Towards a standardised methodology for estimating alcohol‐caused death, injury and illness in Australia

Abstract

Two key methodological issues underlying different methods for calculating estimates of the number of alcohol‐caused deaths are identified and recommendations suggested for future work. 1. How to adjust alcohol aetiologic fractions across time and place to reflect different levels of risky drinking. A common approach is outlined for both acute and chronic alcohol‐related conditions. In the absence of consistent, reliable and regionally specific measures of the prevalence of risky alcohol consumption from national surveys, the use of per capita consumption data as a means of adjusting alcohol population aetiologic fractions over time and across regions is recommended. 2. Whether abstainers or low‐risk drinkers should be used as the reference group when assessing the impact of alcohol consumption and how the resulting information is best presented. It is recommended that when abstainers are used as the reference group, the costs and benefits for both‘low‐risk’ and ‘risky/high‐risk’ drinking should be identified. Using this approach, it was estimated that for Australia in 1998 there was a net benefit of 5,100 lives saved due to low‐risk drinking, while there was a net loss of 2,737 lives due to risky/high‐risk drinking. On its own, the figure of a net saving of 2,363 lives per year is a simplistic and potentially misleading picture of alcohol as a net benefit to public health and safety. For public health communications, there is still value in providing estimates using the low‐risk drinking contrast, of the number of lives saved if risky/high‐risk drinkers all became low‐risk drinkers (n=3,292 in 1998). The use of the abstinence contrast, however, allows the more complex picture of alcohol's impact on public health to be apparent, e.g. including the estimated 1,505 deaths associated with low‐risk drinking (mostly from cancer).

Trends in alcohol‐attributable hospitalisation in the Northern Territory, 1998–99 to 2008–09

“…Methodological improvements developed by the National Alcohol Indicators Project (NAIP) underlie all the estimates provided and build upon previous NAIP reports. Some of the innovations in methodology included in this report are the application of recent recall methods for improved self-reported estimates of alcohol consumption (Stockwell et al in press), the calculation of state/territory and year specific alcohol aetiologic fractions for calculating alcohol-caused deaths and hospitalisations (Chikritzhs et al, 2002a) and the calculation and use of 'Estimated Service Populations' for calculating per capita alcohol consumption . While there was an encouraging, if mostly gradual, decline in alcohol-caused deaths from 1990 to 2001, the overall burden of death, injury and disease from alcohol in this period was substantial.…”

“…Full methodological details can be found in earlier technical reports (Chikritzhs et al, 2000a), the World Health Organisation guide for monitoring alcohol consumption and related harms (2000) and various published papers (e.g. Chikritzhs et al, 2001;Chikritzhs et al, 2002a) and can be obtained from the National Drug Research Institute at GPO Box U1987, Perth, WA 6845 or email requests to: enquiries@ndri.curtin.edu.au…”

“…assault, road injury, drowning). These distinctions also relate to NHMRC drinking guidelines that provide separate recommendations for regular drinking and single drinking occasions (NHMRC, 2000) and were recommended by the WHO International Guide (WHO, 2000) and Chikritzhs et al (2002a). While it is acknowledged that some causes of death (e.g.…”

“…Previous bulletins and technical reports have developed methodologies and estimates for specific indicators of serious alcohol-related harm and risky drinking practices: alcohol-caused deaths and hospitalisations to 1997 , alcohol-related road trauma to 1997 (Chikritzhs et al, 2000), patterns of risky alcohol use in 1998 (Heale et al, 2000), trends in per capita alcohol consumption to 1998/99 ) and trends in alcohol-related violence up to 2000/01 (Matthews et al, 2002). The rationale for the application of health statistics to the development of indicators of alcohol-related harm was developed in close consultation with other researchers who have conducted rigorous epidemiological estimates of alcohol-caused death, injury and illness both in Australia and overseas and is described more fully both in the WHO International Guide mentioned above (WHO, 2000) and in Chikritzhs et al (2002a).…”

“…Alcohol consumption, mostly at low levels, is also thought to have a protective effect against four conditions (ischaemic heart disease, hypertension, stroke and cholelithiasis). For each condition the extent of alcohol causation (or 'alcohol aetiologic fraction') was calculated separately for each state and territory and for each year considered using the 2001 NDSH Survey, estimates of per capita alcohol consumption and other epidemiological data (see Chikritzhs et al, 2001;Chikritzhs et al, 2002a).…”