Excess mortality among clients in alcohol treatment in Latvia: A record-linkage study

Introduction.  Alcohol consumption is among the leading factors for mortality and morbidity worldwide.  It has been estimated that around 4 percent of deaths globally are attributable to alcohol use with the highest proportion of deaths attibutable to alcohol seen in Eastern Europe (more than 10%) and Latin America (around 8%), while the lowest – in Africa.  One way of analyzing mortality is through record-linkage studies. 

Objective.  The aim of this study is to investigate mortality and causes of deaths among clients in alcohol treatment in Latvia and possible socio-economic factors and mediators.

Study design.  Individual level data on clients in public alcohol treatment in Latvia from the Patient REgister DAtabase (PREDA) were linked with the General Mortality Register (GMR) based on a unique personal identifier.  Directly standardized mortality rates, standardized mortality ratios and survival probabilities were calculated for different age and gender groups. 

Results.  Over the period of 2000–2011 a total of 42,894 unique individuals were treated for problems related with alcohol intoxication, dependence or psychosis, of which  by the end of follow-up 7,496 had died.  The highest mortality rates and lowest survival probability was among clients who have received treatment for problems related with alcohol psychosis, while the lowest mortality – for clients with less severe alcohol problems.  The most common cause of death was ischemic heart disease (ICD-10 I20-I25), followed by cardiomyopathy (I42), and liver diseases (K70-K77).

Conclusions.  This study suggest record-linkage studies are a valuable tool in analyzing mortality in Latvia as analyzing only aggregate cause-specific mortality rates might be under-reporting of alcohol-related mortality.  By taking into account high mortality rates among most severe alcohol treatment clients evidence-based alcohol policies and treatment services should be introduced.