Laboratory

Population Health

At a Glance Projects Publications Team

Project

Mortality from Substance Abuse in High-Income Countries (Dissertation)

Adarsh + (MPIDR / University of St Andrews, School of Geography and Sustainable Development, United Kingdom), Mikko Myrskylä, Enrique Acosta (MPIDR / Autonomous University of Barcelona, Centre for Demographic Studies, Spain), Hill Kulu (University of St Andrews, School of Geography and Sustainable Development, United Kingdom)

Detailed Description

This PhD thesis investigates cohort-structured patterns of substance-abuse mortality (SAM) due to drugs and alcohol in high-income countries. While many studies have tracked temporal trends in SAM, they have often overlooked the cohort dimension of recent mortality changes and the subnational disparities that shape them. Much of the literature treats drugs and alcohol separately or relies on period trends, leaving unclear how birth cohorts, structural opportunities, and generational identities combine to produce today’s patterns. This thesis examines SAM from an Age-Period framework but acknowledges Cohort perspectives where needed. It first applies APC-informed cohort profiling to harmonized mortality series across 18 high-income countries to identify cohorts disproportionately affected by SAM. It then utilizes state-level models in the United States linking indicators of structural opportunity (relative cohort size, income, labor force participation) and generational identity (mismatch in expectations, religious inclination, political opinions) to cohort-specific SAM. Finally, it employs cause-deleted life table counterfactuals to quantify the contribution of SAM to life-expectancy stagnation in Scotland. The analysis first shows substantial cross-national heterogeneity in cohort disadvantage, with cohorts born roughly 1965–1980 often at elevated risk, albeit with country-specific timing and magnitude. Second, treating drugs and alcohol jointly reveals overlapping cohort disadvantage and sequential risks that existing literature miss. Third, both structural opportunities and generational identities are associated with cohort-patterned SAM, and their interaction modifies effects across places. Fourth, period shocks (e.g., synthetic opioid infiltration) produce synchronous rises, but cohort imprints persist as lasting “scars,” clarifying age, period, and cohort channels. Fifth, counterfactual estimates indicate that SAM has materially contributed to Scotland’s recent stagnation in life expectancy, with the largest gains under realistic scenarios emerging at working ages (25–44). This thesis meaningfully improves understanding of how cohorts, structures, and identities shape SAM and offers a framework for cohort-smart, culture-fit policy to reduce premature mortality.