Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol - the case of Canada

Aims To analyse post-war variations in per capita alcohol consumption in relation to gender-specific liver cirrhosis mortality in Canadian provinces and to assess the extent to which alcohol bears a different relation to cirrhosis deaths with mention of alcohol (alcoholic cirrhosis) compared to cirrhosis deaths without mention of alcohol (non-alcoholic cirrhosis). Data and method Annual liver cirrhosis mortality rates by 5-year age groups were converted into gender-specific and age-adjusted mortality rates. Outcome measures included total cirrhosis-the conventional measure of liver cirrhosis-alcoholic cirrhosis and non-alcoholic cirrhosis. Per capita alcohol consumption was measured by alcohol sales and weighted with a 10-year distributed lag model. A graphical analysis was used to examine the regional relationship and the Box-Jenkins technique for time-series analysis was used to estimate the temporal relationship. Findings Geographical variations in alcohol consumption corresponded to variations in total liver cirrhosis and particularly alcoholic cirrhosis, whereas non-alcoholic cirrhosis rates were not associated geographically with alcohol consumption. In general, for all provinces, time-series analyses revealed positive and statistically significant effects of changes in alcohol consumption on cirrhosis mortality. In Canada at large, a 1-litre increase in per capita consumption was associated with a 17%, increase in male total cirrhosis rates and a 13% increase in female total cirrhosis rates. Alcohol consumption had a stronger impact on alcoholic cirrhosis, which increased by fully 30%, per titre increase in alcohol per capita for men and women. Although the effect on the non-alcoholic cirrhosis rate was weaker (12% for men and 7% for women) it was nevertheless statistically significant and suggests that a large proportion of these deaths may actually be alcohol-related. Conclusions Some well-established findings in alcohol research were confirmed by the Canadian experience: per capita alcohol consumption is related closely to death rates from liver cirrhosis and alcohol-related deaths tend to be under-reported in mortality statistics.