Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Abstract

Background: 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.

Funding: Bill & Melinda Gates Foundation.

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

Figures

Figure 1

Age-standardised prevalence of current drinking for females (A) and males (B) in 2016, in 195 locations Current drinkers are defined as individuals who reported having consumed alcohol within the past 12 months. ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. Isl=Islands. FSM=Federated States of Micronesia. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste.

Figure 2

Average standard drinks (10 g of pure ethanol per serving) consumed per day, age-standardised, for females (A) and males (B) in 2016, in 195 locations ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. Isl=Islands. FSM=Federated States of Micronesia. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste.

Figure 3

Attributable DALY rate disaggregated by outcome, shown globally and for each region, by age and sex, in 2016 (A) Females. (B) Males. DALY=disability-adjusted life-year. SDI=Socio-demographic Index.

Figure 3

Attributable DALY rate disaggregated by outcome, shown globally and for each region, by age and sex, in 2016 (A) Females. (B) Males. DALY=disability-adjusted life-year. SDI=Socio-demographic Index.

Figure 4

Relative risk curves for selected conditions by number of standard drinks consumed daily (A) Relative risk curves for breast cancer, ischaemic heart disease, diabetes, and tuberculosis for females. (B) Relative risk curves for lip and oral cavity cancer, ischaemic heart disease, diabetes, and tuberculosis for males. Points are relative risk estimates from studies. The vertical and horizontal bars capture the uncertainty in each study, related to the sample size and number of drinks consumed by individuals in the study. The black line represents the estimated relative risk for each condition at each level of consumption. The shaded green areas represent the 95% uncertainty interval associated with the estimated relative risk. The dotted line is a reference line for a relative risk of 1. The relative risk curves for all other health outcomes associated with alcohol use are presented in appendix 2 (pp 57–146).

Figure 5

Weighted relative risk of alcohol for all attributable causes, by standard drinks consumed per day Age-standardised weights determined by the DALY rate in 2016, for both sexes. The dotted line is a reference line for a relative risk of 1. DALY=disability-adjusted life-year.