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:
- They adjusted alcohol sales estimates to take into account tourist and unrecorded consumption;
- They did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and
- 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:
- tuberculosis (1·4% of total deaths),
- road injuries (1·2%), and
- 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.
- The researchers consolidated 694 individual and population-level data sources to estimate alcohol consumption levels among current alcohol users.
- The researchers developed a method to adjust population-level consumption for alcohol consumed by tourists.
- The researchers improved pre-existing methods that account for unrecorded population-level consumption.
- 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.
- 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 Filip Jonas David Finger Florian Fischer Abraham D Flaxman Richard Charles Franklin Neal D Futran Silvano Gallus Morsaleh Ganji Fortune Gbetoho Gankpe 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Moti Tolera Jalu Achala Upendra Jayatilleke Ravi Prakash Jha Jost B Jonas Jacek Jerzy Jozwiak Zubair Kabir Rajendra Kadel Amaha Kahsay Umesh Kapil Amir Kasaeian Tesfaye D Dessale Kassa Srinivasa Vittal Katikireddi Norito Kawakami Seifu Kebede Adane Teshome Kefale Peter Njenga Keiyoro Andre Pascal Kengne Yousef Khader Morteza Abdullatif Khafaie Ibrahim A Khalil Md Nuruzzaman Khan Young-Ho Khang Mona M Khater Jagdish Khubchandani Cho-Il Kim Daniel Kim Yun Jin Kim Ruth W Kimokoti Adnan Kisa Mika Kivimäki Sonali Kochhar Soewarta Kosen Parvaiz A Koul Ai Koyanagi Kewal Krishan Barthelemy Kuate Defo Burcu Kucuk Bicer Veena S Kulkarni Pushpendra Kumar Alessandra Lafranconi Arjun Lakshmana Balaji Ratilal Lalloo Tea Lallukka Hilton 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 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Legesse Nirayo Jean Jacques Noubiap Richard Ofori-Asenso Felix Akpojene Ogbo In-Hwan Oh Olanrewaju Oladimeji Andrew T Olagunju Pedro R Olivares Bolajoko Olubukunola Olusanya Jacob Olusegun Olusanya Anu Mary Oommen Eyal Oren Heather M Orpana Doris D V Ortega-Altamirano Justin R Ortiz Erika Ota Mayowa Ojo Owolabi Abayomi Samuel Oyekale Mahesh P A Adrian Pana Eun-Kee Park Charles D H Parry Hadi Parsian Ajay Patle George C Patton Deepak Paudel Max Petzold Michael R Phillips Julian David Pillay Maarten J Postma Farshad Pourmalek Dorairaj Prabhakaran Mostafa Qorbani Amir Radfar Anwar Rafay Alireza Rafiei Fakher Rahim Afarin Rahimi-Movaghar Mahfuzar Rahman Muhammad Aziz Rahman Rajesh Kumar Rai Sasa Rajsic Sree Bhushan Raju Usha Ram Saleem M Rana Chhabi Lal Ranabhat David Laith Rawaf Salman Rawaf Robert C Reiner Cesar Reis Andre M N Renzaho Mohammad Sadegh Rezai Leonardo Roever Luca Ronfani Robin Room Gholamreza Roshandel Ali Rostami Gregory A Roth Ambuj Roy Yogesh Damodar Sabde Basema Saddik 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Mohsen Naghavi Christopher J L Murray Emmanuela Gakidou
Bill & Melinda Gates Foundation.