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We investigate all alcohol\u2010related multiple (underlying and contributory) causes of death and compare mortality distributions in countries with different levels and patterns of drinking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Analysis of population\u2010level mortality data for persons aged 20 and over in Austria, Czechia, Poland and Spain. Age\u2010standardised death rates and standardised ratios of multiple to underlying cause were calculated for alcohol\u2010related causes of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Multiple\u2010cause mortality ranged from 20 to 58 deaths per 100,000 for men and from 5 to 16 per 100,000 for women. Liver diseases were the most common underlying and multiple causes, but mental and behavioural disorders were the second or third, depending on country and sex, most prevalent multiple mentions. Two distinct age patterns of alcohol\u2010related mortality were observed: in Czechia and Poland an inverted\u2010U distribution with a peak at the age of 60\u201364, in Austria and Spain a distribution increasing with age and then levelling off for older age groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusion<\/jats:title><jats:p>The importance of alcohol\u2010related conditions that indirectly impact mortality can be re\u2010assessed with the use of contributory mentions. The multiple\u2010cause\u2010of\u2010death approach provides convergent results for countries characterised by similar patterns of alcohol consumption. Multiple\u2010cause mortality was almost double the level of mortality with alcohol as the underlying cause, except in Poland. Mental and behavioural disorders were mostly certified as contributory to other, non\u2010alcohol\u2010related underlying causes of death.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.13624","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T04:14:58Z","timestamp":1676434498000},"page":"938-945","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Alcohol\u2010related mortality in four European countries: A multiple\u2010cause\u2010of\u2010death study"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8747-1299","authenticated-orcid":false,"given":"Agnieszka","family":"Fihel","sequence":"first","affiliation":[{"name":"University of Warsaw  Warsaw Poland"},{"name":"Institut National d'\u00c9tudes D\u00e9mographiques  Aubervilliers 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