Study results published in Lancet Public Health underscores the significant worldwide burden of disease attributable to alcohol. Alcohol-attributable death rates were highest in Eastern Europe, sub-Saharan Africa, and countries with low human development indices (HDIs). Across countries, alcohol use disproportionately affected young people and men.
Kevin Shield, PhD, led study efforts to investigate global trends in the alcohol-related burden of disease. The investigators conducted a comparative risk assessment for 2000, 2005, 2010, 2015, and 2016 using alcohol exposure data and relative risk (RR) estimates. Mortality data, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were obtained from World Health Organization Global Health Estimates, and population and HDI data were obtained from the United Nations Population Division and Development Program, respectively.
Drinking status data stratified by age brackets were extracted from national surveys and taxation data. Population attributable fractions (PAFs) were estimated by combining alcohol exposure data with RR estimates. Confidence intervals (CIs) for alcohol-attributable estimates were calculated with a Monte Carlo-like approach.
Globally, in 2016, 3.0 million (95% CI, 2.6-3.6) deaths and 131.4 million (95% CI, 119.4-154.4) DALYs could be attributed to alcohol. These figures represented 5.3% (95% CI, 4.6-6.3) and 5.0% (95% CI, 4.6-5.9) of all worldwide deaths and DALYs, respectively. The global burden of disease due to alcohol was principally linked to mortality (106.6 million YLLs; 95% CI, 95.3-127.7) rather than morbidity (24.8 million YLDs; 95% CI, 22.9-28.3).
Alcohol use was a major risk factor for death due to communicable, maternal, perinatal, and nutritional conditions (PAF, 3.3%; 95% CI, 1.9-5.6%), including tuberculosis (PAF, 18.3%; 95% CI, 5.8-35.3%), HIV/AIDS (PAF, 3.0%; 95% CI, 2.3-5.6%), and lower respiratory infections (PAF, 3.2%; 95% CI, 1.6-6.0%). Alcohol use also significantly increased the risk for death from non-communicable diseases (PAF, 4.3%; 95% CI, 3.6-5.1%) and injury (PAF, 17.7%; 95% CI, 14.3-23.0%).
The alcohol-attributable age-standardized death rates and DALYs were highest in Eastern Europe, primarily due to ischemic heart disease, and in sub-Saharan African regions, where cirrhosis takes a serious toll. Generally, the wider Middle East-North Africa region was the least affected.
In 2016, countries with a low HDI had the greatest age-standardized rates of alcohol attributable deaths (67.5 per 100,000 people) and DALYs (2872.6 per 100,000 people). Furthermore, 52.4% of alcohol-attributable deaths occurred in people younger than 60 years. In people aged 30 to 34 years, 13.7% (95% CI, 12.0-16.6%) of all deaths were attributable to alcohol and 57.4% of all alcohol-attributable deaths in individuals younger than 60 years occurred in men, whereas 39.3% occurred in women.
As study limitations, the investigators noted that RR estimates from varying sources and the assumption of no lag time between exposure and outcome may have introduced potential error. The researchers concluded: “Despite an increase in alcohol use globally, this study observed that the global alcohol-attributable burden of disease decreased between 2000 and 2016. However, globally, health gains attained through improvements in the alcohol-attributable burden of disease have proportionally not kept pace with total health gains.”
Shield K, Manthey J, Rylett M, et al. National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study. Lancet Public Health. 2020;5(1):E51-E61.