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Age- and cause-specific contributions of deaths of despair to changes in life expectancy across European countries, 2001-2021

Kiadaliri, Ali LU orcid (2026)
Abstract
Background
Deaths of despair (DoD)—comprising suicide, drug-related, and alcohol-related deaths— have been linked to recent slowdowns in life expectancy (LE) in the USA, but comparative cross-national evidence on their contributions to LE changes across Europe remains limited. This study quantified the age- and cause-specific contributions of DoD to changes in LE at birth across European countries from the turn of the 21st century onwards.
Methods
Using mortality and population data from the WHO Mortality Database and the Human Mortality Database, abridged life tables were constructed for three reference periods (2001–2003, 2017–2019 and 2020–2021). Underlying causes of death were classified as drug-related, suicide,... (More)
Background
Deaths of despair (DoD)—comprising suicide, drug-related, and alcohol-related deaths— have been linked to recent slowdowns in life expectancy (LE) in the USA, but comparative cross-national evidence on their contributions to LE changes across Europe remains limited. This study quantified the age- and cause-specific contributions of DoD to changes in LE at birth across European countries from the turn of the 21st century onwards.
Methods
Using mortality and population data from the WHO Mortality Database and the Human Mortality Database, abridged life tables were constructed for three reference periods (2001–2003, 2017–2019 and 2020–2021). Underlying causes of death were classified as drug-related, suicide, alcohol-related, and remaining causes. Changes in LE across two intervals—pre-pandemic (2001–2003 to 2017–2019) and pandemic (2017–2019 to 2020–2021)— were decomposed by age and cause using the continuous-change model.
Results
DoD causes combined mostly contributed to LE gains in the pre-pandemic but to losses in the pandemic interval, although absolute contributions were small in most countries (females/males: median + 1.2/+3.8 and − 0.1/-0.1 months in the pre-pandemic and pandemic intervals, respectively). This reversal was driven mainly by alcohol-related mortality, with changing contributions from mostly positive (pre-pandemic) to mostly negative (the pandemic), while suicide and drug-related deaths had mostly positive and negative contributions, respectively, in both intervals. Across both intervals, DoD contributions were concentrated in midlife (the 40–59 age groups), with some shift toward younger ages during the pandemic. The UK constituent countries were unique in negative contributions of DoD causes combined in both sexes in both intervals, with Scotland recording the largest LE losses from drug-related deaths in both intervals. Central and Eastern Europe and the Baltic states generally had the largest gains from DoD in the pre-pandemic interval, many of which then experienced LE losses during the pandemic. The shift was most striking in Estonia, which moved from the top three countries with the largest LE gains from DoD in the pre-pandemic to the top three with largest losses during the pandemic.
Conclusions
DoD contributions to LE changes varied substantially across European countries by sex, age, and cause, challenging the unified DoD framework and supporting cause-specific policy responses.

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Please use this url to cite or link to this publication:
author
organization
publishing date
type
Working paper/Preprint
publication status
published
subject
publisher
Research Square
DOI
10.21203/rs.3.rs-9983069/v1
language
English
LU publication?
yes
id
a485fd48-86e6-4be3-8916-09d3ccf23e4f
date added to LUP
2026-08-08 11:39:29
date last changed
2026-08-10 08:59:03
@misc{a485fd48-86e6-4be3-8916-09d3ccf23e4f,
  abstract     = {{Background <br/>Deaths of despair (DoD)—comprising suicide, drug-related, and alcohol-related deaths— have been linked to recent slowdowns in life expectancy (LE) in the USA, but comparative cross-national evidence on their contributions to LE changes across Europe remains limited. This study quantified the age- and cause-specific contributions of DoD to changes in LE at birth across European countries from the turn of the 21st century onwards. <br/>Methods <br/>Using mortality and population data from the WHO Mortality Database and the Human Mortality Database, abridged life tables were constructed for three reference periods (2001–2003, 2017–2019 and 2020–2021). Underlying causes of death were classified as drug-related, suicide, alcohol-related, and remaining causes. Changes in LE across two intervals—pre-pandemic (2001–2003 to 2017–2019) and pandemic (2017–2019 to 2020–2021)— were decomposed by age and cause using the continuous-change model. <br/>Results <br/>DoD causes combined mostly contributed to LE gains in the pre-pandemic but to losses in the pandemic interval, although absolute contributions were small in most countries (females/males: median + 1.2/+3.8 and − 0.1/-0.1 months in the pre-pandemic and pandemic intervals, respectively). This reversal was driven mainly by alcohol-related mortality, with changing contributions from mostly positive (pre-pandemic) to mostly negative (the pandemic), while suicide and drug-related deaths had mostly positive and negative contributions, respectively, in both intervals. Across both intervals, DoD contributions were concentrated in midlife (the 40–59 age groups), with some shift toward younger ages during the pandemic. The UK constituent countries were unique in negative contributions of DoD causes combined in both sexes in both intervals, with Scotland recording the largest LE losses from drug-related deaths in both intervals. Central and Eastern Europe and the Baltic states generally had the largest gains from DoD in the pre-pandemic interval, many of which then experienced LE losses during the pandemic. The shift was most striking in Estonia, which moved from the top three countries with the largest LE gains from DoD in the pre-pandemic to the top three with largest losses during the pandemic. <br/>Conclusions <br/>DoD contributions to LE changes varied substantially across European countries by sex, age, and cause, challenging the unified DoD framework and supporting cause-specific policy responses.<br/><br/>}},
  author       = {{Kiadaliri, Ali}},
  language     = {{eng}},
  month        = {{07}},
  note         = {{Preprint}},
  publisher    = {{Research Square}},
  title        = {{Age- and cause-specific contributions of deaths of despair to changes in life expectancy across European countries, 2001-2021}},
  url          = {{http://dx.doi.org/10.21203/rs.3.rs-9983069/v1}},
  doi          = {{10.21203/rs.3.rs-9983069/v1}},
  year         = {{2026}},
}