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 our comprehensive approach to
health accounting within the Global Burden of Diseases, Injuries, and
Risk Factors Study 2016, we 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.
Methods
Using
694 data sources of individual and population-level alcohol
consumption, along with 592 prospective and retrospective studies on the
risk of alcohol use, we produced estimates of the prevalence of current
drinking, abstention, the distribution of alcohol consumption among
current drinkers in standard drinks daily (defined as 10 g of pure ethyl
alcohol), and alcohol-attributable deaths and DALYs. We made several
methodological improvements compared with previous estimates: first, we
adjusted alcohol sales estimates to take into account tourist and
unrecorded consumption; second, we did a new meta-analysis of relative
risks for 23 health outcomes associated with alcohol use; and third, we
developed a new method to quantify the level of alcohol consumption that
minimises the overall risk to individual health.
Findings
Globally,
alcohol use was the seventh leading risk factor for both deaths and
DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI]
1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) 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% (95%
UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths
attributable to alcohol use. For the population aged 15–49 years, female
attributable DALYs were 2·3% (95% UI 2·0–2·6) 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% [95% UI 1·0–1·7] of
total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1%
[0·6–1·5]). For populations aged 50 years and older, cancers accounted
for a large proportion of total alcohol-attributable deaths in 2016,
constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable
female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol
consumption that minimised harm across health outcomes was zero (95% UI
0·0–0·8) standard drinks per week.
Interpretation
Alcohol
use is a leading risk factor for global disease burden and causes
substantial health loss. We 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.
Important, related article.
Important, related article.
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