Levels and trends in alcohol-related mortality and morbidity
One useful measure, in trying to assess the impact of alcohol consumption on mortality, is to calculate the age-standardized mortality rates for alcohol-related diseases and then to compare the rates across countries. Table 2 lists the age-standardized mortality rates for the four principal alcohol-related diseases across countries. Analyzing the age-standardized mortally rates in relation to the per capita consumption of a specific country may reveal interesting trends. Using Costa Rica as an example, we compare mortality dare from table 2 and figure 7 with consumption data from Annex table A-l. The data are revealing. Agestandardized mortality data in table 2 indicates that Costa Rica experiences high mortality rates for cancer of the liver and cirrhosis, 7.47 and 11.96, respectively, while figure 7 shows that between 1983 and 1986 the number of deaths attributable to cirrhosis increased for every age group. These elevated rates may be partially explained by the consumption dare in Annex Table A-l, which indicate that between 1970 and 1989 total alcohol consumption in Costa Rica increased from 2.2 to 3.2 liters of alcohol per person (this figure is likely much higher if only the population over 15 is considered).
TABLE 2: Age Standardized Mortality Rates for Alcohol-Related Diseases
Source: Mortality Dab, International Classification of Disease, WHO, 1989
In comparison, during the same period in France, alcohol consumption per Capita declined from 17.3 liters per capita to 13.2 liters per capita. The consequences of this decline are shown in figure 8, which shows that cirrhosis deaths decreased for nearly every age group between 1977 and 1989.
The evidence from these two countries underscores the potential effect of changes in alcohol consumption on society. Changes in per capita consumption of alcohol can have a significant impact on mortality within a country. More importantly, household level effects of alcohol-related diseases may have an even greater effect on the poor, who are more exposed to other risk factors for chronic disease, harder to reach with IEC, and less likely to have access to appropriate medical care. The degree to which alcoholrelated diseases affect the poor in developing countries is unknown. However, it has been shown for other diseases that premature death and disability among the poor is likely to have a more significant impact on the health and economic well-being of the household. In addition, because alcohol is an addictive substance (whether it is because of genetic, behavioral. or chemical factors) and due to a lack of information on the part of consumers. households may not be maximizing their welfare in choosing to consume alcohol over other consumer goods.
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