Individual- and area-level characteristics associated with alcohol-related mortality among adult Lithuanian males: A multilevel analysis based on census-linked data

PLoS One. 2017 Jul 21;12(7):e0181622. doi: 10.1371/journal.pone.0181622. eCollection 2017.

Abstract

Background: Although excessive alcohol-related mortality in the post-Soviet countries remains the major public health threat, determinants of this phenomenon are still poorly understood.

Aims: We assess simultaneously individual- and area-level factors associated with an elevated risk of alcohol-related mortality among Lithuanian males aged 30-64.

Methods: Our analysis is based on a census-linked dataset containing information on individual- and area-level characteristics and death events which occurred between March 1st, 2011 and December 31st, 2013. We limit the analysis to a few causes of death which are directly linked to excessive alcohol consumption: accidental poisonings by alcohol (X45) and liver cirrhosis (K70 and K74). Multilevel Poisson regression models with random intercepts are applied to estimate mortality rate ratios (MRR).

Results: The selected individual-level characteristics are important predictors of alcohol-related mortality, whereas area-level variables show much less pronounced or insignificant effects. Compared to married men, never married (MRR = 1.9, CI:1.6-2.2), divorced (MRR = 2.6, CI:2.3-2.9), and widowed (MRR = 2.4, CI: 1.8-3.1) men are disadvantaged groups. Men who have the lowest level of educational attainment have the highest mortality risk (MRR = 1.7 CI:1.4-2.1). Being unemployed is associated with a five-fold risk of alcohol-related death (MRR = 5.1, CI: 4.4-5.9), even after adjusting for all other individual variables. Lithuanian males have an advantage over Russian (MRR = 1.3, CI:1.1-1.6) and Polish (MRR = 1.8, CI: 1.5-2.2) males. After adjusting for all individual characteristics, only two out of seven area-level variables-i.e., the share of ethnic minorities in the population and the election turnout-have statistically significant direct associations. These variables contribute to a higher risk of alcohol-related mortality at the individual level.

Conclusions: The huge and increasing socio-economic disparities in alcohol-related mortality indicate that recently implemented anti-alcohol measures in Lithuania should be reinforced by specific measures targeting the most disadvantaged population groups and geographical areas.

MeSH terms

  • Adult
  • Cause of Death / trends*
  • Censuses
  • Divorce
  • Ethanol / adverse effects*
  • Humans
  • Information Storage and Retrieval
  • Lithuania
  • Male
  • Marriage
  • Middle Aged
  • Multilevel Analysis
  • Risk Factors
  • Russia
  • Single Person

Substances

  • Ethanol

Grants and funding

The study has been conducted in the framework of the project “Contemporary demographic problems in Belarus and Lithuania: variations, similarities, and ways for transition to sustainable development” (TAP LB-17-027) funded by the Research Council of Lithuania on the basis of the bilateral agreement on the partnership in the areas of science and technology between Lithuania and Belarus http://www.lmt.lt/en/rnd/intergov/lt-by.html. The participation of VMS was partially supported by the Russian Academic Excellence Project «5-100» (http://5top100.com/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.