The GBD study is the largest global effort by the Institute for Health Metrics and Evaluation (IHME) to quantify health harm from a large number of risk factors, including alcohol. The latest data is from 2021, but the GBD data goes back all the way to 1990. The GBD study is one of the most comprehensive studies of its kind and relies on the work of thousands of collaborators around the world. For alcohol as risk factor in the global disease burden there are some concerns, however, regarding how the GBD deals with diseases due to alcohol and how alcohol’s risks are assessed.
From March to May 2024, the IHME released papers published in The Lancet with results from GBD 2021. These publications present new findings and explore timely global health issues. This week, the IHME published the final two capstones on risk factors, including alcohol, and on forecasting (see below).
Estimates and DALYs
Measuring the total burden of more than 450 health outcomes and risk factors in 204 countries is extremely complex, requiring a baffling 607 billion estimates to be made. The overall burden of disease is assessed using the disability-adjusted life year (DALY), a measure that combines years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health. One DALY represents the loss of the equivalent of one year of full health.
In order to make sense of the new data, Movendi International analyzed the role of alcohol use in a number of health outcomes, focusing on a selected number of countries where there are ongoing alcohol policy processes, as well as on data on the global level. This is not a comprehensive selection. But the overview allows to highlight development, trends and to draw conclusions.
All the data has been collected using the GBD Compare tool. It’s open for all to search and try out.
Alcohol remains top risk factor for global disease burden
Overall, the DALYs caused by alcohol have slowly decreased over the last 20 years, but alcohol is still one of the top risk factors for the disease burden globally.
In the 2021 data, alcohol use ranks as number 10 among all the risk factors (same as 2019).
Among the age group of 15 to 49-year-olds, alcohol use is still the number one risk factor for global health harm.
In most of the countries Movendi International has reviewed, alcohol harm is increasing.
- For example, in Lesotho alcohol harm almost tripled since the beginning of the GBD study.
- In Vietnam the alcohol health burden has increased by 368% since 1990.
- In Mexico, the increase in the health burden due to alcohol has been 22% since 2015.
Alcohol and disability-adjusted life year lost in the world’s regions
Movendi International reviewed GBD 2021 data for a selected number of countries, per world region, to illustrate alcohol’s contribution to years of life lost (DALYs).
In the Americas, the United States and Mexico face dramatic increases of years of life lost due to alcohol, especially since the early 2000s.
In the African region, especially Lesotho but also Kenya (slightly) face increases of years of life lost due to alcohol since the 1990s. At the same, other countries saw a decline in alcohol’s contribution to DALYs.
In the Asian region, Vietnam, Thailand, and Nepal face dramatic increases of years of life lost due to alcohol. Also the Philippines are facing an increase, with only Sri Lanka (of the reviewed countries) experiencing a decline of DALYs due to alcohol.
In Eastern Europe, all three Baltic countries and the Russian Federation see remarkable declines in DALYs due to alcohol since the early 2000s. But compared to 1990 levels of alcohol’s contribution to years of life lost, all four countries are either at the same or still at higher levels in 2021.
In Western Europe, Germany and Sweden see a decline in DALYs due to alcohol. But in Iceland and the United Kingdom years of lost due to alcohol increases between 1990 and 2021.
Globally, DALYs caused by alcohol have slowly decreased over the last 20 years, but alcohol is still one of the top risk factors for the disease burden globally.
Alcohol’s contribution to NCDs overall
Regarding alcohol’s contribution to all the non-communicable diseases (NCDs), there is a mixed bag. Globally, NCDs harm due to alcohol has slowly been decreasing since 2005, but in many countries the trend is increasing. Increases in alcohol’s contribution to NCDs are especially noticeable in Nepal, Vietnam, Mexico and the United States.
One example is the NCDs burden due to alcohol in African countries. Lesotho, Zambia, and Kenya are three countries that face a growing NCDs burden due to alcohol, while Ghana has a falling trend in recent years but has also not achieved a reduction compared to 1990.
Cancer due to alcohol is increasing
Since 2006, the total number of healthy life years lost due to alcohol-related cancer in the world has increased by 11%.
In some of the countries Movendi International has reviewed, the increase is noticeably even sharper:
- Vietnam (117%),
- Nepal (105%), and
- Kenya (28%) are three examples.
Regarding the cancer burden due to alcohol, Ghana is the only country in Africa with a stable burden while all other countries Movendi International reviewed face steep increases in cancer due to alcohol.
In the Americas, the story the data tell is very similar, with three reviewed countries facing dramatic increases in cancer due to alcohol, while only one country, Brazil, has a stable burden compared to 1990. But also Brazil faces an increase of cancer DALYs due to alcohol since the early 2000s.
In Asia, all five reviewed countries face increases in cancer burden due to alcohol. Especially Vietnam and Thailand are affected by dramatic increases in cancer DALYs due to alcohol.
Also in the Eastern European countries, the cancer burden due to alcohol is growing, as per GBD 2021 data. Lithuania and Latvia both face dramatic increases in cancer DALYs due to alcohol. In recent years (since 2015), the cancer burden due to alcohol is falling in Estonia but is still high above 1990 levels.
In Western European countries, the cancer burden due to alcohol is generally very high. Germany sees a slight decline in cancer DALYs due to alcohol. So does Sweden. But Iceland and the UK face increases in years of life lost from cancer due to alcohol.
And globally, cancer DALYs due to alcohol keep rising. Since 2006, the total number of healthy life years lost due to cancer caused by alcohol has increased by 11%, according to GBD 2021 data.
For cardiovascular disease, the number of DALYs from alcohol is more or less stable globally (a small increase since 1990 can be noted), but as with alcohol-related NCDs, some countries show large increases. For example, Vietnam, the Philippines and U.S. stand out among the countries Movendi International has reviewed, but it’s worth noting that also countries like Sweden, Iceland and the UK show increasing trends in alcohol’s contribution to cardiovascular disease.
Case for urgent action
The latest GBD data reveal a clear and urgent case for action on alcohol as major cause of death and disease globally.
Alcohol’s role in the disease burden of young people between 15 and 49-years of age is one key example. Alcohol contribution to the global cancer and cardiovascular disease burden is another example.
In addition to the global picture, what happens in countries such as Mexico, United States, Vietnam, Lesotho, and other countries Movendi International reviewed is a clear case for urgent alcohol policy action to prevent years of life lost, reduce the cancer and heart disease burden due to alcohol and thus ensure more people live in more healthy communities for more years of their lives.
Overview of GBD 2021 Capstones for 2024
- Demographics (published March 11)
Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic
- Fertility (published March 20)
Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100
- Causes of death (published April 3)
Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021
- YLDs/DALYs/HALE (published April 17)
Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021
- Risk factors (published May 16)
Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021
- Forecasting (published May 16)
Burden of disease scenarios for 204 countries and territories, 2022–2050
- Viewpoint (published May 16)
Findings from the Global Burden of Disease Study 2021