Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Mar;60(3):693-703.
doi: 10.1007/s00127-024-02749-4. Epub 2024 Aug 23.

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

Chrianna Bharat #  1 , Ria E Hopkins #  2 , Mark Chambers  2 , Louisa Degenhardt  2 , Amy Peacock  2   3 , Michael Farrell  2 , Wing See Yuen  2 , Nicola Man  2 , Natasa Gisev  2
Affiliations
Observational Study

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

Chrianna Bharat et al. Soc Psychiatry Psychiatr Epidemiol. 2025 Mar.

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.

Keywords: Alcohol-related disorders; Drug overdose; Illicit drugs; Mental health; Suicide.

PubMed Disclaimer

Conflict of interest statement

Declaration. Conflict of interest: LD has received untied educational funding from Reckitt Benckiser, Indivior, Mundipharma Pty Ltd, and Seqirus. AP has received untied educational grants from Seqirus and Mundipharma for study of opioid medications. These untied grants are all unrelated to the current study. All other authors declare no competing financial or non-financial interests.

Figures

Fig. 1
Fig. 1
Age-standardised rates of substance poisoning, alcohol-related disease, and suicide deaths, 1980–2019
Fig. 2
Fig. 2
Age-standardised rates of combined and cause-specific (alcohol-related disease, substance poisoning, and suicide) deaths by sex, 1980–2019
Fig. 3
Fig. 3
Age-specific annual percentage change of rates of combined and cause-specific (alcohol-related diseases, substance poisoning, and suicide) deaths, by sex, between 1980 and 2019. Dashed horizontal lines are annual percentage changes averaged over all age classes (net drifts) with 95 percent confidence intervals given by dotted lines
Fig. 4
Fig. 4
Birth-cohort rate ratios (reference year = 1950) for combined and cause-specific (alcohol-related disease, substance-poisoning, and suicide) deaths by sex
Fig. 5
Fig. 5
Mortality rates for alcohol-related disease, substance poisoning, and suicide by sex with cohort (C), period (P) and age (A) axes
See this image and copyright information in PMC

References

    1. Case A, Deaton A (2017) Mortality and morbidity in the 21(st) century. Brook Pap Econ Act 2017:397–476. 10.1353/eca.2017.0005 - PMC - PubMed
    1. Case A, Deaton A (2015) Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci USA 112(49):15078. 10.1073/pnas.1518393112 - PMC - PubMed
    1. Australian Institute of Health and Welfare (2020) Suicide and self-harm monitoring. 25 Sept 2020. https://www.aihw.gov.au/suicide-self-harm-monitoring
    1. Australian Institute of Health and Welfare (2020) Australia’s health 2020: suicide and intentional self-harm. AIHW, Canberra
    1. Tilstra AM, Simon DH, Masters RK (2021) Trends in “deaths of despair” among working-aged white and black Americans, 1990–2017. Am J Epidemiol 190(9):1751–1759. 10.1093/aje/kwab088 - PMC - PubMed

Publication types