The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview

Addiction - Tập 98 Số 9 - Trang 1209-1228 - 2003
Jürgen Rehm1, Robin Room2, Kathryn Graham3, Maristela Monteiro4, Gerhard Gmel5, Christopher T. Sempos6
1Addiction Research Institute, Zurich, Switzerland
2Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
3Centre for Addiction and Mental Health, Toronto, Canada
4Management of Substance Dependence, World Health Organization (WHO), Geneva, Switzerland,
5Swiss Institute for the Prevention of Alcohol and Other Drug Problems, Lausanne, Switzerlandand
6University at Buffalo , Buffalo , NY , USA

Tóm tắt

ABSTRACT

Aims  As part of a larger study to estimate the global burden of disease attributable to alcohol:

to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and

to combine exposure and risk estimates to determine regional and global alcohol‐attributable fractions (AAFs) for major disease and injury categories.

Design, methods, setting  Systematic literature reviews were used to select diseases related to alcohol consumption. Meta‐analyses of the relationship between alcohol consumption and disease and multi‐level analyses of aggregate data to fill alcohol–disease relationships not currently covered by individual‐level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi‐level analyses with prevalence data.

Findings  Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed.

Conclusions  Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.

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Addiction

Tập 98 Số 9

1209-1228

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