The relation between different dimensions of alcohol consumption and burden of disease: an overview

Authors

  • Jürgen Rehm,

    Corresponding author
    1. Centre for Addiction and Mental Health (CAMH), Toronto, Canada,
    2. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,
    3. Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany,
      Jürgen Rehm, Centre for Addiction and Mental Health, Public Health and Regulatory Policy, 33 Russell Street, Room 2035, Toronto, ON, Canada M5S 2S1. E-mail: jtrehm@aol.com
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  • Dolly Baliunas,

    1. Centre for Addiction and Mental Health (CAMH), Toronto, Canada,
    2. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,
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  • Guilherme L. G. Borges,

    1. Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico,
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  • Kathryn Graham,

    1. Centre for Addiction and Mental Health (CAMH), Toronto, Canada,
    2. Department of Psychology, University of Western Ontario, London, Ontario, Canada,
    3. National Drug Research Institute, Curtin University of Technology, Perth, Western Australia,
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  • Hyacinth Irving,

    1. Centre for Addiction and Mental Health (CAMH), Toronto, Canada,
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  • Tara Kehoe,

    1. Centre for Addiction and Mental Health (CAMH), Toronto, Canada,
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  • Charles D. Parry,

    1. Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa,
    2. Department of Psychiatry, Stellenbosch University, Cape Town, South Africa,
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  • Jayadeep Patra,

    1. Centre for Addiction and Mental Health (CAMH), Toronto, Canada,
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  • Svetlana Popova,

    1. Centre for Addiction and Mental Health (CAMH), Toronto, Canada,
    2. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,
    3. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada,
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  • Vladimir Poznyak,

    1. Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland,
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  • Michael Roerecke,

    1. Centre for Addiction and Mental Health (CAMH), Toronto, Canada,
    2. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,
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  • Robin Room,

    1. School of Population Health, University of Melbourne, Australia and
    2. AER Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia
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  • Andriy V. Samokhvalov,

    1. Centre for Addiction and Mental Health (CAMH), Toronto, Canada,
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  • Benjamin Taylor

    1. Centre for Addiction and Mental Health (CAMH), Toronto, Canada,
    2. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,
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Jürgen Rehm, Centre for Addiction and Mental Health, Public Health and Regulatory Policy, 33 Russell Street, Room 2035, Toronto, ON, Canada M5S 2S1. E-mail: jtrehm@aol.com

ABSTRACT

Aims  As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease.

Methods  Systematic literature reviews were used to identify alcohol-related diseases, birth complications and injuries using standard epidemiological criteria to determine causality. The extent of the risk relations was taken from meta-analyses.

Results  Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome. Dose–response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases. Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries. For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day). For several disease and injury categories, the effects were stronger on mortality compared to morbidity. There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden.

Conclusions  Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes. Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol–disease relationships.

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