Major Determinants of Premature Mortality in Middle-Aged Urban Males: Alcohol-Related Deaths and Degree of Participation in a Preventive Population Program Against Alcohol and Its Complications

Abstract

The total, consecutive mortality in a population of 10,353 middle-aged males invited to participate in a preventive medical population program in Malmö was followed up 1.5-6.5 years, mean 4.5 years, after the time of invitation and analyzed in relation to participation or nonparticipation, forensic or in-hospital autopsy and possible intervention effects. The total mortality was twice as high in the nonparticipants as in the participants, and the death rate due to alcohol-related diseases was five times higher. There were no significant differences in other causes of death, including cancer and cardiovascular diseases. In the nonparticipants autopsied at the Forensic Department the proportion of alcohol-related deaths was 60.5%, compared with 10.0% in participants autopsied in hospital. A history of alcohol abuse was present in 45.2% of the total sample, and in 61.0% of the group autopsied at the Forensic Department. In participants with increased screening gamma-glutamyltransferase, mortality at 48-72 months' follow-up was lower in an intervention group in comparison with a control group matched for sex, age and gamma-glutamyltransferase. The results support findings that alcohol-related deaths, nonparticipation in a preventive population program, and intervention effects in a public health strategy against alcohol and its complications are major determinants of premature mortality in middle-aged urban males.

Long‐term outcome of the Malmö Preventive Project: mortality and cardiovascular morbidity

“…We have previously reported that the identification and treatment of high‐risk individuals with impaired glucose tolerance [11, 20], or alcohol abuse [12–16], proved to be beneficial, implying positive effects of a ‘high‐risk strategy’ for such patient groups. The current analyses of the long‐term outcome of the Malmö Preventive Project illustrate the effects of a high‐risk approach on the outcome in the total invited population.…”

“…In Malmö, Sweden a preventive case‐finding programme for cardiovascular risk factors, alcohol abuse and breast cancer, the Malmö Preventive Project, started at the Section of Preventive Medicine, Department of Medicine, University Hospital in 1974. The aim of the project at the start was to invite and examine large strata of the adult population, mostly middle‐aged males and females, born in prespecified years and at the time living in the city, in order to find high‐risk individuals for preventive intervention on cardiovascular risk factors, alcohol abuse, impaired glucose tolerance, and breast cancer [9, 11–17].…”

“…Those were intervened on at an outpatient clinic at the Department of Preventive medicine outside the University Hospital for periods up to several years. The intervention and its results have been described [12–16].…”

“…Previous reports from the Malmö Preventive Project have shown beneficial long‐term treatment effects of intervention in selected individuals with impaired glucose tolerance [11], or alcohol abuse [12–16]. Another observational study has focused on risk factors for ischaemic heart disease and long‐term outcome in males [17].…”

Sudden Unexpected Death in Alcohol Misuse—An Unrecognized Public Health Issue?

“…The fact that alcohol can be a cause of sudden cardiac death is unrecognized by many pathologists [8] and many of these deaths are being incorrectly attributed to other causes such as minor coronary artery atherosclerosis [10]. Studies of 10,353 middle aged males involved in a health screening program in Malmo, Sweden, found that alcohol related mortality was the commonest cause of death [11–13]. Of the 347 deaths in this program investigated in 1988 [10], 46 (0.4%) were sudden unwitnessed deaths with an alcohol risk and no pathological findings.…”