eTable. List of Causes of Death Wholly Attributable to Alcohol Consumption Included in the Analysis
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Zatoński WA, Zatoński M, Janik-Koncewicz K, Wojtyła A. Alcohol-Related Deaths in Poland During a Period of Weakening Alcohol Control Measures. JAMA. 2021;325(11):1108–1109. doi:10.1001/jama.2020.25879
In Poland since 2001, a number of policy measures designed to reduce alcohol consumption were weakened. After stable alcohol consumption since the 1980s, between 2002 and 2017 the annual consumption of alcohol increased from 6.9 L to almost 10 L of pure alcohol per capita.1,2 We examined changes in mortality wholly attributable to alcohol consumption in Poland between 2002 and 2017.
We used the World Health Organization (WHO) Mortality Database, which compiles mortality data by age, sex, and cause of death as reported by individual member states from their civil registration systems (the WHO categorized Polish data for the period 1999-2015 as being complete but of “medium” quality).3 Poland has used International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, which include specific alcohol harm indicators, since 1999. Absolute numbers of alcohol-related deaths and population counts were obtained from the WHO and standardized mortality rates per 100 000 were calculated. Because alcohol and tobacco are shared risk factors for many noncommunicable causes of death and cigarette consumption declined in Poland over the analyzed period, we used a narrow definition of primary causes of death wholly attributable to alcohol consumption. These 25 conditions are mental and behavioral disorders (ICD-10 codes F10.0-F10.7), poisoning (ICD-10 codes X45, X65, Y15), liver disorders (ICD-10 codes K70.0-K70.9), gastrointestinal disorders (ICD-10 codes K29.2, K85.2, K86.0), and other disorders due to alcohol (ICD-10 codes E24.4, G31.2, G62.1, G72.1, I42.6) (eTable in the Supplement).4
Trends in alcohol-related mortality between 2002 and 2017 were analyzed using joinpoint regression analysis to calculate average annual percentage changes (AAPCs) (Joinpoint Regression Program version 220.127.116.11; US National Cancer Institute). Because of large differences in alcohol consumption by sex and age, mortality was examined separately in men and women and by age groups (20-44 years, 45-64 years, 65 years or older, and all ages). A 2-sided P < .05 defined statistical significance. Institutional review board approval was not required because the data were anonymized and publicly available.
In 2002, among men in Poland, there were 3256 alcohol-related deaths and a mortality rate of 13.9 per 100 000. In 2017, there were 7604 deaths and a mortality rate of 28.0 per 100 000 (Figure). Between 2002 and 2017, the AAPC was 4.9% (95% CI, 3.2%-6.6%; P < .001) (Table).
In 2002, among women in Poland, there were 429 alcohol-related deaths and a mortality rate of 1.7 per 100 000. In 2017, there were 1879 deaths and a mortality rate of 6.4 per 100 000 (Figure). Between 2002 and 2017, the AAPC was 9.7% (95% CI, 7.0%-12.4%; P < .001) (Table).
Mortality rates were highest in the 45- to 64-year age groups in both men (88.8/100 000) and women (21.3/100 000) (Figure), and between 2002 and 2017 the AAPCs were highest in those aged 65 years or older among men (AAPC, 8.5%; 95% CI, 6.7%-10.2%) and among women (AAPC, 12.2%; 95% CI, 10.6%-13.7%), but because of overlapping 95% CIs, differences between age groups cannot be deemed statistically significant (Table). The AAPCs were significant in all age groups for both men and women.
An increase in mortality wholly attributable to alcohol consumption in Poland for both men and women and among all ages was observed between 2002 and 2017. This coincided with the weakening of alcohol control measures. In 2001, beer advertising returned to television, and in 2002, excise taxes on spirits were reduced by 30%. From 2010 onward, the alcohol industry began a marketing campaign associated with an increase in sales of small vodka bottles.1,2 At the same time, alcohol-related mortality declined in several other countries of the region, including Russia and Lithuania, where new alcohol control measures were introduced.5
Limitations of the study are that only mortality wholly attributable to alcohol consumption was included, likely underestimating alcohol-related mortality; the medium quality of cause-of-death data; and that factors other than policy changes may have played a role. Additional policy solutions should be considered, such as bans on alcohol advertising, measures to limit alcohol availability, educational campaigns, increases in alcohol taxation, and a monitoring system for alcohol-related diseases.6
Corresponding Author: Witold A. Zatoński, MD, PhD, Institute–European Observatory of Health Inequalities, Calisia University, Nowy Świat 4, 62-800 Kalisz, Poland (email@example.com).
Accepted for Publication: December 14, 2020.
Author Contributions: Dr W. A. Zatoński and Ms Janik-Koncewicz had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: W. A. Zatoński, Janik-Koncewicz, Wojtyła.
Acquisition, analysis, or interpretation of data: W. A. Zatoński, M. Zatoński, Janik-Koncewicz.
Drafting of the manuscript: W. A. Zatoński, M. Zatoński, Janik-Koncewicz.
Critical revision of the manuscript for important intellectual content: All authors.
Administrative, technical, or material support: Janik-Koncewicz, Wojtyła.
Supervision: W. A. Zatoński, M. Zatoński, Wojtyła.
Conflict of Interest Disclosures: None reported.
Additional Information: This analysis was carried out as part of routine monitoring conducted at the Institute–European Observatory of Health Inequalities at Calisia University. Calisia University had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review and approval of the manuscript; or decision to submit the manuscript for publication.