alcohol as leading risk facor for death in those 15-49yo
The Lancet recently published a review of the global burden of disease from alcohol use from 1990 to 2016, a systematic analysis for the Global Burden of Disease Study 2016 (see alcohol leading risk factor death globally lancet2018 in dropbox, or doi.org/10.1016/ S0140-6736(18)31571-X). Funding Bill & Melinda Gates Foundation.
Details:
-- 694 data sources of individual and population-level alcohol consumption, including 28 million individuals and 649,000 registered cases of the respective outcomes, in 195 countries
-- a standard drink was considered 10 g of pure ethyl alcohol
-- as opposed to prior studies, they included:
-- estimates of tourist and unrecorded alcohol consumption (they used local published data to estimate consumption both from tourists as well as from illicit production, homebrewing, local beverages, or alcohol sold as nonalcohol products), though they acknowledge that this data might not be completely reflective of the drinking patterns
-- they tried to use controls for different reference categories and the average age of participants (ie, “the sick quitter hypothesis”: the big issue from old studies finding the protective effect of alcohol was the nondrinker category included people sick from alcohol consumption who had stopped drinking as a result).
-- They devised a new methodology to assess what level of alcohol consumption minimized the overall risk to individual health
-- they divided countries into different socio-demographic groups (they refer to this as a socio-demographic index, SDI)
Results, in 2016:
-- 32.5% of people globally were current drinkers: 25% of females and 39% of males, corresponding to 2.4 billion people (1.5 billion males and 0.9 billion females)
-- the mean amount of alcohol consumed was 0.73 standard drinks daily for females and 1.7 for males
-- prevalence for drinking was highest in the high SDI locations (72% of females and 83% of males were current drinkers), and lowest in low to middle SDI locations (8.9% of females and 20% of males)
-- globally, alcohol use was the 7th leading risk factor for both deaths and disability-adjusted life-years (DALYs) in 2016, with 2.8 million deaths attributable to alcohol use
-- 2.2% of age-standardized female deaths
-- 6.8% of age-standardized male deaths
-- DALYs: in females, 1.6% of total; in males 6.0% of total
-- 15 to 49 years olds: alcohol use was the leading risk factor for:
-- 3.8% of female deaths and 12.2% of male deaths
-- 2.3% of the attributable female DALYs and 8.9% of attributable male DALYs
-- the 3 leading causes of attributable deaths were tuberculosis (1.4%), road injuries (1.2%) and self-harm (1.1%).
-- >50 year olds:
-- cancer was a large proportion of total alcohol attributable deaths: 27.1% of female deaths and 18.9% of male deaths
-- in females, alcohol-attributable burden increased with age, though there was some protective effects for ischemic heart disease and diabetes beyond 60 years of age. There was a J-shaped curve for ischemic heart disease (but not diabetes or ischemic stroke) with a minimum relative risk of 0.82
-- in males alcohol-attributable burden increased until between 55 to 65 years old, and those in high SDI and low SDI locations had some protective effect for ischemic heart disease, but this effect was very small compared with the total attributable burden in these locations, with a minimum relative risk of 0.86
-- for all other outcomes the relative risk increased monotonically with alcohol consumption
-- they do present data on the individual risks by countries per SDI, for example finding that tuberculosis was the leading cause of death/DALYs by far in lower SDI countries
-- “the level of alcohol consumption that minimized harm across health incomes was zerostandard drinks per week”
Commentary:
-- there are significant issues with quantifying the actual burden of alcohol use on human health.
--As mentioned, many studies categorize as nondrinkers people who are very sick from alcohol use and therefore not currently drinking . Studies which try to exclude these people have found no or minimal benefit from moderate alcohol consumption (specifically in cardioprotection), and no benefit has been found in a few Mendelian randomization studies (see http://gmodestmedblogs.blogspot.com/2015/02/moderate-alcohol-and-cardioprotection.html )
-- there may well be differences in the manner of alcohol consumption in terms of its adverse effects, and studies have not been great in differentiating the effects of cumulative alcohol consumption vs acute intoxication vs dependent drinking
-- the cancers related to alcohol use included breast, esophageal, liver, larynx, lip and oral cavity, and pharynx and nasopharynx. They used other studies to assess the magnitude of the alcohol-attributable risk for these cancers
-- it should be noted that in terms of cardiovascular outcomes, there was a relatively small benefit in terms of ischemic heart disease, however there was also a net negative in terms of hypertensive heart disease, ischemic and hemorrhagic stroke, and atrial fibrillation and flutter.
-- There are certainly several limitations of the study, including: really accurate estimates of alcohol consumption (e.g. getting really accurate data on illicit production and unrecorded consumption), the specifics of drinking patterns as noted above, limited data on the estimate of motor vehicle deaths/DALYs related to alcohol, the harms caused to others from alcohol (e.g. alcohol-attributable interpersonal violence), and data on youth drinking, given that this study started at age 15.
So, the bottom line is that though there may be a small protective effect of alcohol on ischemic heart disease outcomes (which is debatable), all of the other outcomes they measured showed that alcohol was toxic and associated with lots of deaths and DALYs. And, despite the small degree of cardioprotection from ischemic heart disease that they found, the overall net effect of alcohol was clearly negative and began at anything above 0 drinks per day.
geoff
Details:
-- 694 data sources of individual and population-level alcohol consumption, including 28 million individuals and 649,000 registered cases of the respective outcomes, in 195 countries
-- a standard drink was considered 10 g of pure ethyl alcohol
-- as opposed to prior studies, they included:
-- estimates of tourist and unrecorded alcohol consumption (they used local published data to estimate consumption both from tourists as well as from illicit production, homebrewing, local beverages, or alcohol sold as nonalcohol products), though they acknowledge that this data might not be completely reflective of the drinking patterns
-- they tried to use controls for different reference categories and the average age of participants (ie, “the sick quitter hypothesis”: the big issue from old studies finding the protective effect of alcohol was the nondrinker category included people sick from alcohol consumption who had stopped drinking as a result).
-- They devised a new methodology to assess what level of alcohol consumption minimized the overall risk to individual health
-- they divided countries into different socio-demographic groups (they refer to this as a socio-demographic index, SDI)
Results, in 2016:
-- 32.5% of people globally were current drinkers: 25% of females and 39% of males, corresponding to 2.4 billion people (1.5 billion males and 0.9 billion females)
-- the mean amount of alcohol consumed was 0.73 standard drinks daily for females and 1.7 for males
-- prevalence for drinking was highest in the high SDI locations (72% of females and 83% of males were current drinkers), and lowest in low to middle SDI locations (8.9% of females and 20% of males)
-- globally, alcohol use was the 7th leading risk factor for both deaths and disability-adjusted life-years (DALYs) in 2016, with 2.8 million deaths attributable to alcohol use
-- 2.2% of age-standardized female deaths
-- 6.8% of age-standardized male deaths
-- DALYs: in females, 1.6% of total; in males 6.0% of total
-- 15 to 49 years olds: alcohol use was the leading risk factor for:
-- 3.8% of female deaths and 12.2% of male deaths
-- 2.3% of the attributable female DALYs and 8.9% of attributable male DALYs
-- the 3 leading causes of attributable deaths were tuberculosis (1.4%), road injuries (1.2%) and self-harm (1.1%).
-- >50 year olds:
-- cancer was a large proportion of total alcohol attributable deaths: 27.1% of female deaths and 18.9% of male deaths
-- in females, alcohol-attributable burden increased with age, though there was some protective effects for ischemic heart disease and diabetes beyond 60 years of age. There was a J-shaped curve for ischemic heart disease (but not diabetes or ischemic stroke) with a minimum relative risk of 0.82
-- in males alcohol-attributable burden increased until between 55 to 65 years old, and those in high SDI and low SDI locations had some protective effect for ischemic heart disease, but this effect was very small compared with the total attributable burden in these locations, with a minimum relative risk of 0.86
-- for all other outcomes the relative risk increased monotonically with alcohol consumption
-- they do present data on the individual risks by countries per SDI, for example finding that tuberculosis was the leading cause of death/DALYs by far in lower SDI countries
-- “the level of alcohol consumption that minimized harm across health incomes was zerostandard drinks per week”
Commentary:
-- there are significant issues with quantifying the actual burden of alcohol use on human health.
--As mentioned, many studies categorize as nondrinkers people who are very sick from alcohol use and therefore not currently drinking . Studies which try to exclude these people have found no or minimal benefit from moderate alcohol consumption (specifically in cardioprotection), and no benefit has been found in a few Mendelian randomization studies (see http://gmodestmedblogs.blogspot.com/2015/02/moderate-alcohol-and-cardioprotection.html )
-- there may well be differences in the manner of alcohol consumption in terms of its adverse effects, and studies have not been great in differentiating the effects of cumulative alcohol consumption vs acute intoxication vs dependent drinking
-- the cancers related to alcohol use included breast, esophageal, liver, larynx, lip and oral cavity, and pharynx and nasopharynx. They used other studies to assess the magnitude of the alcohol-attributable risk for these cancers
-- it should be noted that in terms of cardiovascular outcomes, there was a relatively small benefit in terms of ischemic heart disease, however there was also a net negative in terms of hypertensive heart disease, ischemic and hemorrhagic stroke, and atrial fibrillation and flutter.
-- There are certainly several limitations of the study, including: really accurate estimates of alcohol consumption (e.g. getting really accurate data on illicit production and unrecorded consumption), the specifics of drinking patterns as noted above, limited data on the estimate of motor vehicle deaths/DALYs related to alcohol, the harms caused to others from alcohol (e.g. alcohol-attributable interpersonal violence), and data on youth drinking, given that this study started at age 15.
So, the bottom line is that though there may be a small protective effect of alcohol on ischemic heart disease outcomes (which is debatable), all of the other outcomes they measured showed that alcohol was toxic and associated with lots of deaths and DALYs. And, despite the small degree of cardioprotection from ischemic heart disease that they found, the overall net effect of alcohol was clearly negative and began at anything above 0 drinks per day.
geoff
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