Trends in alcohol‐related mortality in East and West Germany, 1980–2014: age, period and cohort variations.

Abstract: Background and aims: Several indicators suggest that the extent and trends of alcohol‐related mortality differ between East and West Germany. Regional drinking patterns and differences in health‐care systems are assumed to affect the risk of dying from an alcohol‐induced disease. The study addresses two questions: (1) what are the unbiased and independent age, period and cohort effects on alcohol‐related mortality trends in Germany; and (2) do these trends differ between East and West Germany? Methods: Data on alcohol‐related mortality for East and West Germany came from the national causes of death register for the years 1980–2014. Analyses included all deaths fully attributable to alcohol based on the International Classification of Diseases (ICD‐9 and ICD‐10). Gender‐stratified age–period–cohort analyses were conducted using the intrinsic estimator model. Results: Age effects showed a concave pattern with a peak at ages 55–64 years in both regions. Incidence rate ratios (IRR) in East Germany were highest in the years 1990–1994 (men and women: IRR = 1.52) and declined thereafter. In West Germany, IRR were lowest in 1980–1984 (men: IRR = 0.81, women: IRR = 0.75) and stabilized at approximately 1.10 since 1995–1999. Cohort effects showed continuously lower IRR for those born after 1955–1959 in the East and those born after 1945–1949 in the West. Patterns for males and females were comparable. Conclusions: The results suggest that alcohol‐related mortality showed different trends in East and West Germany, which can be explained partly by different drinking patterns before and changes in the health‐care system after the reunification. [ABSTRACT FROM AUTHOR]