of population health lack indicators capturing the variability in age-at-morbidity onset, an important marker to assess the timing patterns of individuals' health deterioration and evaluate the compression of morbidity. We provide global, regional, and national estimates of the variability in morbidity onset from 1990 to 2019 using indicators of healthy lifespan inequality (HLI). Using data from the Global Burden of Disease Study 2019, we reconstruct age-at-death distributions to calculate lifespan inequality (LI), and age-at-morbidity onset distributions to calculate HLI. We measure LI and HLI with the standard deviation. Between 1990 and 2019, global HLI decreased from 24.74 years to 21.92, and has been decreasing in all regions except in high-income countries, where it has remained stable. Countries with high HLI are more present in sub-Saharan Africa and south Asia, whereas low HLI values are predominant in high-income countries and central and eastern Europe. HLI tends to be higher for females than for males, and HLI tends to be higher than LI. Globally, between 1990 and 2019 HLI at age 65 increased from 6.83 years to 7.44 for females, and from 6.23 to 6.96 for males. Improvements in longevity are not necessarily accompanied by further reductions in HLI among longevity vanguard countries. Morbidity is compressing, except in high-income countries, where it stagnates. The variability in the ages at morbidity onset tends to be larger than the variability in lifespans, and such divergence broadens over time. As longevity increases worldwide, the locus of health inequality is moving from death-related inequalities to disease- and disability-centered ones

Monitoring life expectancy levels during the COVID-19 pandemic : example of the unequal impact of the first wave on Spanish regions

Background: To provide an interpretable summary of the impact on mortality of the COVID-19 pandemic we estimate weekly and annual life expectancies at birth in Spain and its regions. Methods: We used daily death count data from the Spanish Daily Mortality Monitoring System (MoMo), and death counts from 2018, and population on July 1st, 2019 by region (CCAA), age groups, and sex from the Spanish National Statistics Institute. We estimated weekly and annual (2019 and 2020*, the shifted annual calendar period up to 5 july 2020) life expectancies at birth as well as their differences with respect to 2019. Results: Weekly life expectancies at birth in Spain were lower in weeks 11-20, 2020 compared to the same weeks in 2019. This drop in weekly life expectancy was especially strong in weeks 13 and 14 (March 23rd to April 5th), with national declines ranging between 6.1 and 7.6 years and maximum regional weekly declines of up to 15 years in Madrid. Annual life expectancy differences between 2019 and 2020 also reflected an overall drop in annual life expectancy of 0.9 years for both men and women. These drops ranged between 0 years in several regions (e.g. Canary and Balearic Islands) to 2.8 years among men in Madrid. Conclusions: Life expectancy is an easy to interpret measure for understanding the heterogeneity of mortality patterns across Spanish regions. Weekly and annual life expectancy are sensitive useful indicators for understanding disparities and communicating the gravity of the situation because differences are expressed in intuitive year units

Future alcohol-attributable mortality in France using a novel generalizable age-period-cohort projection methodology

Aim.- To forecast age- and sex-specific alcohol-attributable mortality in France for the period 2015-2050 using a novel generalizable methodology that includes different scenarios regarding period and cohort change. Methods.- For the French national population aged 25-90 years (1979-2014), we estimated alcohol-attributable mortality by mortality from the main causes of death wholly attributable to alcohol, plus liver cirrhosis mortality. We modelled sex-specific alcohol-attributable mortality by adjusting for age, period and birth cohort. We forecasted the model parameters to obtain future age- and sex-specific alcohol-attributable mortality up until 2050 using a conventional baseline, scenario I (favourable period change) and scenario II (unfavourable cohort change). Results.- Alcohol-attributable mortality is clearly declining in France, with the decline decelerating from 1992 onwards. In 2014, the age-standardized alcohol-attributable mortality rates, in deaths per 100,000, were 34.7 among men and 9.9 among women. In 2050, the estimated rates are between 10.5 (prediction interval: 7.6-14.4; scenario I) and 17.6 (13.1-23.7; scenario II) among men, and between 1.1 (0.7-1.7; scenario I) and 1.8 (1.2-2.9; scenario II) among women; which implies declines of 58% for men and 84% for women (baseline). Conclusion.- Alcohol-attributable mortality in France is expected to further decline in the coming decades, accompanied by age pattern changes. However, France's levels are not expected to reach the current lower levels in Italy and Spain for 15 years or more. Our results point to the value of implementing preventive policy measures that discourage alcohol consumption among people of all ages, but especially among adolescents