A narrative review of alcohol consumption as a risk factor for global burden of disease

Abstract

Since the original Comparative Risk Assessment (CRA) for alcohol consumption as part of the Global Burden of Disease Study for 1990, there had been regular updates of CRAs for alcohol from the World Health Organization and/or the Institute for Health Metrics and Evaluation. These studies have become more and more refined with respect to establishing causality between dimensions of alcohol consumption and different disease and mortality (cause of death) outcomes, refining risk relations, and improving the methodology for estimating exposure and alcohol-attributable burden. The present review will give an overview on the main results of the CRAs with respect to alcohol consumption as a risk factor, sketch out new trends and developments, and draw implications for future research and policy.

The relationship between different dimensions of alcohol use and the burden of disease—an update

“…Improving measurement of alcohol exposure (including but not limited to measurement of chronic and irregular heavy drinking), as described in the limitations above, should be one of the research priorities. Other research priorities (see also 1) include: Improving incorporating time lags 186 into future CRAs: this applies not only to effects of alcohol use, but also to all risk factors, as CRAs need to be comparative.Improving our knowledge about risk relations: as indicated above, for most countries with the exception of Russia and surrounding countries 269, we assume that risk relations taken from the most comprehensive meta‐analysis are applicable. Given the genetic and environmental differences, we would expect some differences in risk relations between alcohol use and disease/mortality outcomes in different regions (see the example of genetically based varying cancer risks described above, which had marked implications for the population‐level burden of oesophagus cancer in Japan 175; see also some indications that alcohol use has different risk for cardiovascular events in Asians versus non‐Asians 263, 350).…”

“…Alcohol consumption has been identified as a major contributor to the burden of disease and mortality in all the global Comparative Risk Assessments (CRAs 1) conducted thus far as part of the Global Burden of Disease (GBD) studies 2, 3, 4, 5, 6, 7, and in the World Health Organization (WHO) Global Status Reports on Alcohol and Health and their predecessors 8, 9, 10. All CRAs restricted themselves to modifiable risk factors 11, where the modifications could be linked to reductions in the disease burden 12.…”

The contribution of unrecorded alcohol to health harm

“…While most people who report a psychotic experience will not develop schizophrenia, they are still at risk for non-psychotic psychiatric disorders [3], chronic health conditions [7,8], suicidal behaviors [9] and perceived need for help [10,11]. In other words, psychotic experiences indicate the presence of a broad range of mental and physical health problems, and so it is certainly possible that cannabis can be used to selfmedicate the underlying stress associated with these problems.…”

“…An estimated 25% of the global alcohol consumption is estimated as unrecorded [7], and this proportion is highest in low-and middle-income countries [8]. Estimating the contribution of unrecorded alcohol to the alcohol-attributable burden of disease correctly is thus crucial for comparative risk assessments [9,10]. The arguments of Lachenmeier & Walch [1] raise two questions: (1) should we estimate attributable burden for all or part of unrecorded alcohol with different relative risk functions than for recorded alcohol and (2) are we confident about the inclusion of all the deaths from substances such as methanol under alcohol-attributable deaths?…”

Predictors of Persistence of Risky Drinking in Adults: An 11-Year Follow-Up Study

“…Excessive alcohol use is one of the major health hazards that is currently prevailing worldwide [1] and poses a threat not only to the health and well-being of the drinker but also to the welfare of the society, thereby creating significant financial burden [2,3]. During the past 2 decades, a great potential for reducing alcohol-related harm has been recognised to lie in secondary prevention, that is, screening and brief intervention, which refers to counselling risky or hazardous drinkers to reduce their drinking and to avoid alcohol dependence and other alcohol-related hazards [4,5,6].…”