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 lifeyears (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 agestandardised 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.
Bibliographical noteFunding Information:
Yannick Béjot reports grants and personal fees from AstraZeneca, personal fees from Daiichi-Sankyo, personal fees from Pfizer, personal fees from MSD, personal fees from Medtronic, personal fees from BMS, personal fees from Amgen, grants and personal fees from Boehringer-Ingelheim, outside the submitted work. Jacek Jóźwiak reports grants and personal fees from VALEANT, personal fees from ALAB Laboratoria, personal fees from AMGEN, non-financial support from MICROLIFE, non-financial support from SERVIER, outside the submitted work. Srinivasa Vittal Katikireddi reports grants from Medical Research Council, grants from Scottish Government Chief Scientist Office, grants from NRS Senior Clinical Fellowship, during the conduct of the study. Ted Miller reports other support from AB InBev Foundation (ABIF), outside the submitted work. Maarten Postma reports grants and personal fees from Sigma Tau, grants and personal fees from MSD, grants and personal fees from GSK, grants and personal fees from Pfizer, grants from Mundipharma, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novavax, grants and personal fees from Ingress Health, personal fees from Quintiles, grants from Bayer, grants from BMS, grants and personal fees from AbbVie, grants from Astra Zeneca, grants and personal fees from Sanofi, personal fees from Astellas, personal fees from Mapi, personal fees from OptumInsight, grants from ARTEG, grants and personal fees from AscA, personal fees from Novartis, personal fees from Swedish Orphan, personal fees from Innoval, personal fees from Jansen, personal fees from Intercept, personal fees from Pharmerit, other support from Ingress Health, other support from PAG Ltd, outside the submitted work. Dan Stein reports personal fees from LUNDBECK, personal fees from NOVARTIS, personal fees from AMBRF, grants from NRGF, grants from SERVIER, grants from BIOCODEX, grants from MRC, personal fees from CIPLA, personal fees from SUN, outside the submitted work. All other authors declare no competing interests.
Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number P30AG047845. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Syed Mohamed Aljunid acknowledges the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and Department of Health Policy and Management, Faculty of Public Health, Kuwait University for the approval and support to participate in this research project. Ashish Awasthi acknowledges funding support from Department of Science and Technology, Government of India through INSPIRE Faculty scheme. Tambe Betran Ayuk acknowledges the Institute of Medical Research and Medicinal Plant studies for institutional support. Peter Azzopardi is supported by a NHMRC Early Career Fellowship. Alaa Badawi is supported by the Public Health Agency of Canada. Shahrzad Bazargan-Hejazi was supported by NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number UL1TR001881. Juan J Carrero acknowledges support from the Swedish Heart and Lung Foundation. Felix Carvalho acknowledges the support of the European Union (FEDER funds POCI/01/0145/FEDER/007728 and POCI/01/0145/FEDER/007265) and National Funds (FCT/MEC, Fundação para a Ciência e a Tecnologia and Ministério da Educação e Ciência) under the Partnership Agreements PT2020 UID/MULTI/04378/2013 and PT2020 UID/QUI/50006/2013. Sheng-Chia Chung is supported by the MRC Population Health Scientist Fellowship (MR/M015084/1). José das Neves was supported in his contribution to this work by a Fellowship from Fundação para a Ciência e a Tecnologia, Portugal (SFRH/BPD/92934/2013). Jan-Walter De Neve was supported by the Alexander von Humboldt Foundation. Louisa Degenhardt is supported by an Australian National Health and Medical Research Council Senior Principal Research Fellowship (IDs: 1041472, 1135991); the National Drug and Alcohol Research Centre at the University of NSW is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund. Yuming Guo was supported by the Career Development Fellowship of Australian National Health and Medical Research Council (#APP1107107). Praveen Hoogar would like to acknowledge the Department of Studies in Anthropology, Karnatak University, Dharwad and Transdisciplinary Centre for Qualitative Methods, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal. Shariful Islam is funded by a Senior Fellowship from Institute for Physical Activity and Nutrition (IPAN), Deakin University and received career transition grants from High Blood Pressure Research Council of Australia. Mihajlo Jakovljevic would like to acknowledge that the South-East European part of this GBD Contribution was co-financed with the Serbian Ministry of Education Science and Technological Development Grant OI 175 014. Srinivasa Vittal Katikireddi acknowledges funding from an NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13 and MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13 and SPHSU15). Ai Koyanagi's work is supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R + D + I and funded by the ISCIII - General Branch Evaluation and Promotion of Health Research - and the European Regional Development Fund (ERDF-FEDER). Kewal Krishan is supported by DST PURSE Grant and UGC Centre of Advanced Study (CAS) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Tea Lallukka is supported by the Academy of Finland (Grants #287488 and #294096). Miriam Levi acknowledges the institutional support received from CeRIMP, Regional Centre for Occupational Diseases and Injuries, Local Health Unit Tuscany Center, Florence, Italy. Andrea Lobato-Cordero acknowledges the Instituto Nacional de Eficiencia Energética y Energías Renovables (INER), Ecuador. Isis Machado acknowledges the Brazilian National Council for Scientific and Technological Development (CNPq) for Post-doc scholarship. Azeem Majeed acknowledges support of Imperial College London from the NW London NIHR Collaboration for Leadership in Applied Health Research & Care. Toni Meier acknowledges funding from the German Federal Ministry of Education and Research (nutriCARD, Grant agreement number 01EA1411C). Walter Mendoza is Program Analyst Population and Development at the Peru Country Office of the United Nations Population Fund-UNFPA, which does not necessarily endorse this study. Sudan Prasad Neupane acknowledges the Southeastern Norway Regional Health Authority [grant number 2016082]. Dr Oladimeji is an African Research Fellow hosted by Human Sciences Research Council (HSRC), South Africa and also has honorary affiliations with Walter Sisulu University (WSU), Eastern Cape, South Africa and School of Public Health, University of Namibia (UNAM), Namibia. Mayowa Owolabi is supported by SIREN grant (U54 HG007479) for investigation of risk factors of stroke (including alcohol). Charles Parry acknowledges institutional support from the South African Medical Research Council. Maria Dolores Sanchez-Niño was funded by Instituto de Salud Carlos III (Miguel Servet CP14/00133). Rodrigo Sarmiento-Suárez receives institutional support from Universidad de Ciencias Aplicadas y Ambientales UDCA, Bogotá, Colombia. Mete Saylan is an employee of Bayer AG. Aletta Schutte was supported by the South African Medical Research Council, and the National Research Foundation (SARChI Research Chair). Aziz Sheikh is supported by The Farr Institute and Health Data Research UK. Nadine Steckling acknowledges funding from the European Union's Seventh Programme for research, technological development, and demonstration under Grant Agreement No. 603946 (Health and Environment-wide Associations based on Large population Surveys, HEALS). Rafael Tabarés-Seisdedos was supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI17/00719 from ISCIII-FEDER. Stefanos Tyrovolas was supported by the Foundation for Education and European Culture (IPEP), the Sara Borrell postdoctoral program (reference no. CD15/00019 from the Instituto de Salud Carlos III (ISCIII—Spain) and the Fondos Europeo de Desarrollo Regional (FEDER). Job FM van Boven was funded by the Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands. Harvey Whiteford is supported by the Queensland Centre for Mental Health Research at the University of Queensland, Brisbane, Australia.
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