Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Max Griswold, Nancy Fullman, Caitlin Hawley, Nicholas Arian, Stephanie R M Zimsen, Hayley Tymeson, Vidhya Venkateswaran, Austin Douglas Tapp, Mohammad H. Forouzanfar, Joseph S Salama, Kalkidan Hassen Abate, Degu Abate, Solomón Mequanente Abay, Cristiana Abbafati, Rizwan Suliankatchi Abdulkader, Abebe Zegeye, Victor Aboyans, Mohammed Mehdi Abrar, Pawan Acharya, Olatunji Adetokunboh, Tara Ballav Adhikari, José Carmelo Adsuar, Mohsen Afarideh, Emilie Agardh, Gina Agarwal, Sargis A. Aghayan, Sutapa Agrawal, Muktar Beshir Ahmed, Mohammed Akibu, Tomi Akinyemiju, Nadia Akseer, Deena Alasfoor, Ziyad Al‐Aly, Fares Alahdab, Khurshid Alam, Ammar Albujeer, Kefyalew Addis Alene, Raghib Ali, Syed Danish Ali, Mehran Alijanzadeh, Syed Mohamed Aljunid, Ala’a Alkerwi, Peter Allebeck, Nelson Alvis‐Guzmán, Azmeraw T. Amare, Léopold Ndemnge Aminde, Walid Ammar, Yaw Ampem Amoako, Gianna Gayle Herrera Amul, Cătălina Liliana Andrei, Colin Angus, Mustafa Geleto Ansha, Carl Abelardo T. Antonio, Olatunde Aremu, Johan Ärnlöv, Al Artaman, Krishna K Aryal, Reza Assadi, Marcel Ausloos, Leticia Ávila‐Burgos, Euripide Avokpaho, Ashish Awasthi, Henok Tadesse Ayele, Rakesh Ayer, Ayuk Betrand Tambe, Peter Azzopardi, Hamid Badali, Alaa Badawi, Maciej Banach, Suzanne Barker‐Collo, Lope H. Barrero, Huda Basaleem, Estifanos Baye, Shahrzad Bazargan‐Hejazi, Neeraj Bedi, Yannick Béjot, Abate Bekele Belachew, Saba Abraham Belay, Derrick Bennett, Isabela M. Benseñor, Eduardo Bernabé, Robert S. Bernstein, Addisu Shunu Beyene, Tina Beyranvand, Soumyadeeep Bhaumik, Zulfiqar A Bhutta, Belete Biadgo, Ali Bijani, Nigus Bililign, Sait Mentes Birlik, Charles Birungi, Hailemichael Bizuneh, Peter Bjerregaard, Tone Bjørge, Guilherme Borges, Cristina Bosetti, Soufiane Boufous, Nicola Luigi Bragazzi, Hermann Brenner, Zahid A Butt
Abstract
BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. METHODS: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. FINDINGS: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5-3·0) of age-standardised female deaths and 6·8% (5·8-8·0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2-4·3) of female deaths and 12·2% (10·8-13·6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2·3% (95% UI 2·0-2·6) and male attributable DALYs were 8·9% (7·8-9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0-1·7] of total deaths), road injuries (1·2% [0·7-1·9]), and self-harm (1·1% [0·6-1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2-33·3) of total alcohol-attributable female deaths and 18·9% (15·3-22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0-0·8) standard drinks per week. INTERPRETATION: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. FUNDING: Bill & Melinda Gates Foundation.