Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Authors: Max G Griswold, Nancy Fullman, Caitlin Hawley, Nicholas Arian, Stephanie R M Zimsen, Hayley D Tymeson, Vidhya Venkateswaran, Austin Douglas Tapp, Mohammad H Forouzanfar, Joseph S Salama, Kalkidan Hassen Abate, Degu Abate, Solomon M Abay, Cristiana Abbafati, Rizwan Suliankatchi Abdulkader, Zegeye Abebe, Victor Aboyans, Mohammed Mehdi Abrar, Pawan Acharya, Olatunji O Adetokunboh, Tara Ballav Adhikari, Jose C Adsuar, Mohsen Afarideh, Emilie Elisabet Agardh, Gina Agarwal, Sargis Aghasi Aghayan, Sutapa Agrawal, Muktar Beshir Ahmed, Mohammed Akibu, Tomi Akinyemiju, Nadia Akseer, Deena H Al Asfoor, Ziyad Al-Aly, Fares Alahdab, Khurshid Alam, Ammar Albujeer, Kefyalew Addis Alene, Raghib Ali, Syed Danish Ali, Mehran Alijanzadeh, Syed Mohamed Aljunid, Ala'a Alkerwi, Peter Allebeck, Nelson Alvis-Guzman, Azmeraw T Amare, Leopold N Aminde, Walid Ammar, Yaw Ampem Amoako, Gianna Gayle Herrera Amul, Catalina Liliana Andrei, Colin Angus, Mustafa Geleto Ansha, Carl Abelardo T Antonio, Olatunde Aremu, Johan Ärnlöv, Al Artaman, Krishna K Aryal, Reza Assadi, Marcel Ausloos, Leticia Avila-Burgos, Euripide F Avokpaho, Ashish Awasthi, Henok Tadesse Ayele, Rakesh Ayer, Tambe B Ayuk, Peter S Azzopardi, Hamid Badali, Alaa Badawi, Maciej Banach, Suzanne Lyn Barker-Collo, Lope H Barrero, Huda Basaleem, Estifanos Baye, Shahrzad Bazargan-Hejazi, Neeraj Bedi, Yannick Béjot, Abate Bekele Belachew, Saba Abraham Belay, Derrick A Bennett, Isabela M Bensenor, Eduardo Bernabe, Robert S Bernstein, Addisu Shunu Beyene, Tina Beyranvand, Soumyadeeep Bhaumik, Zulfiqar A Bhutta, Belete Biadgo, Ali Bijani, Nigus Bililign, Sait Mentes Birlik, Charles Birungi, Hailemichael Bizuneh, Peter Bjerregaard, Tone Bjørge, Guilherme Borges, Cristina Bosetti, Soufiane Boufous, Nicola Luigi Bragazzi, Hermann Brenner, Zahid A Butt, Lucero Cahuana-Hurtado, Bianca Calabria, Ismael R Campos-Nonato, Julio Cesar Campuzano, Giulia Carreras, Juan J Carrero, Félix Carvalho, Carlos A Castañeda-Orjuela, Jacqueline Castillo Rivas, Ferrán Catalá-López, Jung-Chen Chang, Fiona J Charlson, Aparajita Chattopadhyay, Pankaj Chaturvedi, Rajiv Chowdhury, Devasahayam J Christopher, Sheng-Chia Chung, Liliana G Ciobanu, Rafael M Claro, Sara Conti, Ewerton Cousin, Michael H Criqui, Berihun Assefa Dachew, Paul I Dargan, Ahmad Daryani, José Das Neves, Kairat Davletov, Filipa De Castro, Barbora De Courten, Jan-Walter De Neve, Louisa Degenhardt, Gebre Teklemariam Demoz, Don C Des Jarlais, Subhojit Dey, Rupinder Singh Dhaliwal, Samath Dhamminda Dharmaratne, Meghnath Dhimal, David Teye Doku, Kerrie E Doyle, Manisha Dubey, Eleonora Dubljanin, Bruce B Duncan, Hedyeh Ebrahimi, Dumessa Edessa, Maysaa El Sayed Zaki, Sergei Petrovich Ermakov, Holly E Erskine, Alireza Esteghamati, Mahbobeh Faramarzi, Andrea Farioli, Andre Faro, Maryam S Farvid, Farshad Farzadfar, Valery L Feigin, Mariana Santos Felisbino-Mendes, Eduarda Fernandes, Alize J Ferrari, Cleusa P Ferri, Daniel Obadare Fijabi, Irina Filip, Jonas David Finger, Florian Fischer, Abraham D Flaxman, Richard Charles Franklin, Neal D Futran, Silvano Gallus, Morsaleh Ganji, Fortune Gbetoho Gankpe, Gebremedhin Berhe Gebregergs, Tsegaye Tewelde Gebrehiwot, Johanna M Geleijnse, Reza Ghadimi, Lilian A Ghandour, Mamata Ghimire, Paramjit Singh Gill, Ibrahim Abdelmageed Ginawi, Ababi Zergaw Z Giref, Philimon N Gona, Sameer Vali Gopalani, Carolyn C Gotay, Alessandra C Goulart, Felix Greaves, Giuseppe Grosso, Yuming Guo, Rahul Gupta, Rajeev Gupta, Vipin Gupta, Reyna Alma Gutiérrez, Murthy GVS, Nima Hafezi-Nejad, Tekleberhan Beyene Hagos, Gessessew Bugssa Hailu, Randah R Hamadeh, Samer Hamidi, Graeme J Hankey, Hilda L Harb, Sivadasanpillai Harikrishnan, Josep Maria Haro, Hamid Yimam Hassen, Rasmus Havmoeller, Simon I Hay, Behzad Heibati, Andualem Henok, Ileana Heredia-Pi, Norberto Francisco Hernández-Llanes, Claudiu Herteliu, Desalegn Ts Tsegaw Hibstu, Praveen Hoogar, Nobuyuki Horita, H Dean Hosgood, Mostafa Hosseini, Mihaela Hostiuc, Guoqing Hu, Hsiang Huang, Abdullatif Husseini, Bulat Idrisov, Bogdan Vasile Ileanu, Olayinka Stephen Ilesanmi, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Maria D Jackson, Mihajlo Jakovljevic, Moti Tolera Jalu, Achala Upendra Jayatilleke, Ravi Prakash Jha, Jost B Jonas, Jacek Jerzy Jozwiak, Zubair Kabir, Rajendra Kadel, Amaha Kahsay, Umesh Kapil, Amir Kasaeian, Tesfaye D Dessale Kassa, Srinivasa Vittal Katikireddi, Norito Kawakami, Seifu Kebede, Adane Teshome Kefale, Peter Njenga Keiyoro, Andre Pascal Kengne, Yousef Khader, Morteza Abdullatif Khafaie, Ibrahim A Khalil, Md Nuruzzaman Khan, Young-Ho Khang, Mona M Khater, Jagdish Khubchandani, Cho-Il Kim, Daniel Kim, Yun Jin Kim, Ruth W Kimokoti, Adnan Kisa, Mika Kivimäki, Sonali Kochhar, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Veena S Kulkarni, Pushpendra Kumar, Alessandra Lafranconi, Arjun Lakshmana Balaji, Ratilal Lalloo, Tea Lallukka, Hilton Lam, Faris Hasan Lami, Qing Lan, Justin J Lang, Sonia Lansky, Anders O Larsson, Arman Latifi, Janet L Leasher, Paul H Lee, James Leigh, Mall Leinsalu, Janni Leung, Miriam Levi, Yichong Li, Lee-Ling Lim, Shai Linn, Shiwei Liu, Andrea Lobato-Cordero, Alan D Lopez, Stefan Lorkowski, Paulo A Lotufo, Erlyn Rachelle King Macarayan, Isis Eloah Machado, Fabiana Madotto, Hassan Magdy Abd El Razek, Muhammed Magdy Abd El Razek, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Chabila Christopher Mapoma, Jose Martinez-Raga, Pallab K Maulik, Mohsen Mazidi, Martin Mckee, Varshil Mehta, Toni Meier, Tesfa Mekonen, Kidanu Gebremariam Meles, Addisu Melese, Peter T N Memiah, Walter Mendoza, Desalegn Tadese Mengistu, George A Mensah, Tuomo J Meretoja, Haftay Berhane Mezgebe, Tomasz Miazgowski, Ted R Miller, Gk Mini, Andreea Mirica, Erkin M Mirrakhimov, Babak Moazen, Karzan Abdulmuhsin Mohammad, Noushin Mohammadifard, Shafiu Mohammed, Lorenzo Monasta, Paula Moraga, Lidia Morawska, Seyyed Meysam Mousavi, Satinath Mukhopadhyay, Kamarul Imran Musa, Aliya Naheed, Gurudatta Naik, Farid Najafi, Vinay Nangia, Jobert Richie Nansseu, Mudavath Siva Durga Prasad Nayak, Chakib Nejjari, Subas Neupane, Sudan Prasad Neupane, Josephine W Ngunjiri, Cuong Tat Nguyen, Long Hoang Nguyen, Trang Huyen Nguyen, Dina Nur Anggraini Ningrum, Yirga Legesse Nirayo, Jean Jacques Noubiap, Richard Ofori-Asenso, Felix Akpojene Ogbo, In-Hwan Oh, Olanrewaju Oladimeji, Andrew T Olagunju, Pedro R Olivares, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Anu Mary Oommen, Eyal Oren, Heather M Orpana, Doris D V Ortega-Altamirano, Justin R Ortiz, Erika Ota, Mayowa Ojo Owolabi, Abayomi Samuel Oyekale, Mahesh P A, Adrian Pana, Eun-Kee Park, Charles D H Parry, Hadi Parsian, Ajay Patle, George C Patton, Deepak Paudel, Max Petzold, Michael R Phillips, Julian David Pillay, Maarten J Postma, Farshad Pourmalek, Dorairaj Prabhakaran, Mostafa Qorbani, Amir Radfar, Anwar Rafay, Alireza Rafiei, Fakher Rahim, Afarin Rahimi-Movaghar, Mahfuzar Rahman, Muhammad Aziz Rahman, Rajesh Kumar Rai, Sasa Rajsic, Sree Bhushan Raju, Usha Ram, Saleem M Rana, Chhabi Lal Ranabhat, David Laith Rawaf, Salman Rawaf, Robert C Reiner, Cesar Reis, Andre M N Renzaho, Mohammad Sadegh Rezai, Leonardo Roever, Luca Ronfani, Robin Room, Gholamreza Roshandel, Ali Rostami, Gregory A Roth, Ambuj Roy, Yogesh Damodar Sabde, Basema Saddik, Saeid Safiri, Amirhossein Sahebkar, Joseph S Salama, Zikria Saleem, Joshua A Salomon, Sundeep Santosh Salvi, Juan Sanabria, Maria Dolores Sanchez-Niño, Damian Francesco Santomauro, Itamar S Santos, Milena M M Santric Milicevic, Abdur Razzaque Sarker, Rodrigo Sarmiento-Suárez, Nizal Sarrafzadegan, Benn Sartorius, Maheswar Satpathy, Monika Sawhney, Sonia Saxena, Mete Saylan, Michael P Schaub, Maria Inês Schmidt, Ione J C Schneider, Ben Schöttker, Aletta Elisabeth Schutte, Falk Schwendicke, Sadaf G Sepanlou, Masood Ali Shaikh, Mehdi Sharif, Jun She, Aziz Sheikh, Jiabin Shen, Mekonnen Sisay Shiferaw, Mika Shigematsu, Rahman Shiri, Kawkab Shishani, Ivy Shiue, Sharvari Rahul Shukla, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, Natacha Torres Da Silva, Dayane Gabriele Alves Silveira, Dhirendra Narain Sinha, Freddy Sitas, Adauto Martins Soares Filho, Moslem Soofi, Reed J D Sorensen, Joan B Soriano, Chandrashekhar T Sreeramareddy, Nadine Steckling, Dan J Stein, Mu'awiyyah Babale Sufiyan, Patrick J Sur, Bryan L Sykes, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Mohammad Tavakkoli, Arash Tehrani-Banihashemi, Merhawi Gebremedhin Tekle, Subash Thapa, Nihal Thomas, Roman Topor-Madry, Fotis Topouzis, Bach Xuan Tran, Christopher E Troeger, Thomas Clement Truelsen, Nikolaos Tsilimparis, Stefanos Tyrovolas, Kingsley Nnanna Ukwaja, Irfan Ullah, Olalekan A Uthman, Pascual R Valdez, Job F M Van Boven, Tommi Juhani Vasankari, Narayanaswamy Venketasubramanian, Francesco S Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Stein Emil Vollset, Theo Vos, Fasil Wagnew Shiferaw Wagnew, Yasir Waheed, Yuan-Pang Wang, Elisabete Weiderpass, Fitsum Weldegebreal, Kidu Gidey Weldegwergs, Andrea Werdecker, Ronny Westerman, Harvey A Whiteford, Justyna Widecka, Tissa Wijeratne, Grant M A Wyper, Gelin Xu, Tomohide Yamada, Yuichiro Yano, Pengpeng Ye, Ebrahim M Yimer, Paul Yip, Biruck Desalegn Yirsaw, Engida Yisma, Naohiro Yonemoto, Seok-Jun Yoon, Marcel Yotebieng, Mustafa Z Younis, Geevar Zachariah, Zoubida Zaidi, Mohammad Zamani, Xueying Zhang, Sanjay Zodpey, Ali H Mokdad, Mohsen Naghavi, Christopher J L Murray, Emmanuela Gakidou
Journal: The Lancet (2018)

<h2>Summary</h2><h3>Background</h3> 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. <h3>Methods</h3> 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. <h3>Findings</h3> 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. <h3>Interpretation</h3> 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. <h3>Funding</h3> Bill & Melinda Gates Foundation.