The total attributable burden of alcohol use was larger than previous evidence has indicated and increases monotonically with consumption. Based on weighted relative risk curves for each health outcome associated with alcohol use, the level of consumption that minimises health loss due to alcohol use is zero. These findings strongly suggest that alcohol control policies should aim to reduce total population-level consumption. To potentially reduce the effects of alcohol use on future health loss, there is a need for countries to revisit their alcohol control policies and assess how they can be modified to further lower population-level consumption…


GBD 2016 Alcohol Collaborators*


Max G Griswold, et. al. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016, The Lancet, Volume 392, Issue 10152, 2018, Pages 1015-1035, ISSN 0140-6736,

The Lancet, Volume 392, Issue 10152, 22–28 September 2018, Pages 1015-1035
Release date

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Alcohol Collaborators*



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 the researchers’ comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, they 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.


Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, the researchers produced estimates of the prevalence of current alcohol use, abstention, the distribution of alcohol consumption among current alcohol users in standard alcohol drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs.

The researchers made several methodological improvements compared with previous estimates:

  1. They adjusted alcohol sales estimates to take into account tourist and unrecorded consumption;
  2. They did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and
  3. They developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.


Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% of age-standardised female deaths and 6·8% 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% of female deaths and 12·2% of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were:

  1. tuberculosis (1·4% of total deaths),
  2. road injuries (1·2%), and
  3. self-harm (1·1%).

For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% of total alcohol-attributable female deaths and 18·9% of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero standard alcohol drinks per week.


Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. The researchers 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.

Research in context

Evidence before this study

Although researchers recognise alcohol use as a leading risk factor for premature death and disability, some evidence suggests that low intake might have a protective effect on specific conditions such as ischaemic heart disease and diabetes. Monitoring of consumption behaviour is required to analyse the health effects of alcohol use. Historically, researchers have relied on self-reported survey data to estimate consumption levels and trends. However, these data have systematic biases that make cross-country comparisons unreliable.

The Global Status Report on Alcohol and Health, as well as previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study, have sought to produce harmonised, cross-country comparisons of alcohol consumption and its harms, by leveraging data on alcohol sales, the prevalence of current drinking and abstention, and self-reports of consumption amounts.

Added value of this study

In this analysis the researchers improved available estimates of alcohol use and its associated health burden in five ways.

  1. The researchers consolidated 694 individual and population-level data sources to estimate alcohol consumption levels among current alcohol users.
  2. The researchers developed a method to adjust population-level consumption for alcohol consumed by tourists.
  3. The researchers improved pre-existing methods that account for unrecorded population-level consumption.
  4. The researchers did a new systematic review and meta-analysis of alcohol use and 23 associated health outcomes, which we used to estimate new dose–response curves of relative risk.
  5. Using the new relative risk curves and a new analytical method, the researchers estimated the exposure of alcohol consumption that minimises an individual’s total attributable risk.

Implications of all the available evidence

The total attributable burden of alcohol use was larger than previous evidence has indicated and increases monotonically with consumption.

Based on weighted relative risk curves for each health outcome associated with alcohol use, the level of consumption that minimises health loss due to alcohol use is zero.

These findings strongly suggest that alcohol control policies should aim to reduce total population-level consumption. To potentially reduce the effects of alcohol use on future health loss, there is a need for countries to revisit their alcohol control policies and assess how they can be modified to further lower population-level consumption.

*GBD 2016 Alcohol Collaborators

Max G Griswold,  Nancy Fullman,  Caitlin Hawley,  Nicholas Arian,  Stephanie R M Zimsen,  Hayley D Tymeson,  Vidhya Venkateswaran,  Austin Douglas Tapp,  Mohammad H Forouzanfar,  Joseph S Salama,  Kalkidan Hassen Abate,  Degu Abate,  Solomon M Abay,  Cristiana Abbafati,  Rizwan Suliankatchi, Abdulkader  Zegeye Abebe,  Victor Aboyans,  Mohammed Mehdi Abrar,  Pawan Acharya,  Olatunji O Adetokunboh,  Tara Ballav Adhikari,  Jose C Adsuar,  Mohsen Afarideh,  Emilie Elisabet Agardh,  Gina Agarwal,  Sargis Aghasi Aghayan,  Sutapa Agrawal,  Muktar Beshir Ahmed,  Mohammed Akibu,  Tomi Akinyemiju,  Nadia Akseer,  Deena H Al Asfoor,  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-Guzman  Azmeraw T Amare  Leopold N Aminde  Walid Ammar  Yaw Ampem Amoako  Gianna Gayle Herrera Amul  Catalina 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 Avila-Burgos  Euripide F Avokpaho  Ashish Awasthi  Henok Tadesse Ayele  Rakesh Ayer  Tambe B Ayuk  Peter S Azzopardi  Hamid Badali  Alaa Badawi  Maciej Banach  Suzanne Lyn Barker-Collo  Lope H Barrero  Huda Basaleem  Estifanos Baye  Shahrzad Bazargan-Hejazi  Neeraj Bedi  Yannick Béjot  Abate Bekele Belachew  Saba Abraham Belay  Derrick A Bennett  Isabela M Bensenor  Eduardo Bernabe  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  Lucero Cahuana-Hurtado  Bianca Calabria  Ismael R Campos-Nonato  Julio Cesar Campuzano  Giulia Carreras  Juan J Carrero  Félix Carvalho  Carlos A Castañeda-Orjuela  Jacqueline Castillo Rivas  Ferrán Catalá-López  Jung-Chen Chang  Fiona J Charlson  Aparajita Chattopadhyay  Pankaj Chaturvedi  Rajiv Chowdhury  Devasahayam J Christopher  Sheng-Chia Chung  Liliana G Ciobanu  Rafael M Claro  Sara Conti  Ewerton Cousin  Michael H Criqui  Berihun Assefa Dachew  Paul I Dargan  Ahmad Daryani  José Das Neves  Kairat Davletov  Filipa De Castro  Barbora De Courten  Jan-Walter De Neve  Louisa Degenhardt  Gebre Teklemariam Demoz  Don C Des Jarlais  Subhojit Dey  Rupinder Singh Dhaliwal  Samath Dhamminda Dharmaratne  Meghnath Dhimal  David Teye Doku  Kerrie E Doyle  Manisha Dubey  Eleonora Dubljanin  Bruce B Duncan  Hedyeh Ebrahimi  Dumessa Edessa  Maysaa El Sayed Zaki  Sergei Petrovich Ermakov  Holly E Erskine  Alireza Esteghamati  Mahbobeh Faramarzi  Andrea Farioli  Andre Faro  Maryam S Farvid  Farshad Farzadfar  Valery L Feigin  Mariana Santos Felisbino-Mendes  Eduarda Fernandes  Alize J Ferrari  Cleusa P Ferri  Daniel Obadare Fijabi  Irina 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Lam  Faris Hasan Lami  Qing Lan  Justin J Lang  Sonia Lansky  Anders O Larsson  Arman Latifi  Janet L Leasher  Paul H Lee  James Leigh  Mall Leinsalu  Janni Leung  Miriam Levi  Yichong Li  Lee-Ling Lim  Shai Linn  Shiwei Liu  Andrea Lobato-Cordero  Alan D Lopez  Paulo A Lotufo  Erlyn Rachelle King Macarayan  Isis Eloah Machado  Fabiana Madotto  Hassan Magdy Abd El Razek  Muhammed Magdy Abd El Razek  Marek Majdan  Reza Majdzadeh  Azeem Majeed  Reza Malekzadeh  Deborah Carvalho Malta  Chabila Christopher Mapoma  Jose Martinez-Raga  Pallab K Maulik  Mohsen Mazidi  Martin Mckee  Varshil Mehta  Toni Meier  Tesfa Mekonen  Kidanu Gebremariam Meles  Addisu Melese  Peter T N Memiah  Walter Mendoza  Desalegn Tadese Mengistu  George A Mensah  Tuomo J Meretoja  Haftay Berhane Mezgebe  Tomasz Miazgowski  Ted R Miller  Gk Mini  Andreea Mirica  Erkin M Mirrakhimov  Babak Moazen  Karzan Abdulmuhsin Mohammad  Noushin Mohammadifard  Shafiu Mohammed  Lorenzo Monasta  Paula Moraga  Lidia Morawska  Seyyed 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Source Website: The Lancet