Alcohol-related digestive disease mortality in Spain (1999-2024): a nationwide joinpoint trend analysis analysis.

INTRODUCTION: Alcohol consumption is a major cause of preventable morbidity and mortality, contributing substantially to digestive diseases. However, long-term nationwide analyses of selected alcohol-specific digestive causes of death in Spain remain scarce. OBJECTIVES: To characterize temporal trends and sex-specific patterns in mortality from selected alcohol-specific digestive diagnoses in Spain, 1999-2024. MATERIAL AND METHODS: We conducted a nationwide, population-based ecological mortality trend study using national vital statistics data. Deaths were identified by underlying cause of death using ICD-10 codes for alcoholic gastritis, alcohol-associated liver disease, and alcohol-induced acute and chronic pancreatitis. Age-standardized mortality rates were calculated, and temporal trends were analysed using joinpoint regression to determine annual percentage changes and identify significant inflection points. RESULTS: A total of 32,876 deaths were recorded, 84.0% among men. Overall mortality from alcohol-specific digestive causes declined significantly among men but remained stable among women. Joinpoint analysis identified a significant decline in overall mortality after 2010 in both sexes, with no additional inflection point during the COVID-19 pandemic. Alcoholic cirrhosis was the leading cause of death, accounting for 64.8% of all deaths, and its mortality rates declined over the study period. In contrast, mortality from alcoholic hepatitis and alcohol-induced chronic pancreatitis increased among men, whereas trends for the remaining alcohol-specific digestive diseases remained stable or declined. CONCLUSIONS: Overall mortality from selected alcohol-specific digestive causes has declined in Spain over the past 26 years, largely driven by reductions in alcohol-associated cirrhosis mortality. Nevertheless, increasing mortality from alcoholic hepatitis and alcohol-induced chronic pancreatitis among men indicates persistent adverse trends for specific alcohol-specific digestive diseases. As this ecological study is based on underlying-cause-of-death coding and restricted to selected alcohol-specific ICD-10 diagnoses, it does not estimate the overall burden of alcohol-attributable digestive mortality.