The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Alcohol and Drug Use Collaborators, Louisa Degenhardt, Fiona Charlson, Alize Ferrari, Damian Santomauro, Holly Erskine, Ana Mantilla-Herrara, Harvey Whiteford, Janni Leung, Mohsen Naghavi, Max Griswold, Jürgen Rehm, Wayne Hall, Benn Sartorius, James Scott, Stein Emil Vollset, Ann Kristin Knudsen, Josep Maria Haro, George Patton, Jacek Kopec, Deborah Carvalho Malta, Roman Topor-Madry, John McGrath, Juanita Haagsma, Peter Allebeck, Michael Phillips, Joshua Salomon, Simon Hay, Kyle Foreman, Stephen Lim, Ali Mokdad, Mari Smith, Emmanuela Gakidou, Christopher Murray, Theo Vos, GBD 2016 Alcohol and Drug Use Collaborators, Louisa Degenhardt, Fiona Charlson, Alize Ferrari, Damian Santomauro, Holly Erskine, Ana Mantilla-Herrara, Harvey Whiteford, Janni Leung, Mohsen Naghavi, Max Griswold, Jürgen Rehm, Wayne Hall, Benn Sartorius, James Scott, Stein Emil Vollset, Ann Kristin Knudsen, Josep Maria Haro, George Patton, Jacek Kopec, Deborah Carvalho Malta, Roman Topor-Madry, John McGrath, Juanita Haagsma, Peter Allebeck, Michael Phillips, Joshua Salomon, Simon Hay, Kyle Foreman, Stephen Lim, Ali Mokdad, Mari Smith, Emmanuela Gakidou, Christopher Murray, Theo Vos

Abstract

Background: Alcohol and drug use can have negative consequences on the health, economy, productivity, and social aspects of communities. We aimed to use data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 to calculate global and regional estimates of the prevalence of alcohol, amphetamine, cannabis, cocaine, and opioid dependence, and to estimate global disease burden attributable to alcohol and drug use between 1990 and 2016, and for 195 countries and territories within 21 regions, and within seven super-regions. We also aimed to examine the association between disease burden and Socio-demographic Index (SDI) quintiles.

Methods: We searched PubMed, EMBASE, and PsycINFO databases for original epidemiological studies on alcohol and drug use published between Jan 1, 1980, and Sept 7, 2016, with out language restrictions, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to estimate population-level prevalence of substance use disorders. We combined these estimates with disability weights to calculate years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 1990-2016. We also used a comparative assessment approach to estimate burden attributable to alcohol and drug use as risk factors for other health outcomes.

Findings: Globally, alcohol use disorders were the most prevalent of all substance use disorders, with 100·4 million estimated cases in 2016 (age-standardised prevalence 1320·8 cases per 100 000 people, 95% uncertainty interval [95% UI] 1181·2-1468·0). The most common drug use disorders were cannabis dependence (22·1 million cases; age-standardised prevalence 289·7 cases per 100 000 people, 95% UI 248·9-339·1) and opioid dependence (26·8 million cases; age-standardised prevalence 353·0 cases per 100 000 people, 309·9-405·9). Globally, in 2016, 99·2 million DALYs (95% UI 88·3-111·2) and 4·2% of all DALYs (3·7-4·6) were attributable to alcohol use, and 31·8 million DALYs (27·4-36·6) and 1·3% of all DALYs (1·2-1·5) were attributable to drug use as a risk factor. The burden of disease attributable to alcohol and drug use varied substantially across geographical locations, and much of this burden was due to the effect of substance use on other health outcomes. Contrasting patterns were observed for the association between total alcohol and drug-attributable burden and SDI: alcohol-attributable burden was highest in countries with a low SDI and middle-high middle SDI, whereas the burden due to drugs increased with higher S DI level.

Interpretation: Alcohol and drug use are important contributors to global disease burden. Effective interventions should be scaled up to prevent and reduce substance use disease burden.

Funding: Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.

Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Age-standardised DALYs per 100 000 people attributable to alcohol and drug use for both sexes by country in 2016, in 195 locations (A) DALYs attributed to alcohol use. (B) DALYs attributable to drug use. DALYs=disability-adjusted life-years. ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. Isl=Islands. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.
Figure 2
Figure 2
Age-standardised DALYs, YLDs, YLLs, and deaths per 100 000 people attributed to drug and alcohol use, in 2016, by country in 2016 Blue indicates mild severity, yellow indicates moderate severity, and red indicates high severity. 95% UI=95% uncertainty intervals. DALYs=disability-adjusted life-years. YLDs=years of life lived with disability. YLLs=years of life lost.
Figure 2
Figure 2
Age-standardised DALYs, YLDs, YLLs, and deaths per 100 000 people attributed to drug and alcohol use, in 2016, by country in 2016 Blue indicates mild severity, yellow indicates moderate severity, and red indicates high severity. 95% UI=95% uncertainty intervals. DALYs=disability-adjusted life-years. YLDs=years of life lived with disability. YLLs=years of life lost.
Figure 2
Figure 2
Age-standardised DALYs, YLDs, YLLs, and deaths per 100 000 people attributed to drug and alcohol use, in 2016, by country in 2016 Blue indicates mild severity, yellow indicates moderate severity, and red indicates high severity. 95% UI=95% uncertainty intervals. DALYs=disability-adjusted life-years. YLDs=years of life lived with disability. YLLs=years of life lost.
Figure 2
Figure 2
Age-standardised DALYs, YLDs, YLLs, and deaths per 100 000 people attributed to drug and alcohol use, in 2016, by country in 2016 Blue indicates mild severity, yellow indicates moderate severity, and red indicates high severity. 95% UI=95% uncertainty intervals. DALYs=disability-adjusted life-years. YLDs=years of life lived with disability. YLLs=years of life lost.
Figure 2
Figure 2
Age-standardised DALYs, YLDs, YLLs, and deaths per 100 000 people attributed to drug and alcohol use, in 2016, by country in 2016 Blue indicates mild severity, yellow indicates moderate severity, and red indicates high severity. 95% UI=95% uncertainty intervals. DALYs=disability-adjusted life-years. YLDs=years of life lived with disability. YLLs=years of life lost.
Figure 2
Figure 2
Age-standardised DALYs, YLDs, YLLs, and deaths per 100 000 people attributed to drug and alcohol use, in 2016, by country in 2016 Blue indicates mild severity, yellow indicates moderate severity, and red indicates high severity. 95% UI=95% uncertainty intervals. DALYs=disability-adjusted life-years. YLDs=years of life lived with disability. YLLs=years of life lost.
Figure 2
Figure 2
Age-standardised DALYs, YLDs, YLLs, and deaths per 100 000 people attributed to drug and alcohol use, in 2016, by country in 2016 Blue indicates mild severity, yellow indicates moderate severity, and red indicates high severity. 95% UI=95% uncertainty intervals. DALYs=disability-adjusted life-years. YLDs=years of life lived with disability. YLLs=years of life lost.
Figure 2
Figure 2
Age-standardised DALYs, YLDs, YLLs, and deaths per 100 000 people attributed to drug and alcohol use, in 2016, by country in 2016 Blue indicates mild severity, yellow indicates moderate severity, and red indicates high severity. 95% UI=95% uncertainty intervals. DALYs=disability-adjusted life-years. YLDs=years of life lived with disability. YLLs=years of life lost.
Figure 3
Figure 3
Regional variation in DALYs attributed to drug and alcohol use in 2016 (A) DALYs attributable to drug use. (B) DALYs attributable to alcohol. DALYs=disability-adjusted life-years.
Figure 4
Figure 4
Estimated burden attributable to alcohol and drug use for both sexes by SDI quintile, in 2016 (A) Burden attributable to alcohol in women (A) and men (B), and burden attributable to drug use in women (C) and men (D). The data on alcohol burden and its association with SDI by age group have been published previously. SDI=Socio-demographic Index. DALYs=disability-adjusted life-years.

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