The aim of this review was to review research addressing the relationship between population drinking and health, particularly mortality. The review is based primarily on articles published in international journals after 1994 to February 2005, identified via Medline. The method used in most studies is time-series analysis based on autoregressive intergrated moving average (ARIMA) modelling. The outcome measures covered included the following mortality indicators: mortality from liver cirrhosis and other alcohol-related diseases, accident mortality, suicide, homicide, ischaemic heart disease (IHD) mortality and all-cause mortality. The study countries included most of the EU member states as of 1995 (14 countries), Canada and the United States. For Eastern Europe there was only scanty evidence. The study period was in most cases the post-war period. There was a statistically significant relationship between per capita consumption and mortality from liver cirrhosis and other alcohol-related diseases in all countries. In about half the countries, there was a significant relationship between consumption, on one hand, and mortality from accidents and homicide as well as all-cause mortality on the other hand. A link between alcohol and suicide was found in all regions except for mid- and southern Europe. There was no systematic link between consumption and IHD mortality. Overall, a 1-litre increase in per capita consumption was associated with a stronger effect in northern Europe and Canada than in mid- and southern Europe. Research during the past decade has strengthened the notion of a relationship between population drinking and alcohol-related harm. At the same time, the marked regional variation in the magnitude of this relationship suggests the importance of drinking patterns for modifying the impact of alcohol. By and large, there was little evidence for any cardioprotective effect at the population level. It is a challenge for future research to reconcile this outcome with the findings from observational studies, most of which suggest a protective effect of moderate drinking.

Aims. To test the hypothesis that a positive population-level relationship between alcohol and suicide is more likely to be found in dry drinking cultures (as indicated by consumption level) than in wet drinking cultures. Design. Gender-and age-speci c suicide rates in 14 western European countries were analysed in relation to per capita alcohol consumption employing the Box-Jenkins technique for time series analysis. The country-speci c estimates were pooled into low-, medium-and high-consumption countries. Measurements. Suicide mortality data for 5-year age groups were converted into gender-and age-speci c mortality rates. Alcohol sales expressed as litres of 100% alcohol per year and inhabitants 15 years and older were used as a measure of alcohol consumption. Findings. A positive and signi cant relationship between per capita consumption and gender-and age-speci c suicide rates was revealed most often in northern Europe and found least often in southern Europe. A stronger absolute alcohol effect for men was found only in northern Europe, whereas the relative alcohol effect was somewhat stronger for women in both northern and central Europe. Also, the suicide rate in younger age groups was more often signi cantly related to per capita consumption than suicide among the elder in northern and central Europe but not in southern Europe. Conclusions. The population-level association between alcohol and suicide is conditioned by cultural factors. In general, the suicide rate tends to be more responsive to changes in alcohol consumption in drinking cultures characterized by a low post-war per capita consumption compared to drinking cultures with higher consumption levels. The ndings give support to the hypothesis derived from previous theoretical and empirical work, suggesting that suicide and alcohol is more closely connected in dry cultures than in wet cultures.

Aim. To estimate the effects of changes in per capita alcohol consumption on liver cirrhosis mortality rates in various demographic groups across 14 western European countries. Method. Yearly changes in gender‐ and age‐specific mortality rates from 1950 to 1995 were analysed in relation to corresponding yearly changes in per capita alcohol consumption, employing the Box‐Jenkins technique for time series analysis. Country‐specific estimates were pooled into three regions: northern, central and southern Europe. Measurements. Cirrhosis mortality data for 5‐year age groups were converted into gender‐specific mortality rates in the age groups 15 +, 15‐44, 45‐64 and 65 + and expressed as the number of deaths per 100 000 inhabitants. Alcohol sales were used to measure aggregate consumption, which were calculated into consumption (litres 100% alcohol) per year per inhabitant over 14 years of age and weighted with a 10‐year distributed lag model. Findings. The country‐specific analyses demonstrated a positive and statistically significant effect of changes in per capita consumption on changes in cirrhosis mortality in 13 countries for males and in nine countries for females. The strongest alcohol effect was found in northern Europe, due mainly to a large effect in Sweden. Moreover, when different age groups were analysed significant estimates were obtained in 29 of 42 cases for males and in 20 of 42 cases for females. Most of the non‐significant estimates were found in older age groups. Conclusions. The results suggest clearly that a change in the overall level of drinking as a general rule affect cirrhosis mortality in different drinking cultures as well as among different demographic groups. Moreover, the findings correspond with what is expected from the collectivity theory of drinking cultures.

This is a repository copy of Alcohol consumption and the physical availability of takeaway alcohol: systematic reviews and meta-analyses of the days and hours of sale and outlet density..