Introduction: Deaths due to substance poisoning, alcohol-related disease, and suicide pose a critical public health issue. Labelled “deaths of despair” in the US, whether these deaths represent a distinct phenomenon in Australia requires exploration.
Aims: To assess temporal trends in mortality rates; compare sex-specific temporal trends; and examine age-period-cohort effects.
Methods: Deaths due to substance poisoning, alcohol-related disease, and suicide occurring in Australia between 1980-2019 were identified from the Cause of Death Unit Record File. Age-standardised rates were examined and compared between sexes for all deaths (combined) and by cause (cause-specific). Age-period-cohort models were examined to investigate interrelated patterns of age at death (age), year of death (period), and year of birth (cohort), with annual percentage changes (net drifts) presented.
Results: Over the forty-year study period, suicide was, and remained, the most common of the three causes of death. Combined mortality rates were stable between 1980-1999: this reflected an increase in substance poisoning deaths, offset by a reduction in alcohol-related disease deaths. A decline (2000-2006) and subsequent increase (2007-2019) in combined rates were then observed, primarily attributable to corresponding changes in substance poisoning and suicide deaths among males. In models, annual percent changes for combined mortality rates were negligible; however, distinct cause-specific trends were observed. There was evidence of increasing substance poisoning deaths for both males (net drift [95% CI]: 3·33 [2·84, 3·83]) and females (2·58 [2·18, 2·98]). Among males, there was evidence of decreasing alcohol-related disease deaths (-1·46 [-1·75, 1·16]) and suicide deaths (-0·52[-0·69, -0·36]). Among females, there was evidence of relative stability for alcohol-related disease deaths (0·28% [-0·66, 0·09]) and suicide deaths (-0·25 [-0·52, 0·01]).
Implications: Although combined trends were relatively stable over the 40-year study period, different and distinct patterns were observed within cause-specific deaths, challenging the notion that these deaths represent a distinct epidemiological phenomenon. Suicide remained the most common of the causes of death, and rates remained relatively stable, despite four decades of prevention efforts and strategies. There is an ongoing need to review the effectiveness of current policies and strategies aimed at preventing these deaths.