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ALCOHOL-RELATED MORTALITY IN FINNISH LAPLAND

Simo Nayha

Department of Public Health Science, University of Oulu, Finland

INTRODUCTION (fable I). The diagnosis was based on autopy in 94%o£the cases of alcohol poisoning. 74%orthose Consumption or alcoholic beverages, and strong or alcoholism, 40% of the li....:r cirrhosis cases and drinks in particular, is known to be high in Finnish 43% or the pallCIUtitis cases. A forensic autopsy Lapland. An earlier n:port by the present autlDr was performed on every case or alcohol poisoning, also showed mortality Crom violent causes to be implying tbat the blood alcohol concentration was considerably higher than normal in this area (1 ). As practiallly always determined in such cases. alcohol is a £actor in violent deaths, a further in\'C!i· ligation was carried out to determine the level of METHODS alcohol mortality and its variations in Lapland. Deaths and person-years by age (5-ycar groups) THE AREA STUDIED were summed ~r the period 1961-lCJSS, and the indirect method Qf standardization was applied to The province of Lapland is the northernmost terri­ obtain~ mortalityratiOlS(SMR)bycom­ toiyofFinland, with a population or 195,000. Its land munc, using cause~tc mortality patterns in the ...... area or 94,000 5<1uarc kilometres is mainly fottst, wbolc or the countiy as a standard. Random varia­ ~ept £or the northern highlands. which arc partly tion in the SMR's was evaluated by the use of 95% treelcss.40%orpopulationliveinthreemajortowns confidence inteivals (2). (Rovaniemi, Kcmi and Tomio) and

Cause of dealh Males Females No.of SMA(95%C~ No.of SMR (95% CU) deattlS dealtll

Alcohol poisoning 25' 128 {111-1421 16 88 (51-143) Chronic akUlolism 71 118 (92-149) 1 126 (50-259) Akdlol psychv5is 4 74 (20-189) u-~ 104 70 (57-84) 55 89 (67·116) Pw1c:1ealilis 43 76 (55-102) 34 102 (71-142)

AU 478 101 (92-110) 112 94 (78-111) 162

tailed cause (Table 1). Male alcohol poisoning but not in the third town, Tornio (SMR 72, 0 2 shows a notable C."Kemi and ROllllniemi in one category and the rc5I of and chronic alcoholism were thus subjected to more the communes in the other. The town ofTomiowas detailed KNtiny. classified as rural, an interpretation ,.hich is justi­ fied on the grounds that the present commune was Local varlallons actually formed by amalgamating the town proper Alcohol poi.saning and two adjacent rural communes in 1973. The estimated age-specific mortalities ror the two Figurc I points to high male mortality in a single area towns and the remainder of Lapland are dcscnbcd rompri&ing lnari (SMR 270, 16.5-417), Kittila a by two sccond..dogrtt cunics in Figure 3. lbc ~ (SMR 184, CJ 101-Ja!) and Muonio (SMR 171, Cl mortality in lhcsc towns is 25 timcsgreatcrthan that SS-400). This area was compared ,.ith the re.st of in the rest or the area, this differential now being upland using the multivariate approach ~ained constant Oller the whole aae scale. ~.Regression anal)"is revealed age, age , area. and the interaction between age2 and area to be significant facto~ DISCUSSION Agc~rK mortality prcdicted by the model is illustrated in Figure 2 by two quadratic curves, one Mortality from alcohol poisoning is high in nonhcrn ror each area both showing a slight inclination to Finland as compared to the south. while the pattern lert. The interaction between the second power or is~idtobc revcisedforchronicakoholiem (4). This age and area is reflected in the broader shape of the suggests that alcohol po1SOning may be typical or curve in the ln.ari-Kinilii-Muonh area, indicating a undc:vcloped country districts and chrome alcohol­ more pronounced age c:lrect. This su~ts that the ism typical of t

FIGURE 1. Slanclardized motlalily ratio (SMR) lot f IGURE 2. Predicted male moltllity from alcol\ol male dealh'5 lrorn alcohol poisoning by commune in poisoning in Ulpland by age and area. 1961·1965. Lapland. 1961-1985 Solid line: lnari, Kitlil.i and Muonio. Broken line: rest of~.

DEATH 11000000

10

.0 IO IO 10 IO ABE(yrl 263

FIGURE 3. Predieled male mot1ality from chronic poisoning mortality across the aIUS. As long-lasting alcoholism in Lapland by age and area. 1961-1985. drinking leads to toler.111cc, a chronic drinker grad­ Solid line: towns. Broken line: counlryside. ually approaches the fatal limit, which is said to be unaffected by the intensity of drinking. Thus, drink­ ing will cause mortality to rise pmgnssivcly by age in populations rontaining large numbers or heavy drinkers, while this effect may be wtaker in "nor­ mal" populations. In chronic alcoholism, on the other hand, the pathological process leading to death also involves long-term changes in the vital otgans and is less dependent on the toxic effects of alcohol as such. Local iDvestigations suggest that the daily con­ sumption of alcohol is twice as high in the northern parts of Lapland as elsewhere (5), a distnoution consistent with the present obselvation oC an llCCU· mvlation of fatal akobol poisonings. Together with earlier findings of a similar accumulation oC male violent deaths (1), the present results point to an inoased ~nee oC social malaise in northern Upland

REFERENCES 20 lica NoJ. Ollu,. 19()1

2. Udddl FOK Si"'!'le .-t~olthe "3lldan!iu:d area may be thought to be ~ble for the high ..-alily rlllio. J ~c,,.,.,, Health UM; 38:~ incidence of a1a>hol poisoning. The Lapp area and l Ajd;jo M. ~ 0. Pr.oncil 8,. ffiode J. Sraol...... , ISlrtalily in l'o I« Alrobol s...ia Vd.211. tm. The high mortality from alrohol poisoningg 11111)' rather be seen as a late rcmnantofthcculturcoftbc 5. ~I. Ni,hiS. 1-la.i J. R,;odocr hlriing lapps drint....., ..... Fam. The Md> ...... Al o( the Kalil 8ruuD Society r... drinkiog habits of these vagrant ~ and timber Sodol ll!d ~ R-a. onAJc:obol floating labourers e~ by lwnbcr rompanics em.-, Hanpy, UJ.-, 199a an: well ~ntcd (6). 6. Somla S. ~ pincn. ia F'"""'1 Uplmd. Heloi