GBD 2016 Alcohol Collaborators
Lancet 2018; 392: 1015–1035
The association of alcohol use with health is complex. Alcohol use is a leading risk factor for death and disability but some studies have shown low use can have protective effects on ischaemic heart disease, diabetes and several other outcomes.1,2 This study aimed to add to existing studies and to address limitations of earlier research, generating improved estimates of alcohol use and associated burden in terms of deaths and disability-adjusted life-years (DALYs) across 195 locations between 1990 and 2016.
The association of alcohol use with health is complex.
Exposure estimates, alcohol-attributable deaths and DALYs were based on 694 sources of individual and population-level alcohol consumption, along with 592 studies on the risk of alcohol use.
Location had an impact on the prevalence of current drinking as well as differences in consumption between men and women.
In 2016, 32.5% of the global population were found to be current drinkers, corresponding to 2.4 billion people, with a greater proportion of men currently drinking (39%) compared to women (25%). Location had an impact on the prevalence of current drinking as well as differences in consumption between men and women. Alcohol consumption was highest for high Socio-Demographic Index (SDI) locations, with 72% of women and 83% of men currently drinking compared to 8.9% of women and 20% of men currently drinking in low to medium SDI locations.
Globally, alcohol use was the seventh leading risk factor for premature death and disability in 2016, accounting for 2.8 million deaths
Globally, alcohol use was the seventh leading risk factor for premature death and disability in 2016, accounting for 2.8 million deaths and 1.6% of total DALYs among women and 6.0% among men. For people aged 15 to 49 years, alcohol use was the leading risk factor for premature death and disability, accounting for 3.8% of deaths and 2.3% of DALYs in women, and 12.2% of deaths and 8.9% of DALYs in men. The leading causes of attributable deaths for people aged 15 to 49 years were tuberculosis, road injuries and self-harm, while cancers accounted for a large proportion of attributable deaths in people aged 50 years and older. The attributable burden increased with age in women, while in men the burden increased until the age of 55 to 65 years, after which the attributable burden decreased. Women, particularly in high SDI locations, experienced more protective effects for ischaemic heart disease and diabetes beyond 60 years of age.
The consumption of zero standard drinks daily was found to minimise the overall risk to health
The consumption of zero standard drinks daily was found to minimise the overall risk to health, confirming comprehensive studies that show non-significant or no protective effect of alcohol.3,4 The protective effects found in this study for ischaemic heart disease and diabetes in women were outweighed by the overall health risk of alcohol consumption, specifically cancer, which increased monotonically with consumption. These findings stress the loss of health related to alcohol, regardless of the amount consumed.
A revision of global policies regarding alcohol consumption is required to lower global alcohol consumption, along with changing the belief that low alcohol consumption has positive implications for health.