Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of observational studies for an etiology/harm question
PubMed 30146330 · doi:10.1016/S0140-6736(18)31310-2
What was done
Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, the authors estimated alcohol use, attributable deaths, and disability-adjusted life-years (DALYs) across 195 countries and territories from 1990 to 2016 for ages 15 to 95+ years. The analysis incorporated 694 data sources on individual and population-level alcohol consumption and 592 prospective and retrospective studies. The authors adjusted for unrecorded and tourist consumption, performed a meta-analysis of relative risks for 23 alcohol-associated health outcomes, and calculated the consumption level (1 standard drink = 10 g ethyl alcohol) that minimises overall individual health risk.
What was found
In 2016, alcohol was the seventh leading risk factor for global deaths and DALYs, accounting for 2.2% (95% UI 1.5–3.0) of age-standardised female deaths and 6.8% (95% UI 5.8–8.0) of age-standardised male deaths. For individuals aged 15–49 years, alcohol was the leading risk factor globally, causing 3.8% (95% UI 3.2–4.3) of female deaths, 12.2% (95% UI 10.8–13.6) of male deaths, 2.3% (95% UI 2.0–2.6) of female DALYs, and 8.9% (95% UI 7.8–9.9) of male DALYs. Leading causes of attributable deaths in this younger bracket were tuberculosis (1.4%), road injuries (1.2%), and self-harm (1.1%). In ages 50 and older, cancers drove 27.1% (95% UI 21.2–33.3) of female and 18.9% (95% UI 15.3–22.6) of male alcohol-attributable deaths. The consumption level that minimised overall health loss across outcomes was 0.0 (95% UI 0.0–0.8) standard drinks per week.
Why it matters
This global analysis challenges established paradigms regarding the net cardiovascular benefits of moderate drinking, showing that any potential protective effects are outweighed by increased risks of cancer, injury, and communicable disease at the population level.
Limits
The underlying relative risk estimates derive primarily from observational studies susceptible to residual confounding and exposure misclassification. Consumption estimates rely heavily on self-reported intake and aggregate sales data, which may introduce recall and reporting biases despite statistical adjustments.
Cited by
- supports Consuming more than one alcoholic drink per day is detrimental to health.
- supports Any cardiovascular benefits associated with low alcohol intake are smaller than the associated increase in cancer risk, resulting in no net reduction in mortality.