title: A comparison of the alcohol-attributable mortality in four European countries.
abstract: BACKGROUND
  Deaths due to alcohol consumption are an important component of all-cause mortality, particularly premature mortality. However, there are considerable regional variations, the reasons for which are unclear.
  
  
  METHODS
  Estimates were made as reliably as possibly using vital statistics and best estimates of risk of the alcohol-attributable mortality, by age, sex and cause for four European countries (England and Wales, Germany, Denmark and Italy). Twenty-seven alcohol-related conditions were considered including the possible cardio-protective effects of alcohol.
  
  
  RESULTS
  It was estimated that there are approximately 2% fewer deaths annually in England and Wales than would be expected in a non-drinking population and 0.3% fewer deaths among East German females. In West Germany, Denmark, Italy and among East German males there are more deaths caused by alcohol than are prevented (between 0.7 and 2.6% of all deaths). The highest age-specific proportion of alcohol-attributable deaths is found in East Germany where around 30% of deaths among males aged 25-44 years are due to drinking. Among young men in all four countries the largest contributor to alcohol-related deaths is road traffic accidents involving alcohol.
  
  
  CONCLUSIONS
  Possible explanations for the variation in alcohol-attributable deaths between countries include different underlying heart disease rates, different patterns of alcohol consumption and beverage preferences, and different use of mortality classification. Differences in the reported alcohol consumption levels explain little of the variation in alcohol-attributable deaths. Estimating alcohol-attributable mortality by age and sex across countries may be a useful indicator for developing alcohol strategies and exploring ways of preventing premature mortality.
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK. a.britton@public-health.ucl.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Britton
authors.forename: E
authors.initials: E
authors.lastname: Nolte
authors.forename: I R
authors.initials: IR
authors.lastname: White
authors.forename: M
authors.initials: M
authors.lastname: Grønbaek
authors.forename: J
authors.initials: J
authors.lastname: Powles
authors.forename: F
authors.initials: F
authors.lastname: Cavallo
authors.forename: K
authors.initials: K
authors.lastname: McPherson
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000401:mortality* / Q000517:prevention & control; D019973:Alcohol-Related Disorders / Q000150:complications / Q000401:mortality* / Q000517:prevention & control; D002423:Cause of Death; D003718:Denmark / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012306:Risk; D012307:Risk Factors; D017678:Sex Distribution; D014798:Vital Statistics; D014852:Wales / Q000453:epidemiology