Expected Years Of Life Lost Due To Alcohol Consumption In Thai Adults: A 16-Year Follow-Up Cohort Of National Health Examination Survey 2004-2019
Evidence of premature death attributable to alcohol, a modifiable risk factor, is crucial for guiding public health policy for alcohol control. The aim of this study was to estimate alcohol-related mortality and potential years of life lost (PYLL) in Thailand in 2004-2019.
The researchers analysed data of the third National Health Examination Survey in 2004 linked to National Death Registry data of 2004-2019. Causes of death were based on International Classification of Diseases version 10.
PYLL was calculated by cause of death, age group and sex.
All analyses were weighted to take into account the probabilities for the multi-stage sampling of the 2004 Thai population aged ≥15 years.
There were 10,704 deaths with a follow-up time of 507,771.7 person-years. The crude mortality rate of the initial sample was 868.6 per 100,000 population.
- The mortality rate attributable to alcohol was 18.6 per 100,000 population.
- 30.7 per 100,000 population in males,
- 6.8 per 100,000 population in females.
The top leading cause of alcohol-attributable deaths was unspecified liver diseases in both males and females (6.1 and 3.1 per 100,000 population, respectively).
The total years of life lost (YLL) at baseline were 9.4 million years or 49.5 years per person on average, with significantly more years in males.
Mortality rate and expected YLL were highest in ages of 30-44 years, followed by 15-29 years.
Males were 4-fold more likely to die from all alcohol-attributable causes compared with females. Young adults had a greater loss of life years than older adults.
Discussion of findings
This study reports a very high number of deaths and life years prematurely lost due to alcohol consumption in a Thai cohort with 16 years of follow-up. It confirms the great effect of alcohol consumption on leading causes of death.
- The study estimates an average of 11,887 alcohol-attributable deaths per year in the Thai population.
- This estimate is lower than the estimates from a previous Thai Burden of Disease (BOD) Study in 2014 (21,843 deaths) (Workgroup for the Study of Burden of Diseases Attributable to Risk Factors 2014, 2018).
This study improves on estimation of mortality attributable to alcohol by using updated RRs for different levels of alcohol consumption from the latest meta-analysis available as well as by including more disease categories, such as tuberculosis, HIV, pancreatitis and epilepsy. Furthermore, using individually linked data over 16 years indeed increases the validity of the results on the contribution of alcohol on deaths and YLL.
Males were 4-fold more likely to die from all alcohol-attributable causes than females.
- 30.7 deaths per year per 100,000 population for Thai males,
- 6.8 deaths per year per 100,000 population for Thai females)
- Males had about five times higher PYLL (7.87 vs. 1.56 million years in 2004–2019), with highest number of deaths and PYLL occurring among those aged 30–44 years.
- This reflects higher levels of alcohol use and higher RRs of deaths due to acute and chronic alcohol-related conditions in males than in females.
Of both sexes, unspecified liver diseases were the highest cause of alcohol-attributable deaths and PYLL. The main factors associated with alcohol-related liver diseases at the population level are the percentage of heavy alcohol users among the population and early onset of alcohol use.
- This group of diseases is a chronic condition which may take 10–30 years for a disease to develop after exposure to risk factors.
- This study has a 16-year follow-up period, and 7% of all subjects at baseline were heavy alcohol users with highest percentage in the youngest age group (15–29 years) in both males and females.
- Although alcohol-attributable deaths due to liver diseases here may be underestimated as the follow-up period may not be long enough for heavy alcohol users to develop the disease and progress until death, the high number in this disease group should be paid attention to.
Prevention strategies to control heavy alcohol use and delay the onset of alcohol use in the population are suggested.
Comparing between diseases, intentional self-harm and assault by unspecified means had the highest PYLL per death (67.4 and 66.9 years per one death) among men, as the largest number of deaths from these conditions occurred in the youngest age group which had the highest proportion of heavy alcohol users.
- Acute use of alcohol, particularly at high dose, and chronic alcohol use disorder are strongly associated with suicide and suicide attempt.
- A study in two emergency departments in Thailand found a dose–response relationship between alcohol use and unintentional injury, intentional injury inflicted by someone else or experiencing a road traffic injury (among drivers) (Sornpaisarn et al., 2020).
This study, thus, confirms the role of alcohol use and injury risk in Thailand and suggests cost-effective interventions are needed to reduce alcohol use, especially heavy or binge alcohol intake among young males.
Among women, death from HIV/AIDS caused the highest life years lost due to premature mortality (61.6 years).
- Alcohol use is strongly associated with the incidence and course of HIV/AIDS, with a causal effect being explained via the intention to engage in condomless sex and a biological pathway being mediated by adherence to antiretroviral medication.
This certainly sets an alarm to the country as the highest number of HIV-related deaths occurred among those aged between 15 and 29 years, the youngest age group, among whom premature deaths would result in a negative effect to the country economy in terms of loss of labor market and productivity loss.