title: The importance of age groups in estimates of alcohol-attributable mortality: impact on trends in Switzerland between 1997 and 2011.
abstract: OBJECTIVE
  Monitoring trends of alcohol-attributable mortality is an integral part of the global strategy to reduce the harmful use of alcohol. However, mortality estimates based on different age ranges come to different conclusions. This study examined the impact of including different age ranges in terms of directions of trends of alcohol-attributable mortality during 14 years in Switzerland.
  
  
  METHODS
  Alcohol-attributable mortality was estimated at four time-points between 1997 and 2011 using the Global Burden of Disease 2010 methodology. Estimates were obtained for two age groups: 15-64 years and the total adult population (15 years and older).
  
  
  RESULTS
  Alcohol-attributable mortality among 15-64-year-olds decreased [1997: 1334 deaths, confidence interval (CI) = 1237-1432; 2011: 1019 deaths, CI = 964-1073; trend per year odds ratio (OR) = 0.99, P < 0.001]. In contrast, alcohol-attributable mortality among those 65 and older increased in the same time-period (1997: 581 deaths, CI = -196 to 1357; 2011: 1664 deaths, CI = 957-2372; OR = 1.07, P< 0.001), resulting in an overall increase of alcohol-attributable mortality for 15+ year-olds (1997: 1915 deaths, CI = 1133-2697; 2011: 2683, CI = 1973-3393; OR = 1.02, P < 0.001). The main shift in trends was due to changes in the mixture (e.g. hypertension, ischaemic heart disease) of cardiovascular diseases over time among those 65+ years old.
  
  
  CONCLUSIONS
  Trends in alcohol-attributable mortality may yield qualitatively different results based on the upper age limit for deaths set for these estimates. Global trends of alcohol-attributable mortality between 1997 and 2011 were influenced heavily by changes in the mixture of deaths across cardiovascular diseases. Trends for alcohol-attributable mortality and cross-country comparisons should be reported separately for 15-64 and 65+ year-olds.
authors.affiliation: Research Institute, Addiction Switzerland, Lausanne, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Marmet
authors.affiliation: Centre for Addiction and Mental Health (CAMH), Toronto, Canada.|Institute of Medical Science, University of Toronto, Toronto, Canada.|Institute for Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany.|Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada.|Department of Psychiatry, University of Toronto, Toronto, Canada.|PAHO/WHO Collaborating Centre for Mental Health and Addiction, Toronto, Canada.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.affiliation: Research Institute, Addiction Switzerland, Lausanne, Switzerland.|Centre for Addiction and Mental Health (CAMH), Toronto, Canada.|Alcohol Treatment Center, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland.|University of the West of England, Frenchay Campus, Bristol, UK.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Gmel
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult
keywords: Age groups; Switzerland; alcohol-attributable mortality; death certificate; elderly people; trend