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

Drug- and alcohol-related deaths, i.e., deaths from substance abuse, are detrimental to overall life expectancy in many high-income countries because they are the leading risk factor for mortality among young adults. The rates of substance abuse mortality have increased over the past decade, a development both unanticipated and alarming and reaching a global crisis. These developments deserve more research attention. 

In this project, we situate substance abuse mortality across several high-income countries, observe deviations in temporal trends, and attribute the resulting temporal inequalities to potential demographic events.

The project addresses the following research questions:

Is the problem of mortality from substance abuse exclusive to the USA? Following the opioid crisis in the United States, much research has been done on mortality from drug overdose in the USA. However, many other countries, including Canada, Australia, Norway, and the UK, are also going through a mortality crisis from drug overdose, though the levels are lower than in the USA. Nevertheless, substance abuse as a cause of death has been pushed to the background in mortality research.

Is substance abuse mortality a period phenomenon? Substance abuse mortality, conventionally, has been studied as a period effect, i.e., as affecting all age groups and cohorts uniformly. Though many countries are going through the worst crisis of substance abuse mortality in their history (Case and Deaton 2015), there is evidence that specific cohorts have a sustained higher risk of death from substance abuse than others during their life course (Acosta et al. 2020).

The project examines temporal patterns in substance abuse mortality by combining deaths from drugs and alcohol and updating previous comparisons across several high-income countries. The project also provides a fresh cohort perspective on deaths from substance abuse, thus challenging existing research and creating room for discussion about the roles of demographic variables such as cohort size and birth order in behavioral mortality. 

To situate mortality from substance abuse, we use age-standardized cause-specific mortality rates to compare countries over time. To study deviations in temporal trends, we plot lexis surfaces of mortality change and use a detrended age-period-cohort approach to quantify "deviations from linear" (i.e., nonlinear) temporal trends. We use a hysteresis model to test the stability of the deviations over the life course.