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Lancet. 2018 Sep 22;392(10152):1015-1035. doi: 10.1016/S0140-6736(18)31310-2. Epub 2018 Aug 23.

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

Collaborators (513)

Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SRM, Tymeson HD, Venkateswaran V, Tapp AD, Forouzanfar MH, Salama JS, Abate KH, Abate D, Abay SM, Abbafati C, Abdulkader RS, Abebe Z, Aboyans V, Abrar MM, Acharya P, Adetokunboh OO, Adhikari TB, Adsuar JC, Afarideh M, Agardh EE, Agarwal G, Aghayan SA, Agrawal S, Ahmed MB, Akibu M, Akinyemiju T, Akseer N, Asfoor DHA, Al-Aly Z, Alahdab F, Alam K, Albujeer A, Alene KA, Ali R, Ali SD, Alijanzadeh M, Aljunid SM, Alkerwi A, Allebeck P, Alvis-Guzman N, Amare AT, Aminde LN, Ammar W, Amoako YA, Amul GGH, Andrei CL, Angus C, Ansha MG, Antonio CAT, Aremu O, Ärnlöv J, Artaman A, Aryal KK, Assadi R, Ausloos M, Avila-Burgos L, Avokpaho EF, Awasthi A, Ayele HT, Ayer R, Ayuk TB, Azzopardi PS, Badali H, Badawi A, Banach M, Barker-Collo SL, Barrero LH, Basaleem H, Baye E, Bazargan-Hejazi S, Bedi N, Béjot Y, Belachew AB, Belay SA, Bennett DA, Bensenor IM, Bernabe E, Bernstein RS, Beyene AS, Beyranvand T, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bililign N, Birlik SM, Birungi C, Bizuneh H, Bjerregaard P, Bjørge T, Borges G, Bosetti C, Boufous S, Bragazzi NL, Brenner H, Butt ZA, Cahuana-Hurtado L, Calabria B, Campos-Nonato IR, Campuzano JC, Carreras G, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Catalá-López F, Chang JC, Charlson FJ, Chattopadhyay A, Chaturvedi P, Chowdhury R, Christopher DJ, Chung SC, Ciobanu LG, Claro RM, Conti S, Cousin E, Criqui MH, Dachew BA, Dargan PI, Daryani A, Das Neves J, Davletov K, De Castro F, De Courten B, De Neve JW, Degenhardt L, Demoz GT, Des Jarlais DC, Dey S, Dhaliwal RS, Dharmaratne SD, Dhimal M, Doku DT, Doyle KE, Dubey M, Dubljanin E, Duncan BB, Ebrahimi H, Edessa D, El Sayed Zaki M, Ermakov SP, Erskine HE, Esteghamati A, Faramarzi M, Farioli A, Faro A, Farvid MS, Farzadfar F, Feigin VL, Felisbino-Mendes MS, Fernandes E, Ferrari AJ, Ferri CP, Fijabi DO, Filip I, Finger JD, Fischer F, Flaxman AD, Franklin RC, Futran ND, Gallus S, Ganji M, Gankpe FG, Gebregergs GB, Gebrehiwot TT, Geleijnse JM, Ghadimi R, Ghandour LA, Ghimire M, Gill PS, Ginawi IA, Giref AZZ, Gona PN, Gopalani SV, Gotay CC, Goulart AC, Greaves F, Grosso G, Guo Y, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Gvs M, Hafezi-Nejad N, Hagos TB, Hailu GB, Hamadeh RR, Hamidi S, Hankey GJ, Harb HL, Harikrishnan S, Haro JM, Hassen HY, Havmoeller R, Hay SI, Heibati B, Henok A, Heredia-Pi I, Hernández-Llanes NF, Herteliu C, Hibstu DTT, Hoogar P, Horita N, Hosgood HD, Hosseini M, Hostiuc M, Hu G, Huang H, Husseini A, Idrisov B, Ileanu BV, Ilesanmi OS, Irvani SSN, Islam SMS, Jackson MD, Jakovljevic M, Jalu MT, Jayatilleke AU, Jha RP, Jonas JB, Jozwiak JJ, Kabir Z, Kadel R, Kahsay A, Kapil U, Kasaeian A, Kassa TDD, Katikireddi SV, Kawakami N, Kebede S, Kefale AT, Keiyoro PN, Kengne AP, Khader Y, Khafaie MA, Khalil IA, Khan MN, Khang YH, Khater MM, Khubchandani J, Kim CI, Kim D, Kim YJ, Kimokoti RW, Kisa A, Kivimäki M, Kochhar S, Kosen S, Koul PA, Koyanagi A, Krishan K, Kuate Defo B, Kucuk Bicer B, Kulkarni VS, Kumar P, Lafranconi A, Lakshmana Balaji A, Lalloo R, Lallukka T, Lam H, Lami FH, Lan Q, Lang JJ, Lansky S, Larsson AO, Latifi A, Leasher JL, Lee PH, Leigh J, Leinsalu M, Leung J, Levi M, Li Y, Lim LL, Linn S, Liu S, Lobato-Cordero A, Lopez AD, Lotufo PA, Macarayan ERK, Machado IE, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Mapoma CC, Martinez-Raga J, Maulik PK, Mazidi M, Mckee M, Mehta V, Meier T, Mekonen T, Meles KG, Melese A, Memiah PTN, Mendoza W, Mengistu DT, Mensah GA, Meretoja TJ, Mezgebe HB, Miazgowski T, Miller TR, Mini G, Mirica A, Mirrakhimov EM, Moazen B, Mohammad KA, Mohammadifard N, Mohammed S, Monasta L, Moraga P, Morawska L, Mousavi SM, Mukhopadhyay S, Musa KI, Naheed A, Naik G, Najafi F, Nangia V, Nansseu JR, Nayak MSDP, Nejjari C, Neupane S, Neupane SP, Ngunjiri JW, Nguyen CT, Nguyen LH, Nguyen TH, Ningrum DNA, Nirayo YL, Noubiap JJ, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olivares PR, Olusanya BO, Olusanya JO, Oommen AM, Oren E, Orpana HM, Ortega-Altamirano DDV, Ortiz JR, Ota E, Owolabi MO, Oyekale AS, P A M, Pana A, Park EK, Parry CDH, Parsian H, Patle A, Patton GC, Paudel D, Petzold M, Phillips MR, Pillay JD, Postma MJ, Pourmalek F, Prabhakaran D, Qorbani M, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi-Movaghar A, Rahman M, Rahman MA, Rai RK, Rajsic S, Raju SB, Ram U, Rana SM, Ranabhat CL, Rawaf DL, Rawaf S, Reiner RC, Reis C, Renzaho AMN, Rezai MS, Roever L, Ronfani L, Room R, Roshandel G, Rostami A, Roth GA, Roy A, Sabde YD, Saddik B, Safiri S, Sahebkar A, Salama JS, Saleem Z, Salomon JA, Salvi SS, Sanabria J, Sanchez-Niño MD, Santomauro DF, Santos IS, Santric Milicevic MMM, Sarker AR, Sarmiento-Suárez R, Sarrafzadegan N, Sartorius B, Satpathy M, Sawhney M, Saxena S, Saylan M, Schaub MP, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwendicke F, Sepanlou SG, Shaikh MA, Sharif M, She J, Sheikh A, Shen J, Shiferaw MS, Shigematsu M, Shiri R, Shishani K, Shiue I, Shukla SR, Sigfusdottir ID, Silva DAS, Silva NTD, Silveira DGA, Sinha DN, Sitas F, Soares Filho AM, Soofi M, Sorensen RJD, Soriano JB, Sreeramareddy CT, Steckling N, Stein DJ, Sufiyan MB, Sur PJ, Sykes BL, Tabarés-Seisdedos R, Tabuchi T, Tavakkoli M, Tehrani-Banihashemi A, Tekle MG, Thapa S, Thomas N, Topor-Madry R, Topouzis F, Tran BX, Troeger CE, Truelsen TC, Tsilimparis N, Tyrovolas S, Ukwaja KN, Ullah I, Uthman OA, Valdez PR, Van Boven JFM, Vasankari TJ, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vos T, Wagnew FWS, Waheed Y, Wang YP, Weiderpass E, Weldegebreal F, Weldegwergs KG, Werdecker A, Westerman R, Whiteford HA, Widecka J, Wijeratne T, Wyper GMA, Xu G, Yamada T, Yano Y, Ye P, Yimer EM, Yip P, Yirsaw BD, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zachariah G, Zaidi Z, Zamani M, Zhang X, Zodpey S, Mokdad AH, Naghavi M, Murray CJL, Gakidou E.

Erratum in

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.

PMID:
30146330
PMCID:
PMC6148333
DOI:
10.1016/S0140-6736(18)31310-2
[Indexed for MEDLINE]
Free PMC Article

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