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Mortality and life expectancy of people with alcohol use disorder in Denmark, Finland and Sweden

Alcohol use disorder (AUD) is a major cause of morbidity and mortality. People with AUD have among the highest all-cause mortality of all people who receive treatment for mental disorders. A meta-analysis that included 81 observational studies from many countries showed that people with AUD have three-fold higher mortality in men and four-fold higher mortality in women than the general population. In all people who have AUD, mortality is relatively higher in women, younger people and people in treatment for addiction. However, comprehensive mortality data over time of patients with AUD are not available from Nordic countries.

Increased alcohol consumption is associated with increased disease burden, accidents, and social problems. In response to these effects, alcohol policies were created in Nordic countries (Sweden, Norway, Denmark, Finland and Iceland) to promote a decrease in alcohol consumption and restrict alcohol availability. The governments of all Nordic countries except Denmark have a monopoly of alcohol retail. However, after joining the European Union in 1995, Finland and Sweden shifted from a highly restrictive to a more liberal alcohol policy. The price of alcohol was reduced by tax reduction on alcoholic beverages in Denmark and Finland, abolition of quantitative quotas on alcoholic beverages in Sweden and Finland, and more generous opening hours of alcohol retailers in Sweden. These changes made alcohol more accessible to the public in these countries since 2003. The alcohol control policies of the countries were associated with total alcohol consumption; Sweden has the most restrictive, and Denmark has the least restrictive alcohol policies. Frequency of heavy alcohol drinkers and alcohol-related problems are often assumed to depend on the level of alcohol consumption in the general population.

The reliable nationwide health care registers in Denmark, Finland and Sweden provide a unique opportunity to study mortality in people diagnosed with AUD.

The purpose of this study was to evaluate mortality and life expectancy in people who had AUD in Denmark, Finland and Sweden between 1987 and 2006.

National health registers from Denmark, Finland and Sweden were used to follow the entire population, approximately 20 million people, aged 15 years or above, in these three countries and identify all people who were admitted to hospital because of AUD as the primary or secondary diagnosis during 20 years (January 1, 1987 to December 31, 2006). Data about patients were retrieved from the national hospital discharge registers in each country.

In Denmark, the number of men and women hospitalized because of AUD was similar for the 5-year periods from 1987 to 2001 but increased for 2002 to 2006. In Finland, the number of men and women with AUD increased from 1987 to 2001 and remained unchanged for 2002 to 2006. In Sweden, the number of men with AUD decreased and the number of women with AUD increased from 1987 to 2006.

Mortality was higher in Denmark than Finland or Sweden. Standardized mortality per 100 000 increased during the entire study period in men and women with AUD in Denmark. In Finland and Sweden, the standardized mortality per 100 000 decreased in men and women with AUD during the entire study period.

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People hospitalized with alcohol use disorder have an average life expectancy of 47–53 years (men) and 50–58 years (women) and die 24–28 years earlier than people in the general population.

Source: Acta Psychiatrica Scandinavica

Westman J, Wahlbeck K, Laursen TM, Gissler M, Nordentoft M, Hällgren J, Arffman M, Ösby U. Mortality and life expectancy of people with alcohol use disorder in Denmark, Finland and Sweden.

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