title: Cirrhosis mortality in Ontario: effects of alcohol consumption and Alcoholics Anonymous participation.
abstract: OBJECTIVE
  We test the hypotheses that cirrhosis mortality rates are positively associated with per capita alcohol consumption and negatively associated with Alcoholics Anonymous (AA) membership rates.
  
  
  METHODS
  The impact of alcohol consumption levels and AA membership rates on cirrhosis mortality rates in Ontario from 1968 to 1989 were examined. Time-series analyses with ARIMA modelling were applied to male and female cirrhosis mortality rates in three age groups: 15-44, 45-64 and 65 + years. Missing AA membership data were interpolated using two methods: linear splines and cubic splines.
  
  
  RESULTS
  In general, cirrhosis mortality rates were positively associated with alcohol consumption and negatively associated with AA membership. For some age and gender combinations, these effects were not statistically significant.
  
  
  CONCLUSIONS
  The limits of this study include restrictions in the length of series available and in the ability to infer causality. Despite these limitations, these findings are consistent with previous research demonstrating that per capita consumption is a strong determinant of cirrhosis mortality rates, and also that higher levels of AA membership can reduce cirrhosis mortality rates.
authors.affiliation: Social, Prevention and Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada. robert_mann@camh.net
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mann
authors.forename: Reginald G
authors.initials: RG
authors.lastname: Smart
authors.forename: Brian R
authors.initials: BR
authors.lastname: Rush
authors.forename: Rosely Flam
authors.initials: RF
authors.lastname: Zalcman
authors.forename: Helen
authors.initials: H
authors.lastname: Suurvali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D000436:Alcoholics Anonymous; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008104:Liver Cirrhosis, Alcoholic / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology