Abstract
Background: Alcohol is a major public health issue in Europe. Although future estimates of alcohol-attributable mortality can aid public health policy making, forecasts are scarce. Moreover, previous forecasts did not include the cohort dimension, despite the important role birth cohorts play in determining alcohol-attributable mortality trends. We forecast age- and sex-specific alcohol-attributable mortality in France for the period 2015-2050 using a novel generalizable methodology that includes different scenarios regarding period and cohort change. Within Western Europe, France has one of the highest levels of alcohol-attributable mortality.Methods: For the French national population aged 25-90 years (1979-2014), we estimated alcohol-attributable mortality by mortality from the main causes of death wholly-attributable to alcohol, plus liver cirrhosis mortality. We modelled sex-specific alcohol-attributable mortality by adjusting for age, period, and birth cohort. We forecasted the model parameters to obtain future age- and sex-specific alcohol-attributable mortality up until 2050 using a conventional baseline, scenario I (favourable period change) and scenario II (unfavourable cohort change). Results: Alcohol-attributable mortality is clearly declining in France, with the decline decelerating from 1992 onwards. In 2014, the age-standardized alcohol-attributable mortality rates, in deaths per 100,000, were 34.7 among men and 9.9 among women. In 2050, the estimated rates are between 10.5 (prediction interval: 7.6-14.4; scenario I) and 17.6 (13.1-23.7; scenario II) among men, and between 1.1 (0.7-1.7; scenario I) and 1.8 (1.2-2.9; scenario II) among women; which implies declines of 58% for men and 84% for women (baseline). The peak of the inverse u-shaped age pattern of alcohol-attributable mortality (currently at around age 65) is expected to shift towards older ages, and an additional hump in the age pattern is projected that moves towards higher ages over time, and is more extended in the cohort scenario.Conclusions: Alcohol-attributable mortality in France is expected to further decline in the coming decades, accompanied by age pattern changes. However, France’s levels are not expected to reach the current lower levels in Italy and Spain for 15 years or more. Our results point to the value of implementing preventive policy measures that discourage alcohol consumption among people of all ages, but especially among adolescents.