Journal Article

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

Grigoriev, P., Jasilionis, D., Stumbrys, D., Stankūnienė, V., Shkolnikov, V. M.
PLOS One, 12:7, e0181622 (2017)
Open Access


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.

Keywords: Lithuania, adult mortality
The Max Planck Institute for Demographic Research (MPIDR) in Rostock is one of the leading demographic research centers in the world. It's part of the Max Planck Society, the internationally renowned German research society.