Smoking epidemic in Europe in the 21st century.

OBJECTIVE: To estimate smoking-attributable mortality in the long-term future in 29 European countries using a novel data-driven forecasting approach that integrates the wave pattern of the smoking epidemic and the cohort dimension. METHODS: We estimated and forecasted age-specific and age-standardised smoking-attributable mortality fractions (SAMF) and 95% projection intervals for 29 European countries by sex, 1950-2100, using age-period-cohort modelling with a generalised logit link function. We projected the (decelerating) period increases (women) by a quadratic curve to obtain future declines, and extrapolated the past period decline (men). In addition, we extrapolated the recent cohort trend. RESULTS: SAMF among men are projected to decline from, on average, 25% in 2014 (11% (Sweden)-41% (Hungary)) to 11% in 2040 (range: 6.3%-15.4%), 7% in 2065 (range: 5.9%-9.4%) and 6% in 2100. SAMF among women in 21 non-Eastern European countries, currently at an average of 16%, are projected to reach peak levels in 2013 (Northern Europe), 2019 (Western Europe), 2027 (Greece, Italy) and 2022 (Central Europe), with maximum levels of, on average, 17% (8% (Greece)-28% (Denmark)), and to decline to 10% in 2040 (range: 4%-20%), 5% in 2065 (range: 3.5%-7.6%) and 4% in 2100. For women, a short-term shift in the peak of the inverse U-shaped age pattern to higher ages is projected, and crossovers between the age-specific trends. CONCLUSION: Our novel forecasting method enabled realistic estimates of the mortality imprint of the smoking epidemic in Europe up to 2100. The high peak values in smoking-attributable mortality projected for women warrant attention.

Future life expectancy in Europe taking into account the impact of smoking, obesity, and alcohol.

Introduction: In Europe, women can expect to live on average 82 years and men 75 years. Forecasting how life expectancy will develop in the future is essential for society. Most forecasts rely on a mechanical extrapolation of past mortality trends, which leads to unreliable outcomes because of temporal fluctuations in the past trends due to lifestyle 'epidemics'. Methods: We project life expectancy for 18 European countries by taking into account the impact of smoking, obesity, and alcohol on mortality, and the mortality experiences of forerunner populations. Results: We project that life expectancy in these 18 countries will increase from, on average, 83.4 years for women and 78.3 years for men in 2014 to 92.8 years for women and 90.5 years for men in 2065. Compared to others (Lee-Carter, Eurostat, United Nations), we project higher future life expectancy values and more realistic differences between countries and sexes. Conclusions: Our results imply longer individual lifespans, and more elderly in society. Funding: Netherlands Organisation for Scientific Research (NWO) (grant no. 452-13-001).

On average, in Europe, men can currently expect to live till the age of 75 and women until they are 82. But what will their lifespans be in the next decades? Reliable answers to this question are essential to help governments plan for future health care and social security costs. While medical improvements are likely to further extend lifespans, lifestyle factors can result in temporal distortions of this trend. Yet, most estimates of future life expectancy fail to consider changing lifestyles, as they only use past mortality trends in their calculations. This can make these projections unreliable: for example, increases in smoking rates among Northern and Western European men led to stagnating male life expectancies in the 1950s and 1960s, but these picked up again after smoking declined. The same pattern is showing for women, except it is lagging as they took up smoking later than men. Based simply on the extrapolation of past mortality trends, current projection models fail to consider the past and predicted modifications of life expectancy trends prompted by changing rates of health behaviours ­ such as increases followed by (anticipated) declines in alcohol consumption and obesity rates, similar to what was observed with smoking. To produce a more reliable forecast, Janssen et al. incorporated trends in smoking, obesity, and alcohol use into life expectancy projections for 18 European countries. The predictions suggest that life expectancy for women in these countries will increase from 83.4 years in 2014 to 92.8 years in 2065. For men, it will also go up, from 78.3 to 90.5 years. In the future, this integrative approach may help to track the effects of health-behaviour related prevention policies on life expectancy, and allow scientists to account for changes caused by the COVID-19 pandemic. In the meantime, these estimates are higher than those obtained using more traditional methods; they suggest that communities should start to adjust to the possibility of longer individual lifespans, and of larger numbers of elderly people in society.

Past and Future Alcohol-Attributable Mortality in Europe.

Although alcohol consumption is an important public health issue in Europe, estimates of future alcohol-attributable mortality for European countries are rare, and only apply to the short-term future. We project (age-specific) alcohol-attributable mortality up to 2060 in 26 European countries, after a careful assessment of past trends. For this purpose we used population-level country-, sex-, age- (20-84) and year-specific (1990-2016) alcohol-attributable mortality fractions (AAMF) from the Global Burden of Disease (GBD) study, which we adjusted at older ages. To these data we apply an advanced age-period-cohort projection methodology, that avoids unrealistic future differences and crossovers between sexes and countries. We project that in the future, AAMF levels will decline in all countries, and will converge across countries and sexes. For 2060, projected AAMF are, on average, 5.1% among men and 1.4% among women, whereas in 2016 these levels were 10.1% and 3.3%, respectively. For men, AAMF is projected to be higher in Eastern and South-western Europe than in North-western Europe. All in all, the share of mortality due to alcohol is projected to eventually decline in all 26 European countries. Achieving these projected declines will, however, require strong ongoing public health action, particularly for selected Eastern and North-western European countries.