Major cardiovascular diseases mortality in Kaunas population for 1983-2002

AIM: To evaluate trends in mortality of ischemic heart disease (IHD) and stroke in Kaunas population aged 25-64 years in 1983 to 2002. MATERIAL AND METHODS: The study based on official mortality statistics covered all residents of Kaunas aged 25-64 years who died of IHD and stroke in 1983-2002. Age-standardized rates were calculated by the direct method and using European population as a standard. The trends were analysed using the method of linear regression on logarithms of the age-standardized annual rates. RESULTS: In 1983-2002, IHD and stroke mortality rates were significantly decreasing both for men and women (by 2.2%/yr, p = 0.003, and 2.9%/yr, p = 0.004, respectively, for men and by 2.6%/yr, p = 0.005 and 3.2%/yr, p = 0.002, respectively, for women). CONCLUSION: In 1983-2002, both IHD and stroke mortality rates among both Kaunas men and women aged 25-64 years decreased significantly.     

Five-year trends in main risk factors of coronary heart disease among open population of Tyumen

AIM: To study five-year trends in main risk factors of coronary heart disease (CHD) among 35-54-year-old population of Tyumen. MATERIAL AND METHODS: Five-year monitoring of 1597 males and females aged 35-54 years was performed as two cardiological screening trials. The risk factors were assessed both by standard and extended WHO criteria. RESULTS: Risk factors studied had the following prevalence trends: a rise in the rate of obesity (7.2-14.5%), hypercholesterolemia by standard criteria (14.4-27.8%) and hypertriglyceridemia (5.8-16.7%) among men aged 35-44 years; a rise of the rate of isolated systolic arterial hypertension by extended criteria (3.5-8.8%), smoking (10.6-19.2%), hypo-alphacholesterolemia (3.9-11.6%) among women aged 35-44 years; a rise in the rate of isolated systolic arterial hypertension (3.9-14.7%), a decrease of diastolic arterial hypertension rate by extended criteria (49.0-31.3%) among women aged 45-54 years. Five-year monitoring revealed that among 45-54-year-old men the number of those who smoke irregularly significantly increased (7.3-21.5%), while the number of non-smokers fell (44.3-21.5%). CONCLUSION: Tyumen population is characterized by a high prevalence of the risk factors with a negative 5-year trend. The results of the screenings give grounds for conduction of a large-scale prophylactic program in an open Tyumen population with a focus on priorities of prophylactic interventions.     

Household income is associated with the risk of metabolic syndrome in a sex-specific manner

OBJECTIVE: To assess the relationship between household income and metabolic syndrome in men and women. RESEARCH DESIGN AND METHODS: A total of 1,695 men and 1,664 women, aged 35-64 years, from three distinct geographical areas of France were investigated. Waist girth, plasma triglycerides, HDL cholesterol, glucose, and systolic blood pressure were used to define metabolic syndrome according to the National Cholesterol Education Program (NCEP)/Adult Treatment Panel III (ATPIII) guidelines. Household income, educational level, occupational category, working status, consumption of psychotropic drugs, accommodation status, household composition, physical activity at work and during leisure time, alcohol consumption, and smoking habits were recorded with a standardized questionnaire. RESULTS: There were 390 (23.0%) men and 381 (16.9%) women who satisfied NCEP/ATPIII criteria for metabolic syndrome. Household income (P < 0.0001) and consumption of psychotropic drugs (P = 0.0005) were associated with metabolic syndrome in women but not in men. In contrast, educational level, occupational category, working status, and accommodation status were associated with metabolic syndrome in both men and women. After adjustment on lifestyle variables, household income (interaction P < 0.004) remained inversely associated with metabolic syndrome in women but not in men. CONCLUSIONS: These data suggest that limited household income, which reflects a complex unfavorable social and economic environment, may increase the risk of metabolic syndrome in a sex-specific manner.     

Trends in hyperinsulinemia among nondiabetic adults in the U.S

OBJECTIVE: Insulin resistance and compensatory hyperinsulinemia have been proposed as increasing risk for a variety of abnormalities and clinical syndromes, including type 2 diabetes and cardiovascular disease. Our aim was to assess the trends in the mean concentrations of fasting serum insulin and the prevalence of hyperinsulinemia among nondiabetic adults during the periods of 1988-1994 and 1999-2002 in the U.S. RESEARCH DESIGN AND METHODS: We conducted analyses of data among men and nonpregnant women without diabetes aged >/=20 years from the Third National Health and Nutrition Examination Survey (NHANES III; 1988-1994; n = 7,926) and NHANES 1999-2002 (n = 2,993). Both surveys were designed to represent the noninstitutionalized civilian U.S. population. We calculated age-adjusted mean concentrations of fasting insulin and the prevalence of hyperinsulinemia defined using the 75th percentile of fasting insulin among nondiabetic individuals as the cutoff value. RESULTS: The geometric mean concentrations of fasting insulin increased by approximately 5% from 1988-1994 to 1999-2002 among nondiabetic adults aged >/=20 years in the U.S. Mexican-American men, men and women aged 20-39 years, and non-Hispanic white women had a greater relative increase in the mean concentrations of fasting insulin than their counterparts. The prevalence of hyperinsulinemia increased by 35.1% overall (38.3% among men and 32.1% among women). CONCLUSIONS: In parallel with the obesity epidemic, concentrations of fasting insulin and prevalence of hyperinsulinemia have increased remarkably among nondiabetic U.S. adults.     

Mortality in patients with atrial fibrillation and common co-morbidities – a cohort study in primary care

Objective: To study the association between cardiovascular co-morbidities and mortality risk in primary care patients with atrial fibrillation.

Methods: The study population included all adults (n?=?12,283)?≥?45 years diagnosed with AF at 75 primary care centres in Sweden between 2001 and 2007. The outcome was mortality (until 2010) and data were explored for co-morbidities using Cox regression with hazard ratios (HRs). Analyses were performed stratified by sex and by age-group (45–64, 65–74 and ≥75 years of age) with adjustment for age, socio-economic factors and relevant co-morbidities.

Results: During a mean of 5.8 years (standard deviation 2.4) of follow-up, 3954 (32%) patients died (1971 (35%) women, and 1983 (30%) men). High HRs were found for congestive heart disease (CHF) and cerebrovascular diseases for all age-groups among men and women (except for the 45–64 year old women); for coronary heart disease among the oldest men; for diabetes among the 65–74 year old men and the 45–64 year old women. Low HRs were found for hypertension among women ≥75 years of age.

Conclusions: In this clinical setting, CHF and cerebrovascular diseases were consistently associated with mortality in all age-groups. The possible protective effect by hypertension among elderly women should be interpreted with caution.

• KEY MESSAGES

• We found congestive heart failure and cerebrovascular diseases to be consistently associated with mortality in both women and men.

• We found hypertension to be associated with lower mortality risk among women ≥75 years of age, although this finding must be interpreted with caution.

• Depression was found to be associated with increased mortality risk among men and women aged 65–74 years of age.

     

The Irish drinking habits of 2002—Drinking and drinking‐related harm in a European comparative perspective

Aims: To examine drinking habits and experiences of adverse consequences of drinking among men and women in Ireland 2002 and to compare some results with earlier European studies using similar data and methods.

Methods: Data on self‐reported drinking habits and experiences of alcohol‐related problems were obtained from a general population survey undertaken in 2002. Two approaches were used: (1) cross‐tabulations of drinking habits and the experience of adverse consequences in various demographic groups (2) logistic regressions predicting the likelihood of experiencing problems.

Results: Self‐reported alcohol consumption confirms statistics on alcohol sales; a lot of alcohol is consumed in Ireland today despite a large fraction of abstainers in the population. Binge drinking is very common, and, out of 100 drinking events, 58 end up in binge drinking for men and 30 for women. Irish drinkers also experience harmful drinking‐related consequences to a larger extent than in other western European countries. Both volume of drinking and binge drinking affect the likelihood of experiencing most alcohol‐related harms. Conclusions: Drinkers in Ireland drink more than in other western European countries and many have risky drinking habits that lead to adverse consequences. It will be an important challenge to find preventive measures that can reduce these problems in Ireland.     

Daily alcohol consumption and the risk of type 2 diabetes in Japanese men: the Osaka Health Survey.

OBJECTIVE: To investigate the relationship between daily alcohol consumption and the risk of type 2 diabetes in a large Japanese cohort. RESEARCH DESIGN AND METHODS: We enrolled 6,362 Japanese men aged 35-61 years who did not have diabetes, impaired fasting glucose, hypertension, or liver cirrhosis at study entry. Type 2 diabetes was defined as a fasting plasma glucose (FPG) level > or =126 mg/dl or was diagnosed by a physician. Data on alcohol consumption were obtained from questionnaires. We confirmed 456 cases of type 2 diabetes during the 62,016 person-years of follow-up. RESULTS: The relationship between daily alcohol consumption and the risk of type 2 diabetes among lean men and among men with a higher BMI was paradoxical. Among lean men (BMI < or =22.0 kg/m2), heavy drinking was associated with an increased risk of type 2 diabetes. Men who consumed > or =50.1 ml/day of alcohol had a relative risk (RR) of 2.48 (95% CI 1.31-4.71) compared with nondrinkers after adjusting for age, BMI, regular physical exercise, parental history of diabetes, smoking habits, and FPG level. However, among men with a BMI > or =22.1 kg/m2, moderate drinking (29.1-50.0 ml/day) was associated with a decreased risk of type 2 diabetes. Daily moderate drinkers had a multiple adjusted RR of 0.58 (0.39-0.87) compared with nondrinkers. CONCLUSIONS: Among men with a BMI > or =22.1 kg/m2, moderate alcohol consumption was associated with a reduced risk of type 2 diabetes, but among lean men (BMI < or =22.0 kg/m2), heavy alcohol consumption was associated with an increased risk of type 2 diabetes.     

Prevalence of insulin resistance syndrome in southwestern France and its relationship with inflammatory and hemostatic markers

OBJECTIVE: To assess the prevalence and relationships of insulin resistance syndrome (IRS) with inflammatory and hemostatic markers in a representative sample of the population of Southwestern France aged 35-64 years. RESEARCH DESIGN AND METHODS: In this cross-sectional study, data were collected from 597 men and 556 women and were assessed regarding BMI, blood pressure, total and HDL cholesterol levels, triglyceride level, glucose level, plasma insulin level, white blood cell count, fibrinogen level, factor VII level, von Willebrand factor, C-reactive protein level, soluble intercellular adhesion molecule, soluble vascular cell adhesion molecule-1, and soluble CD(14). Insulin resistance was defined by homeostasis model assessment > or =3.8. RESULTS: Prevalence of IRS was higher in men than in women (23 vs. 12%, respectively; P < 0.001) and increased with age in both sexes (9, 24, and 34% for age groups 35-44, 45-54, and 55-64 years, respectively, for men and 4, 10, and 21% for women). After adjusting for age, alcohol consumption, tobacco smoking, and also for menopause in women, subjects (men and women) with IRS had significantly higher white blood cell count, factor VII levels, coagulating factor VII levels, and C-reactive protein levels than the other subjects. In men, further increases in soluble intercellular adhesion molecule and soluble vascular cell adhesion molecule-1 were noted, whereas in women, the differences were borderline significant. Conversely, no differences were found in fibrinogen, von Willebrand factor, and soluble CD(14) in both sexes. CONCLUSIONS: IRS is relatively common in residents of Southwestern France and is related to a deleterious increase in hemostatic and inflammatory parameters.     

Completed suicide in chronic pain.

Although convergent lines of evidence indicate that one can expect a high rate of suicide completion for chronic pain patients, this problem has not previously been investigated. Follow-up data from our pain center revealed three chronic pain patients (two men and one woman) who completed suicide. These three cases are presented. The sequential nature of the data enabled us to calculate suicide rates for our chronic pain population and subsamples of this population: 16.5 women per year; 29.3 men per year; 57.1 white men and 34.9 white women in the age range of 35-64 years per year; and 78.6 white worker compensation men in the age range of 35-64 years per year. Calculation of the 95% confidence interval and comparison of these suicide rates to the general population of the United States using the Z statistic indicated that all chronic pain patient suicide rates were significantly greater than that of the general population. White men, white women, and white worker compensation men with chronic pain in the age range of 35-64 years are twice, three, and three times as likely, respectively, as their counterparts in the general population to die by suicide. Although no firm conclusions can be drawn because of the small suicide sample, these case reports indicate a need for further studies of chronic pain patient suicide rates at other pain centers.     

Women living alone have an increased risk to develop diabetes, which is explained mainly by lifestyle factors

OBJECTIVE: The purpose of this study was to assess the role of household conditions for the progression to diabetes in women with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS: A total of 461 women, aged 50-64 years, with IGT defined by an oral glucose tolerance test, had baseline advice on physical exercise, diet, smoking, and alcohol habits. Physical examination, blood tests, and questionnaires were completed at baseline and after 2.5 years. Household status was categorized into living alone or with a partner, other adults, or children. RESULTS: Women living alone had a 2.68-fold increased risk (95% CI 1.02-7.05) of developing diabetes after adjustments for biological risk factors. Further stepwise adjustments for education, occupation, subjective mental health, exercise, diet, and alcohol showed remaining significant odds ratios (ORs), decreasing from 3.26 (1.19-8.96) to 3.03 (1.02-8.99). However, when smoking status was added, the OR became nonsignificant, 2.07 (0.62-6.88). More women who lived alone smoked and did not reduce their daily cigarette consumption compared with women in other household conditions. At follow-up, women living alone had reduced their alcohol consumption and were more often abstainers and fewer had healthy dietary habits or had improved their diet. Physical exercise did not differ among the groups. Separate analyses of any other household status did not show any excess risk for development of diabetes. CONCLUSIONS: Women living alone had a higher risk to progress from IGT to diabetes, mostly explained by smoking, alcohol, and dietary habits. Household conditions should be accounted for when assessing future risk for diabetes.     

Site-specific cancer mortality trends among Kentucky residents: comparison of 1971 to 1975 with 1976 to 1980

We compared the average annual age-adjusted, sex- and site-specific cancer mortality rates among Kentuckians during two five-year time periods: 1971 to 1975 and 1976 to 1980. Lung cancer alone showed a statistically significant increase in mortality rates for both sexes, but significant increases were also found for skin cancer and leukemias among men and for pancreatic cancer and lymphomas among women. Significant decreases in mortality rates were observed for cancer of the rectum and stomach in both sexes, lymphomas among men, and leukemias and liver and uterine (corpus and cervix) cancer among women. Increased lung cancer mortality rates occurred for all age groups of women aged 35 and over, but in men, decreased lung cancer mortality rates were observed for ages 35 to 49 and increased rates only after age 50. All age groups of women experienced substantial declines in cervical cancer mortality rates. Without the dramatic increase in lung cancer mortality during this period, overall cancer mortality rates would have shown almost no change among Kentucky men and would have decreased among Kentucky women.     

Indicators of health and well-being in Iceland and Sweden. A comparative study of various indicators concerning standards of living and mortality.

OBJECTIVE: To study various indicators concerning health and well-being in two Nordic countries with special attention to standards of living and mortality. DESIGN: Comparative study of the mortality rates from various causes of death during the years 1983-1992 and some indicators of standard of living derived from official reports and registers in Iceland and Sweden. SETTING, SUBJECTS: The total populations of Iceland and Sweden. MAIN OUTCOME MEASURES: Mortality rates, indicators of living standard, gross domestic product and demographic variables such as divorces and unemployment. RESULTS: The mortality rates for all causes of death were similar for women in Iceland and Sweden during 1983-1992 but were lower for men in Iceland than in Sweden. The mortality rates from cardiovascular diseases decreased during the study period. The rates for malignant disease were higher in Iceland for both men and women. Iceland has a larger population growth but a much lower population density. Most of the demographic variables were similar in the two countries. Unemployment rates were higher in Sweden. CONCLUSION: In spite of large similarities between Iceland and Sweden in socio-demographic variables there are substantial differences in mortality rates between the countries. The causes for these mortality differences are obscure and should be further investigated.     

20-year monitoring of acute cardiovascular diseases in population of large industrial city in West Siberia (epidemiological study)

AIM: To reveal trends in incidence rates of acute cardiovascular diseases (ACD) in a large industrial city of the West Siberia. MATERIALS AND METHODS: Studies on WHO programs "Acute Myocardial Infarction Register" and "MONICA" have been performed in three districts of Novosibirsk. The diagnostic categories were detected without difference. The observation covered stable population of 500,000 residents aged 25-64 years. Trends in the myocardial infarction (MI) mortality, morbidity and lethality were analysed for 1977-1996. RESULTS: The above trends were stable except for 1986 when MI mortality, morbidity and lethality decreased and 1988 and 1994 when they went up. The reduction was due to 7-year prevention program while the rise was consequent to discontinuation of the preventive measures. Major risk factors of ischemic heart disease, according to screenings conducted in 1984, 1988 and 1994 remained at about the same level. Social stress closely correlates with a rise in MI morbidity and mortality. The latter in 1994 grew owing to higher rates of MI mortality and morbidity among the oldest men and females of different age groups. CONCLUSION: Urgent intensification of prophylactic measures is needed both at the populational level and the level of high risk strategy.     

Declining death rates from hyperglycemic crisis among adults with diabetes, U.S., 1985-2002

OBJECTIVE: To examine trends in death rates for hyperglycemic crisis (diabetic ketoacidosis or hyperglycemic hyperosmolar state) among adults with diabetes in the U.S. from 1985 to 2002. RESEARCH DESIGN AND METHODS: Deaths with hyperglycemic crisis as the underlying cause were identified from national mortality data. Death rates were calculated using estimates of adults with diabetes from the National Health Interview Survey as the denominator and age adjusted to the 2000 U.S. population. The trends from 1985 to 2002 were tested using joinpoint regression analysis. RESULTS: Deaths due to hyperglycemic crisis dropped from 2,989 in 1985 to 2,459 in 2002. During the time period, age-adjusted death rates decreased from 42.4 to 23.8 per 100,000 adults with diabetes (4.4% decrease per year, P for trend <0.01). Death rates declined in all age-groups, with the greatest decrease occurring among individuals aged > or =65 years. Age-adjusted death rates fell for all race-sex subgroups, with black men experiencing the smallest decline. About one-fifth of deaths occurred at home or on arrival at the hospital, and the death rates for hyperglycemic crisis occurring at these places declined only modestly over time (2.1% decrease per year, P for trend = 0.049). CONCLUSIONS: Overall death rates due to hyperglycemic crisis among adults with diabetes have declined in the U.S. However, scope for further improvement remains, especially to further reduce death rates among black men and to prevent deaths occurring at home.     

Middle-age suicide: A literature review and epidemiological study

Middle age (i.e., 45-64 years) has been the least studied period of life in developmental psychology and the field of suicidology. Following a review of the suicide and relevant psychosocial literature on middle age, the present investigation reports the levels and trends in suicide among the middle-aged population along with sex and race differences. Official United States suicide data by sex and race from 1933 to 1986 were collected for persons 45 to 64 years of age and compared with the age groups 15 to 24 years, 25 to 44 years, and 65 years and older. Suicide rates declined markedly over the period studied for the middle aged and particularly for men and Caucasians within that category. Rates have increased for all those younger than 45. However, current rates of suicide are comparable to those for middle-aged adults and 25- to 44-year-old adults, but suicide rates for all adult populations are still slightly higher than those for the younger population (15-24 years). Despite dramatic declines in suicide rates for the elderly, the middle-aged group remains at lower risk. Possible explanations for the levels and trends in suicide among the middle aged as well as reasons for sex and race differences are suggested.     

Prostate cancer mortality in Taiwanese men: Increasing age-standardized trend in general population and increased risk in diabetic men

Abstract

Background. To evaluate the trend of prostate cancer mortality in Taiwanese general population and the association between diabetes and prostate cancer mortality.

Materials and methods. In the general population during 1995–2006, the trends of prostate cancer mortality were evaluated, followed by calculation of age-specific mortality rates for age 40–64, 65–74, and ≥ 75 years. A cohort of 102,651 diabetic men aged ≥ 40 years recruited in 1995–1998 was followed prospectively.

Results. The trends of crude and age-standardized mortality from prostate cancer in the general population increased significantly (P < 0.0001). In the general population, 7,966 men aged ≥ 40 years died of prostate cancer, and aging was associated with increased risk. Age-specific prostate cancer mortality suggested significantly increasing trend for ages 65–74 and ≥ 75 years. A total of 321 diabetic men died of prostate cancer (crude mortality rate 41.9/100,000 person-years). Mortality rate ratios (95% confidence interval) showed higher risk of prostate cancer mortality in the diabetic patients, with magnitude increased with decreasing age: 1.55 (1.29–1.86), 2.68 (2.29–3.13), and 6.84 (5.34–8.75) for age ≥ 75, 65–74, and 40–64 years, respectively.

Conclusions. Prostate cancer mortality in the Taiwanese general population is increasing. Diabetic patients have a higher risk of prostate cancer mortality, which is more remarkable with decreasing age.     

Trends in poststroke survival

AIM: To analyse trends in survival of 25-64-year-old poststroke patients living in Kaunas in 1986-1996. MATERIAL AND METHODS: The study covered all 25-64-year-old citizens of Kaunas affected by the first stroke. All the patients were divided into three groups: those who had stroke in 1986-1989; in 1990-1993; in 1994-1996. All the patients were followed up to December 31, 1997. The survival was analysed by Kaplan-Meier method, probability to survive after stroke was analysed using the method of logistic regression. RESULTS: The data is available for 2864 patients (58.6% males and 41.4% females). Probability to die during the first poststroke year for males in 1994-1996 was by 30% less (p = 0.02) and in females by 27% less (p = 0.1) than in males and females affected by stroke in 1986-1989. Comparison of males and females affected by the first stroke who survived 28 days for 1986-1989 vs 1994-1996 showed that probability of death in the first year was 0.62 (95% CI being 0.37-1.08; p = 0.2) and 0.69 (95% CI 0.31-1.52; p = 0.07), respectively. The same trends were found for 2, 3 and 4 years. In 1986-1989 four-year survival for men was 71.9%, in 1994-1996--81.7% (p = 0.02). In women--83.6 and 86.3% (p = 0.05), respectively. Of men with stroke in 1986-1989 and alive for 28 days, 4-year survival was 71.3%, of those with stroke in 1994-1996--80.6% (p = 0.02). Relevant survival in women was 83.5 and 87.5% (p > 0.05), respectively. CONCLUSION: Short- and long-term survival after the first stroke in 25-64-year-old Kaunas citizens improved.     

Alcohol and arterial wave reflections in middle aged and elderly men

BACKGROUND: Augmentation index (AIx) is a measure of arterial wave reflection, providing information on the workload of the heart. and is a possible marker for cardiovascular disease risk. The relation of alcohol consumption with cardiovascular disease (CVD) risk is U-shaped with a protective effect of moderate alcohol consumption. The relation of alcohol consumption level with AIx has not been widely investigated, which prompted this study of the relation of alcohol consumption with AIx in a population-based cohort of men aged 40-80 years. METHODS: Three hundred and seventy-four men (mean age 60.5 years) participated in this cross-sectional study. Alcohol consumption and smoking habits were determined through a validated questionnaire. Fasting blood samples were drawn and analyzed for glucose and lipid levels and AIx was estimated by radial applanation tonometry using the SphygmoCor Device. The resultant data were analyzed using linear regression models. RESULTS: Age, height, heart rate, blood pressure, packyears, current smoking, presence of CVD and hypertension were independently related to AIx. The relation of alcohol consumption with AIx was U-shaped, with a significantly lower AIx in the group drinking 4-8 glasses/week (difference = -2.91%, 95% CI [-5.65; -0.18]) relative to those drinking 0-3 glasses/week. Additional adjustment for current smoking did not change this relationship, but adjustment for pulse wave velocity attenuated the relation. CONCLUSIONS: In a population-based cohort of men aged 40-80 years the relation of alcohol consumption level with AIx was U-shaped, further expanding the evidence for vascular protective effects of moderate alcohol intake.     

The Troms? Heart Study: distribution of, and determinants for, gamma-glutamyltransferase in a free-living population

Gamma-glutamyltransferase (GGT) was measured in 1579 men, aged 20-54 years, and 1654 women, aged 20-49 years, screened for coronary risk factors. The distribution was right-skewed with medians 15 and 10 U/l for men and women, respectively. Less than 3.8% of the men and 0.8% of the women had GGT greater than or equal to 50 U/l. The low level of GGT matched well with the low mortality of cirrhosis and the modest use of alcohol in Norway. Multiple regression analysis for each sex showed a strong positive association with body mass index, use of alcohol and, unexpectedly, a negative association with coffee consumption, whereas serum triglycerides and the time since the last meal showed a weaker positive association. In women, use of oral contraceptives was positively associated with GGT.     

Ten-year trends in intoxications and requests for emergency ambulance service

Abstract Background. Intoxication, whether from alcohol, drugs, or alcohol and drugs in combination, remains a challenging burden on emergency departments. The increasing alcohol consumption among adolescents and young adults, particularly heavy episodic drinking, and the resulting increase in the use of health care resources for alcohol intoxication has been a widely discussed topic. Objective. The aim of our study was to assess and characterize the use of emergency ambulance services that was required as a result of alcohol and drug intoxication in a major metropolitan area. Methods. We conducted a retrospective, longitudinal study over a 10-year period in the greater metropolitan area of Zurich, Switzerland. The study population included intoxicated patients assessed and initially treated by paramedics of the emergency ambulance service. Data were extracted from the ambulance service reports. The primary outcomes measured were trends over time in the numbers and types of intoxication and trends with respect to gender and age distributions of intoxicated patients. Results. An annual increase of about 5% in the number of intoxicated patients requiring emergency ambulance service was observed over the study period. Alcohol use was present in 73% of the cases. The highest number of cases was among patients 25-44?years of age. The greatest increase in the number of cases over time was among patients under 25?years of age. Women comprised 41% of the patients under 25?years of age but only about 35% of older patients. The number of severe injuries and suicide attempts was small, but the number of suicide attempts increased at a higher rate than the overall number of cases of intoxication. There was a significant increase (17.64% per year on average) in the incidence of aggressive behavior toward paramedics from intoxicated patients, although still small in numbers. Conclusions. Our findings suggest two main vulnerable groups: young persons under 25?years of age, with a particular focus on women, having the greatest increase over time, and middle-aged men, having the greatest proportion among all cases observed. Intervention efforts should include a high-risk approach to reduce alcohol-related problems. Key words: alcohol intoxication; substance-related disorders; aggression; injuries; emergency medical services.