The Global Impact of Alcohol Consumption on Premature Mortality and Health in 2016
Research article
Abstract
This study aimed to estimate the impact of alcohol use on mortality and health among people 69 years of age and younger in 2016. A comparative risk assessment approach was utilized, with population-attributable fractions being estimated by combining alcohol use data from the Global Information System on Alcohol and Health with corresponding relative risk estimates from meta-analyses. The mortality and health data were obtained from the Global Health Observatory.
Among people 69 years of age and younger in 2016, 2.0 million deaths and 117.2 million Disability Adjusted Life Years (DALYs) lost were attributable to alcohol consumption, representing 7.1% and 5.5% of all deaths and DALYs lost in that year, respectively.
The leading causes of the burden of alcohol-attributable deaths were cirrhosis of the liver (457,000 deaths), road injuries (338,000 deaths), and tuberculosis (190,000 deaths).
The numbers of premature deaths per 100,000 people were highest in Eastern Europe (155.8 deaths per 100,000), Central Europe (52.3 deaths per 100,000 people), and Western sub-Saharan Africa (48.7 deaths per 100,000).
A large portion of the burden of disease caused by alcohol among people 69 years of age and younger is preventable through the implementation of cost-effective alcohol policies such as increases in taxation.
Specific highlights
Alcohol-attributable deaths and health loss occur among people relatively young in age. The proportions of alcohol-attributable deaths and DALYs lost that were premature were greater than the proportions of all-cause deaths and DALYs lost that were considered premature.
This indicates that alcohol use disproportionately affects the health of people who are younger in age.
This study modelled both the detrimental and protective effects of alcohol consumption on health (which is an increasingly controversial approach in itself). This study found that for the premature disease burden, the detrimental effects of alcohol at the population level outweighed the protective effects. At the individual level, a recent modelling study found no level of alcohol consumption provided a net health benefit.
The premature burden of disease attributable to alcohol consumption was characterized by tuberculosis, liver cirrhosis, and injuries.
- Tuberculosis risk (i.e., the impact of alcohol on the immune system) is related both to the overall volume of alcohol consumed and binge alcohol use; however, due to the lack of studies, the impact of alcohol use on tuberculosis was modelled based only on the overall volume of alcohol consumed. Therefore, both overall volume of alcohol consumed and alcohol use to intoxication are factors leading to the premature burden of disease attributable to alcohol consumption. Tuberculosis remains an enormous public health concern globally, especially in low and medium Human Development Index (HDI) countries. The treatment of tuberculosis and the interaction between HIV/AIDS and tuberculosis are key public health priorities. Alcohol use is a key risk factor for both diseases, which if addressed can substantially reduce the health burden of tuberculosis and HIV/AIDS.
- Liver cirrhosis is mainly linked to the overall volume of drinking, while injuries attributable to alcohol are mostly related to intoxication (i.e., binge alcohol consumption). The burden of disease due to liver cirrhosis was high in all HDI categories and in most GBD regions. The burden of alcoholic liver cirrhosis is affected by multiple risk factors which interact with alcohol, including hepatitis B and C infections, obesity, and socio-economic status.
- The burden of alcohol-related injuries is problematic as investment in preventing mortality from injury has fallen behind other causes of death, such as HIV/AIDS and reproductive health. Furthermore, mental health concerns have been overlooked in terms of public health programming, especially in young people where injuries and neuropsychiatric conditions are greatly impacted by alcohol consumption.
The burden of premature disease attributable to alcohol consumption was highest in Eastern Europe, Central Europe, and Western sub-Saharan Africa.
- The Central and Eastern Europe region have a high overall volume of alcohol consumption and a high prevalence of Heavy Episodic Alcohol Use. Alcohol control policy measures, including increases in alcohol prices and decreases in availability, have been implemented in the Eastern Europe region and have resulted in marked downward shifts in mortality and the burden of disease.
- The Western sub-Saharan Africa region has a relatively low overall volume of alcohol consumption. The burden of alcohol-attributable premature disease in this region was driven mainly by infectious diseases, liver cirrhosis, and injuries. Cirrhosis-related deaths doubled in the sub-Saharan Africa region between 1980 and 2010, with hepatitis B virus, hepatitis C virus, and alcohol use being contributing factors to this increase. Furthermore, treatment of liver cirrhosis is unavailable in most parts of sub-Saharan Africa, due to a shortage of hepatologists and gastroenterologists, interventional radiologists, hepatobiliary surgeons, and pathologists.
