Individual- and area-level characteristics associated with alcohol-related mortality among adult Lithuanian males: A multilevel analysis based on census-linked data

Abstract

BackgroundAlthough excessive alcohol-related mortality in the post-Soviet countries remains the major public health threat, determinants of this phenomenon are still poorly understood.AimsWe assess simultaneously individual- and area-level factors associated with an elevated risk of alcohol-related mortality among Lithuanian males aged 30–64.MethodsOur analysis is based on a census-linked dataset containing information on individual- and area-level characteristics and death events which occurred between March 1st, 2011 and December 31st, 2013. We limit the analysis to a few causes of death which are directly linked to excessive alcohol consumption: accidental poisonings by alcohol (X45) and liver cirrhosis (K70 and K74). Multilevel Poisson regression models with random intercepts are applied to estimate mortality rate ratios (MRR).ResultsThe selected individual-level characteristics are important predictors of alcohol-related mortality, whereas area-level variables show much less pronounced or insignificant effects. Compared to married men, never married (MRR = 1.9, CI:1.6–2.2), divorced (MRR = 2.6, CI:2.3–2.9), and widowed (MRR = 2.4, CI: 1.8–3.1) men are disadvantaged groups. Men who have the lowest level of educational attainment have the highest mortality risk (MRR = 1.7 CI:1.4–2.1). Being unemployed is associated with a five-fold risk of alcohol-related death (MRR = 5.1, CI: 4.4–5.9), even after adjusting for all other individual variables. Lithuanian males have an advantage over Russian (MRR = 1.3, CI:1.1–1.6) and Polish (MRR = 1.8, CI: 1.5–2.2) males. After adjusting for all individual characteristics, only two out of seven area-level variables—i.e., the share of ethnic minorities in the population and the election turnout—have statistically significant direct associations. These variables contribute to a higher risk of alcohol-related mortality at the individual level.ConclusionsThe huge and increasing socio-economic disparities in alcohol-related mortality indicate that recently implemented anti-alcohol measures in Lithuania should be reinforced by specific measures targeting the most disadvantaged population groups and geographical areas.

Spatial patterns of male alcohol‐related mortality in Belarus, Lithuania, Poland and Russia

“…For example, the higher levels of alcohol-related mortality in the regions with larger shares of Polish minorities reported for Lithuania coincides with the observation that the Polish ethnic group also exhibits the highest alcohol-related mortality levels in the country [14]. The disadvantage of Polish males relative to Lithuanian males remains significant even after compositional differences, including education and urban-rural place of residence, are taken into account [14]. This is a striking finding given that Poland has much lower alcohol-related mortality than Lithuania.…”

“…More comprehensive analyses should eventually involve using micro-data and multilevel modelling. Some steps in this direction have already been taken [14].…”

“…However, the accumulated evidence supporting this relationship is mainly based on national‐level data or data on large regions within a single country [9,10]. Relatively little is known about variations in alcohol‐related mortality across smaller geographical units, and especially about spatial mortality patterns extending beyond national boundaries [11–14].…”

Psychiatric comorbidity as a risk factor for mortality in people with anorexia nervosa

“…Other important risk factors contributing to mortality in people with mental disorders include age, gender, marital status, socioeconomic deprivation and ethnicity [21][22][23][24][25][26][27]. However, these risk factor influence mortality in people with physical diseases, too [28][29][30].…”

Genetic and lifestyle risk factors for advanced liver disease among men and women

“…36 Likewise, single, divorced, and widowed men have higher mortality from alcohol-related causes. 37 In our study, marital status of men was a significant risk factor only for alcoholrelated liver diagnosis but not for non-alcohol-related liver diagnosis.…”