Introduction Alcohol is one of the top 10 risk factors for death in middle and high income countries. As average incomes in developing nations rise, disposable income will become available for alcohol. This could result in epidemics of alcohol related illness. Average national alcohol consumption has been shown to correlate with national rates of liver cirrhosis mortality in developed nations. Many countries have reversed trends of increasing cirrhosis mortality over short time periods. An improved understanding of the mechanism of these reversals would be of great benefit to policy makers.

Methods Mortality data for developed nations over the past 50 years were investigated by the birth cohort approach. Data were obtained from WHO. Age specific mortality rates were plotted against age at death for each birth cohort. This permitted a comparison between age specific rates throughout the life of each birth cohorts.

Results In countries where an increasing trend in alcohol consumption was sharply reversed, liver cirrhosis death rates fell dramatically. Further it did so simultaneously in all adult age groups. Subsequently each birth cohort continued to experience almost uninterrupted falls in age specific death rates. Moreover those birth cohorts which were experiencing high rates of mortality fell faster than those experiencing low rates. This may indicate that birth cohorts with high rates had a higher attributable fraction due to alcohol consumption.

Conclusion This study has shown that dramatic and sustained falls in cirrhosis mortality are possible. The challenge for governments is to implement policies to achieve this.