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      Increased alcohol‐specific mortality in Germany during COVID‐19: State‐level trends from 2010 to 2020

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          Abstract

          Introduction

          The COVID‐19 pandemic may have led to an increase in the alcohol‐specific mortality. Against this backdrop, the aim of this report is to explore alcohol‐specific mortality trends in Germany of the years 2010 to 2020.

          Method

          Alcohol‐specific mortality data aggregated by sex, 5‐year age groups and state were collected from the annual cause‐of‐death statistics and analysed descriptively by visual inspection.

          Results

          The overall alcohol‐specific mortality rate (age‐standardised) has mainly decreased between 2010 and 2020. However, increased alcohol‐specific mortality rates for the year 2020 compared to 2019 were found for both, women (+4.8%) and men (+5.5%), particularly in age groups between 40 and 69 years. Changes in alcohol‐specific mortality rates differed between federated states, with steeper increases in East Germany.

          Discussion and Conclusions

          Different mechanisms related to the increase in alcohol consumption, particularly among high‐risk drinkers, and reduced resources in health care may have led to an increase in alcohol‐specific mortality in Germany in 2020. Despite the recent decline in the alcohol‐specific mortality in Germany, an increase in the death toll was observed in 2020.

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          R: A Language and Environment for Statistical Com- puting

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            The relationship between different dimensions of alcohol use and the burden of disease—an update

            Jürgen Rehm, Gerhard E Gmel, Gerrit Gmel … (2017)
            Abstract Background and aims Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). Methods Systematic review of reviews and meta‐analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. Results In total, 255 reviews and meta‐analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD‐10 three‐digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in‐depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. Conclusions Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
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              Algorithms for enhancing public health utility of national causes-of-death data

              Mohsen Naghavi, Susanna Makela, Kyle Foreman … (2010)
              Background Coverage and quality of cause-of-death (CoD) data varies across countries and time. Valid, reliable, and comparable assessments of trends in causes of death from even the best systems are limited by three problems: a) changes in the International Statistical Classification of Diseases and Related Health Problems (ICD) over time; b) the use of tabulation lists where substantial detail on causes of death is lost; and c) many deaths assigned to causes that cannot or should not be considered underlying causes of death, often called garbage codes (GCs). The Global Burden of Disease Study and the World Health Organization have developed various methods to enhance comparability of CoD data. In this study, we attempt to build on these approaches to enhance the utility of national cause-of-death data for public health analysis. Methods Based on careful consideration of 4,434 country-years of CoD data from 145 countries from 1901 to 2008, encompassing 743 million deaths in ICD versions 1 to 10 as well as country-specific cause lists, we have developed a public health-oriented cause-of-death list. These 56 causes are organized hierarchically and encompass all deaths. Each cause has been mapped from ICD-6 to ICD-10 and, where possible, they have also been mapped to the International List of Causes of Death 1-5. We developed a typology of different classes of GCs. In each ICD revision, GCs have been identified. Target causes to which these GCs should be redistributed have been identified based on certification practice and/or pathophysiology. Proportionate redistribution, statistical models, and expert algorithms have been developed to redistribute GCs to target codes for each age-sex group. Results The fraction of all deaths assigned to GCs varies tremendously across countries and revisions of the ICD. In general, across all country-years of data available, GCs have declined from more than 43% in ICD-7 to 24% in ICD-10. In some regions, such as Australasia, GCs in 2005 are as low as 11%, while in some developing countries, such as Thailand, they are greater than 50%. Across different age groups, the composition of GCs varies tremendously - three classes of GCs steadily increase with age, but ambiguous codes within a particular disease chapter are also common for injuries at younger ages. The impact of redistribution is to change the number of deaths assigned to particular causes for a given age-sex group. These changes alter ranks across countries for any given year by a number of different causes, change time trends, and alter the rank order of causes within a country. Conclusions By mapping CoD through different ICD versions and redistributing GCs, we believe the public health utility of CoD data can be substantially enhanced, leading to an increased demand for higher quality CoD data from health sector decision-makers.
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                Author and article information

                Contributors
                Carolin Kilian:
                ORCID: https://orcid.org/0000-0001-5913-6488
                carolin.kilian@tu-dresden.de
                Journal
                Journal ID (nlm-ta): Drug Alcohol Rev
                Journal ID (iso-abbrev): Drug Alcohol Rev
                Journal ID (doi): 10.1111/(ISSN)1465-3362
                Journal ID (publisher-id): DAR
                Title: Drug and Alcohol Review
                Publisher: John Wiley & Sons Australia, Ltd (Melbourne )
                ISSN (Print): 0959-5236
                ISSN (Electronic): 1465-3362
                Publication date (Electronic): 09 November 2022
                Publication date PMC-release: 09 November 2022
                Electronic Location Identifier: 10.1111/dar.13573
                Affiliations
                [ 1 ] Institute of Clinical Psychology and Psychotherapy Technische Universität Dresden Dresden Germany
                [ 2 ] Institute for Mental Health Policy Research Centre for Addiction and Mental Health Toronto Canada
                [ 3 ] Centre for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy University Medical Centre Hamburg‐Eppendorf Hamburg Germany
                [ 4 ] Department of Psychiatry, Medical Faculty University of Leipzig Leipzig Germany
                Author notes
                [*] [* ] Correspondence

                Carolin Kilian, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46a, 01187 Dresden, Germany.

                Email: carolin.kilian@ 123456tu-dresden.de

                Author information
                https://orcid.org/0000-0001-5913-6488
                https://orcid.org/0000-0003-0421-3145
                https://orcid.org/0000-0003-1139-030X
                https://orcid.org/0000-0003-1231-3760
                Article
                Publisher ID: DAR13573
                DOI: 10.1111/dar.13573
                PMC ID: 9878067
                PubMed ID: 36352737
                SO-VID: 614831e8-8e17-46b0-ab42-bc27f02bd33e
                Copyright © © 2022 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 24 August 2022
                Date received : 18 January 2022
                Date accepted : 24 August 2022
                Page count
                Figures: 3, Tables: 1, Pages: 8, Words: 4581
                Categories
                Subject: Original Paper
                Subject: Original Papers
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.4 mode:remove_FC converted:26.01.2023

                Keywords: alcohol,alcohol‐specific mortality,covid‐19,germany,pandemic
                Data availability:
                Keywords: alcohol, alcohol‐specific mortality, covid‐19, germany, pandemic

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