Life expectancy and alcohol use health burden in Poland after 2002

Introduction
Between 1990 and 2002 Poland experienced one of the steepest gains in health in Europe. However, in 2002, unexpectedly, the health improvement in Poland halted. An increase in alcohol-related diseases after 2002 was most likely caused by an increase in alcohol consumption that followed a 30% reduction in excise tax on spirits and other weakening of alcohol control policies. This study examines the development of the health situation in Poland between 2002 and 2019, and describes potential causes of the health crisis, based on life expectancy statistics and epidemiological indicators of alcohol-related health burden.

Material and methods
We examined life expectancy and 100% alcohol-attributable death cases (AAC). Standardised death rates were calculated using population statistics from the World Bank and the Segi standard. Changes in trends were analysed using Joinpoint Regression. The present analysis comprises the Polish adult population aged 20+.

Results
The increase in life expectancy starting in 1991 in Poland first slowed down after 2002 and then stopped in 2014 in men and in 2016 in women. During the years 2002-2019, there was a manyfold linear growth of alcohol-attributable mortality in both sexes and all adult age groups. AAC standardised mortality rates increased from 7.5 (13.9 in men, 1.7 in women) in 2002 to 17.8 (29.3 in men, 7.1 in women) per 100,000 in 2019. The National Statistical Office recorded an increase of AAC deaths from 3685 (3256 in men and 429 in women) in 2002 to 10,396 (8251 in men, and 2145 in women) in 2019. During the years 2002-2019, the cumulative number of AAC deaths was 130,000 in men and women combined.

Conclusions
The halt in the improvement of health in Poland, probably caused by the increase in alcohol consumption, constitutes a serious public health challenge. Strong alcohol control action is urgently needed.