Worldwide, 1 in 25 deaths and 5% of years lived with disability are attributable to alcohol consumption. Disease burden is closely related to average volume of alcohol consumption, and, for every unit of exposure, is strongest in poor people and in those who are marginalised from society. These are among the conclusions of the first in a Series of three papers on alcohol in this week's edition of the Lancet. This first paper was written by Dr Jürgen Rehm, Centre for Addiction and Mental health, Toronto, Canada, and colleagues.
The industrialisation of production and globalisation of marketing and promotion of alcohol have increased both the amount of worldwide consumption and the harms associated with it. Alcohol-use disorders, especially for men, are among the most disabling disease categories for the global burden of disease. And while there have been some positive effects on cardiovascular disease associated with regular drinking, these beneficial effects have been controversial and are far outweighed by the detrimental effects of alcohol on disease and injury. The authors say that two different dimensions of alcohol consumption affect health: average drinking volume, and patterns of drinking including binge/heavy drinking.
Some diseases and injuries are caused by alcohol by definition, eg, (alcohol-use disorders, alcoholic liver disease) meaning they would not exist if alcohol were not consumed. A wide range of other diseases and injuries has been deemed to have an alcohol attributable effect, eg, mouth and throat cancer, colorectal cancer, breast cancer, depression, stroke, road traffic accidents, violence, poisoning, and many others.
The authors found that globally, average alcohol consumption is the equivalent of 6.2L of pure ethanol per year, or around 12 units per person per week (1 unit = 10 ml ethanol). In Europe, the figure is higher at 11.9 L ethanol per person per year or 21.5 units per week. Corresponding figures for North America are 9.4L / 18 units; The Americas as a whole 8.7L / 17 units; and the WHO eastern Mediterranean region was the lowest at 0.7L / 1.3 units per week. The authors say: "In all regions worldwide, men consume more alcohol than do women, although the exact ratio varies, with women in high-income countries consuming a larger proportion than those in low-income countries. In the interpretation of these numbers, we should keep in mind that most of the adult population worldwide actually abstains from drinking alcohol (45% of men and 66% of women), most of them for their lifetime."
For 2004 (the latest year with comparable data available on a global level) 3.8% of all global deaths (around 1 in 25) were attributable to alcohol—6.3% for men and 1.8% for women. Men drink a lot more and have more heavy drinking sessions (Europe units per week comparison men v women?). Most of the deaths caused by alcohol were through injuries, cancer, cardiovascular disease, and liver cirrhosis. Overall, alcohol-attributable deaths have increased since 2000 mainly because of increases in the number of women drinking. In people under 60 years, the proportion of alcohol-attributable deaths was higher at 5.3%. Europe had the highest proportion of deaths related to alcohol, with 1 in 10 deaths directly attributable. Within Europe, the former Soviet Union countries had the highest proportion at 15%, or around one in seven deaths. Relative to volume of alcohol consumed per head, the rates of alcohol-attributable mortality were higher in developing countries, especially southeast Asia. Globally, alcohol-attributable mortality rates for men were more than five times those for women.
In contrast with other traditional risk factors such as high blood pressure or cholesterol, the alcohol-attributable disease burden lies more with younger people than older populations. Of all years lived with disability attributable to alcohol, 34% were experienced by people aged 15—29 years, 31% by those 30—44 years, and 22% by those aged 45—59 years.
The authors provide two country-based analyses*, including a high-income (France, USA, Scotland, Canada) vs middle-income (South Korea, Thailand), looking at costs attributable to alcohol. Among their findings were that alcohol-attributable cost per head in high-income countries ranged from I$358**in Scotland to I$837 in the USA; in middle-income countries, South Korea (I$524) had more than four times greater alcohol-attributable cost per head than did Thailand (I$122). All countries spent more than 1% of their GDP PPP, with the highest in the USA (2•7%) in the selected high-income countries, and in Korea (3•3%) in the selected middle-income countries. A further analysis of the 10 most populated countries in the world gives a breakdown of different disease categories and the proportion of years lived with disability due to alcohol in each.
The authors say: "Globally, the effect of alcohol on burden of disease is about the same size as that of smoking in 2000, but it is greatest in developing countries... This finding is not surprising since global consumption is increasing, especially in the most populous countries of India and China."
They conclude: "We face a large and increasing alcohol-attributable burden at a time when we know more than ever about which strategies can effectively and cost-effectively control alcohol-related harms. The next papers of this Series will therefore discuss ways in which to decrease this burden."
Dr Jürgen Rehm, Centre for Addiction and Mental health, Toronto, Canada T) +1 416 535 8501 ext. 6907 E) jtrehm@aol.com
For full Series paper, see: http://press.thelancet.com/alcseries1.pdf
Note to editors: *see full Series paper for both country analyses
**An international dollar (I$) is equivalent to the purchasing power of one US dollar in a particular year, in this case 2007.
Journal
The Lancet