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PLoS One. 2018 Mar 22;13(3):e0194478. doi: 10.1371/journal.pone.0194478. eCollection 2018.

Comparison of different approaches for estimating age-specific alcohol-attributable mortality: The cases of France and Finland.

Author information

Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.
Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland.
Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden.
Max Planck Institute for Demographic Research, Rostock, Germany.
Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland.
Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands.



Accurate estimates of the impact of alcohol on overall and age-specific mortality are crucial for formulating health policies. However, different approaches to estimating alcohol-attributable mortality provide different results, and a detailed comparison of age-specific estimates is missing.


Using data on cause of death, alcohol consumption, and relative risks of mortality at different consumption levels, we compare eight estimates of sex- and age-specific alcohol-attributable mortality in France (2010) and Finland (2013): five estimates using cause-of-death approaches (with one accounting for contributory causes), and three estimates using attributable fraction (AF) approaches.


AF-related approaches and the approach based on alcohol-related underlying and contributory causes of death provided estimates of alcohol-attributable mortality that were twice as high as the estimates found using underlying cause-of-death approaches in both countries and sexes. The differences across the methods were greatest among older age groups An inverse U-shape in age-specific alcohol-attributable mortality (peaking at around age 65) was observed for cause-of-death approaches, with this shape being more pronounced in Finland. AF-related approaches resulted in different estimates at older ages: i.e., mortality was found to increase with age in France; whereas in Finland mortality estimates depended on the underlying assumptions regarding the effects of alcohol consumption on cardiovascular mortality.


While the most detailed approaches (i.e., the AF-related approach and the approach that includes underlying and contributory causes) are theoretically able to provide more accurate estimates of alcohol-attributable mortality, they-especially the AF approaches- depend heavily on data availability and quality. To enhance the reliability of alcohol-attributable mortality estimates, data quality for older age groups needs to be improved.

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