Age, period, and cohort trends of substance poisoning, alcohol-related disease, and suicide deaths in Australia, 1980–2019

Abstract

Purpose: Deaths due to substance poisoning, alcohol-related disease, and suicide pose a critical public health issue, and have been categorized as “deaths of despair” in the US. Whether these deaths represent a distinct phenomenon requires exploration, particularly in other countries. Methods: This retrospective observational study examines age-period-cohort trends of (combined and cause-specific) substance poisoning, alcohol-related disease, and suicide deaths among Australians aged ≥15-years that occurred between 1980 and 2019 and compares trends between males and females. Results: Combined mortality rates were initially (1980–1999) relatively stable, reflecting a reduction in alcohol-related disease deaths offset by an increase in substance poisoning deaths. A decline (2000–2006) and subsequent increase (2007–2019) in combined rates were primarily attributable to corresponding changes in both substance poisoning and suicide deaths among males. Distinct age-period-cohort trends were observed between cause of death sub-types, with net drifts: increasing for male (net drift [95% CI]: 3.33 [2.84, 3.83]) and female (2.58 [2.18, 2.98]) substance poisoning deaths; decreasing among male alcohol-related disease (− 1.46 [− 1.75, − 1.16]) and suicide deaths (− 0.52[− 0.69, − 0.36]); and remaining relatively stable for female alcohol-related disease (− 0.28 [− 0.66, 0.09]) and suicide deaths (− 0.25 [− 0.52, 0.01]). Conclusions: Although combined age-specific trends were relatively stable over the study period, different and distinct patterns were observed within cause-specific deaths, challenging the notion that these causes of death represent a distinct epidemiological phenomenon. These data indicate a critical need to review the appropriateness of guidance for clinical practice, prevention strategies, and policy initiatives aimed at preventing future deaths.