title: Changes in mortality due to major alcohol-related diseases in four Nordic countries, France and Germany between 1980 and 2009: a comparative age-period-cohort analysis.
abstract: OBJECTIVE
  To investigate age, period and cohort effects on time trends of alcohol-related mortality in countries with different drinking habits and alcohol policies.
  
  
  METHODS
  Age-period-cohort (APC) analyses on alcohol-related mortality were conducted in Denmark, Finland, Norway, Sweden, France and Germany.
  
  
  METHODS
  Cases included alcohol-related deaths in the age range 20-84 years between 1980 and 2009.
  
  
  METHODS
  Mortality data were taken from national causes of death registries and covered the ICD codes alcoholic psychosis, alcohol use disorders, alcoholic liver disease and toxic effect of alcohol.
  
  
  RESULTS
  In all countries changes across age, period and cohort were found to be significant for both genders [effect value with confidence interval (CI) shown in Supporting information, Table S1]. Period effects pointed to an increase in alcohol-related mortality in Denmark, Finland and Germany and a slightly decreasing trend in Sweden, while in Norway an inverse U-shaped curve and in France a U-shaped curve was found. Compared with the cohorts born before 1960, the risk of alcohol-related mortality declined substantially in cohorts born in the 1960s and later. Pairwise between-country comparisons revealed more statistically significant differences for period (P < 0.001 for all 15 comparisons by gender) than for age [P < 0.001 in seven (men) and four (women) of 15 comparisons] or cohort [P < 0.01 in two (men) and three (women) of 15 comparisons].
  
  
  CONCLUSIONS
  Strong period effects suggest that temporal changes in alcohol-related mortality in Denmark, Finland, Norway, Sweden, France and Germany between 1980 and 2009 were related to secular differences affecting the whole population and that these effects differed across countries.
authors.affiliation: Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden.|IFT Institut für Therapieforschung, München, Germany.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kraus
authors.affiliation: The Norwegian Institute for Alcohol and Drug Research (SIRUS), Oslo, Norway.
authors.forename: Ståle
authors.initials: S
authors.lastname: Østhus
authors.affiliation: The Norwegian Institute for Alcohol and Drug Research (SIRUS), Oslo, Norway.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Amundsen
authors.affiliation: IFT Institut für Therapieforschung, München, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Piontek
authors.affiliation: The National Institute for Health and Welfare (THL), Helsinki, Finland.|The Finnish Foundation for Alcohol Studies, Helsinki, Finland.
authors.forename: Janne
authors.initials: J
authors.lastname: Härkönen
authors.affiliation: Institut national des études démographiques (INED), Paris, France.|INSERM, U669, Paris, France.|University Paris-Sud and University Paris Descartes, UMR-S0669, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Legleye
authors.affiliation: Centre for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Bloomfield
authors.affiliation: The National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Mäkelä
authors.affiliation: The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden.|Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Landberg
authors.affiliation: Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden.
authors.forename: Jukka
authors.initials: J
authors.lastname: Törrönen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019973:Alcohol-Related Disorders / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D055815:Young Adult
keywords: Age-period-cohort analysis; alcohol-related mortality; trends