Cirrhosis mortality in Ontario: effects of alcohol consumption and Alcoholics Anonymous participation.

AIMS 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. DESIGN 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. FINDINGS 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.

[1]  Robert E Mann,et al.  The Epidemiology of Alcoholic Liver Disease , 2018, Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism.

[2]  P. Cuijpers,et al.  The effects on mortality of brief interventions for problem drinking: a meta-analysis. , 2004, Addiction.

[3]  R. Groszmann,et al.  I. Veterans Affairs Cooperative Study of polyenylphosphatidylcholine in alcoholic liver disease: effects on drinking behavior by nurse/physician teams. , 2003, Alcoholism, clinical and experimental research.

[4]  M. Ramstedt.  Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol--the case of Canada. , 2003, Addiction.

[5]  W. Kerr,et al.  Wartime Paris, cirrhosis mortality, and the ceteris paribus assumption. , 2002, Journal of studies on alcohol.

[6]  M. Ramstedt.  Per capita alcohol consumption and liver cirrhosis mortality in 14 European countries. , 2001, Addiction.

[7]  R. Smart,et al.  The direct and indirect relationships between alcohol prevention measures and alcoholic liver cirrhosis mortality. , 2000, Journal of studies on alcohol.

[8]  P. Gruenewald,et al.  Beverage-specific alcohol consumption and cirrhosis mortality in a group of English-speaking beer-drinking countries. , 2000, Addiction.

[9]  K. Humphreys,et al.  Alcoholics anonymous affiliation at treatment intake among white and black Americans. , 1999, Journal of studies on alcohol.

[10]  R E Mann,et al.  Treatment, Alcoholics Anonymous and alcohol controls during the decrease in alcohol problems in Alberta: 1975-1993. , 1998, Alcohol and alcoholism.

[11]  Alan D. Lopez,et al.  Alcohol consumption and mortality among middle-aged and elderly U.S. adults. , 1997, The New England journal of medicine.

[12]  A. Romelsjö,et al.  The effect of changes in alcohol consumption on mortality and admissions with alcohol-related diagnoses in Stockholm County--a time series analysis. , 1997, Addiction.

[13]  S. L. Lee,et al.  Does increased spending on alcoholism treatment lead to lower cirrhosis death rates? , 1996, Alcohol and alcoholism.

[14]  R. Mann,et al.  Rehabilitation for convicted drinking drivers (second offenders): effects on mortality. , 1994, Journal of studies on alcohol.

[15]  S. Schwartz.  The fallacy of the ecological fallacy: the potential misuse of a concept and the consequences. , 1994, American journal of public health.

[16]  J. Bunn,et al.  The relationship between mortality and intensity of inpatient alcoholism treatment. , 1994, American journal of public health.

[17]  R. Mann,et al.  Mortality in a sample of convicted drinking drivers. , 1993, Addiction.

[18]  W. Miller,et al.  Brief interventions for alcohol problems: a review. , 1993, Addiction.

[19]  R. Smart,et al.  Recent liver cirrhosis declines: estimates of the impact of alcohol abuse treatment and alcoholics anonymous. , 1993, Addiction.

[20]  R. Parker,et al.  Effect of alcoholism treatment on cirrhosis mortality: a 20-year multivariate time series analysis. , 1992, British journal of addiction.

[21]  I. Grant,et al.  Reduced mortality risk in alcoholics who achieve long-term abstinence. , 1992, JAMA.

[22]  R. Smart,et al.  Reductions in cirrhosis deaths in the United States: associations with per capita consumption and AA membership. , 1991, Journal of studies on alcohol.

[23]  J. Rankin,et al.  Changing trends of cirrhosis mortality in Ontario, Canada, 1911-1986. , 1991, International journal of epidemiology.

[24]  R. Smart,et al.  Are increases in treatment levels and Alcoholics Anonymous membership large enough to reduce liver cirrhosis rates? , 1990, British journal of addiction.

[25]  T. Norström.  Deriving relative risks from aggregate data. 1. Theory. , 1988, Journal of epidemiology and community health.

[26]  R. Smart,et al.  Are decreases in liver cirrhosis rates a result of increased treatment for alcoholism? , 1988, British journal of addiction.

[27]  G. C. Tiao,et al.  Estimation of time series parameters in the presence of outliers , 1988 .

[28]  R. Smart,et al.  Reductions in liver cirrhosis mortality and morbidity in Canada: demographic differences and possible explanations. , 1988, Alcoholism, clinical and experimental research.

[29]  A. Romelsjö,et al.  Decline in alcohol-related in-patient care and mortality in Stockholm County. , 1987, British journal of addiction.

[30]  R. Smart,et al.  Large decreases in alcohol-related problems following a slight reduction in alcohol consumption in Ontario 1975-83. , 1987, British journal of addiction.

[31]  H. Barr,et al.  Mortality of treated alcoholics and drug addicts: the benefits of abstinence. , 1984, Journal of studies on alcohol.

[32]  O. Skog.  The risk function for liver cirrhosis from lifetime alcohol consumption. , 1984, Journal of studies on alcohol.

[33]  C. Robert Cloninger,et al.  Predictors of mortality in alcoholic women: prospective follow-up study. , 1983, Alcoholism, clinical and experimental research.

[34]  H. Ohlin,et al.  Identification and intervention of heavy drinking in middle-aged men: results and follow-up of 24-60 months of long-term study with randomized controls. , 1983, Alcoholism, clinical and experimental research.

[35]  R. Miller,et al.  Modeling daily river flows with precipitation input , 1981 .

[36]  J. D. de Lint,et al.  Causes of death of alcoholics. , 1972, Quarterly journal of studies on alcohol.

[37]  M. Terris.  Epidemiology of cirrhosis of the liver: national mortality data. , 1967, American journal of public health and the nation's health.

[38]  J. Seeley.  Death by liver cirrhosis and the price of beverage alcohol. , 1960, Canadian Medical Association journal.

[39]  Frank H. Galvan,et al.  Alcohol Use and Related Problems Among Ethnic Minorities in the United States , 2003, Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism.

[40]  R E Mann,et al.  The impact of programs for high-risk drinkers on population levels of alcohol problems. , 2000, Addiction.

[41]  W. Miller,et al.  Meta-analysis of the literature on Alcoholics Anonymous: sample and study characteristics moderate findings. , 1996, Journal of studies on alcohol.

[42]  R. Caetano,et al.  Priorities for alcohol treatment research among U.S. Hispanics. , 1993, Journal of psychoactive drugs.

[43]  T. Norström.  The impact of per capita consumption on Swedish cirrhosis mortality. , 1987, British journal of addiction.

[44]  Osvaldo Ferreiro,et al.  Methodologies for the estimation of missing observations in time series , 1987 .

[45]  B. Rush,et al.  Alcohol availability, alcohol consumption and alcohol-related damage. I. The distribution of consumption model. , 1986, Journal of studies on alcohol.

[46]  J. Rankin,et al.  Risk of fatty infiltration or cirrhosis of the liver in relation to ethanol consumption: a case-control study. , 1986, Clinical and investigative medicine. Medecine clinique et experimentale.

[47]  R. Room.  Alcohol control and public health. , 1984, Annual review of public health.

[48]  Lon-Mu Liu,et al.  Identification of multiple-input transfer function models , 1982 .