Two Eras of Despair: A Long-Term Trend Analysis of Deaths of Despair in Central and Eastern Europe and Central Asia

초록

Background: That Central and Eastern Europe and Central Asia (CEECA) experienced a major mortality crisis in the 1990s is a well-established finding, with most analyses focusing on singular causes like alcohol-related deaths. However, the utility of the integrated "deaths of despair" framework, which views alcohol, drug, and suicide deaths as a unified socio-economic phenomenon, remains under-explored in this context. Crucially, the long-term evolution of the composition of despair within the region remains a largely unexplored area of inquiry. Therefore, this study aims to analyze the long-term trends, changing composition, and regional heterogeneity of deaths from despair in the CEECA region from 1980 to 2021. Methods: Using 2021 Global Burden of Disease (GBD) data (1980-2021), we analyzed deaths of despair mortality trends in 29 CEECA countries. We employed Joinpoint regression to identify significant trend changes and conducted stratified analyses by cause, gender, and age group. Results: The CEECA deaths of despair crisis began as an alcohol and suicide driven phenomenon concentrated in middle-aged men (50-74 years) during the 1990s, with mortality rates for alcohol use disorders and self-harm surging annually by 30.35% (p = 0.002) and 13.44% (p = 0.001), respectively, between 1991 and 1994. It has since evolved, marked by a contrasting and emerging threat in the 21st century: a rising proportion of drug-related deaths among the younger (15-49 years) male cohort, where the share of drug use disorders increased from 6.9% in 2000 to 11.8% in 2008. Conclusion: The deaths of despair crisis in the CEECA region is not a past event but an ongoing, evolving phenomenon. Its changing nature demands a shift in public health focus from solely historical drivers to new, generation-specific threats, particularly the rise of drug-related despair among youth.

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