Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Max Griswold(University of Washington), Nancy Fullman(University of Washington), Caitlin Hawley(University of Washington), Nicholas Arian(University of Washington), Stephanie R M Zimsen(University of Washington), Hayley Tymeson(University of Washington), Vidhya Venkateswaran(University of Washington), Austin Douglas Tapp(University of Washington), Mohammad H. Forouzanfar(University of Washington), Joseph S Salama(University of Washington), Kalkidan Hassen Abate(University of Washington), Degu Abate(University of Washington), Solomón Mequanente Abay(University of Washington), Cristiana Abbafati(University of Washington), Rizwan Suliankatchi Abdulkader(University of Washington), Abebe Zegeye(University of Washington), Victor Aboyans(University of Washington), Mohammed Mehdi Abrar(University of Washington), Pawan Acharya(University of Washington), Olatunji Adetokunboh(University of Washington), Tara Ballav Adhikari(University of Washington), José Carmelo Adsuar(University of Washington), Mohsen Afarideh(University of Washington), Emilie Agardh(University of Washington), Gina Agarwal(University of Washington), Sargis A. Aghayan(University of Washington), Sutapa Agrawal(University of Washington), Muktar Beshir Ahmed(University of Washington), Mohammed Akibu(University of Washington), Tomi Akinyemiju(University of Washington), Nadia Akseer(University of Washington), Deena Alasfoor(University of Washington), Ziyad Al‐Aly(University of Washington), Fares Alahdab(University of Washington), Khurshid Alam(University of Washington), Ammar Albujeer(University of Washington), Kefyalew Addis Alene(University of Washington), Raghib Ali(University of Washington), Syed Danish Ali(University of Washington), Mehran Alijanzadeh(University of Washington), Syed Mohamed Aljunid, Ala’a Alkerwi(University of Washington), Peter Allebeck(University of Washington), Nelson Alvis‐Guzmán(University of Washington), Azmeraw T. Amare(University of Washington), Léopold Ndemnge Aminde(University of Washington), Walid Ammar(University of Washington), Yaw Ampem Amoako(University of Washington), Gianna Gayle Herrera Amul(University of Washington), Cătălina Liliana Andrei(University of Washington), Colin Angus(University of Washington), Mustafa Geleto Ansha, Carl Abelardo T. Antonio(University of Washington), Olatunde Aremu(University of Washington), Johan Ärnlöv(University of Washington), Al Artaman(University of Washington), Krishna K Aryal(University of Washington), Reza Assadi(University of Washington), Marcel Ausloos(University of Washington), Leticia Ávila‐Burgos(University of Washington), Euripide Avokpaho(University of Washington), Ashish Awasthi(University of Washington), Henok Tadesse Ayele(University of Washington), Rakesh Ayer(University of Washington), Ayuk Betrand Tambe(University of Washington), Peter Azzopardi(University of Washington), Hamid Badali(University of Washington), Alaa Badawi(University of Washington), Maciej Banach(University of Washington), Suzanne Barker‐Collo(University of Washington), Lope H. Barrero(University of Washington), Huda Basaleem(University of Washington), Estifanos Baye(University of Washington), Shahrzad Bazargan‐Hejazi(University of Washington), Neeraj Bedi(University of Washington), Yannick Béjot(University of Washington), Abate Bekele Belachew(University of Washington), Saba Abraham Belay(University of Washington), Derrick Bennett(University of Washington), Isabela M. Benseñor(University of Washington), Eduardo Bernabé(University of Washington), Robert S. Bernstein(University of Washington), Addisu Shunu Beyene(University of Washington), Tina Beyranvand(University of Washington), Soumyadeeep Bhaumik(University of Washington), Zulfiqar A Bhutta(University of Washington), Belete Biadgo(University of Washington), Ali Bijani(University of Washington), Nigus Bililign(University of Washington), Sait Mentes Birlik(University of Washington), Charles Birungi(University of Washington), Hailemichael Bizuneh(University of Washington), Peter Bjerregaard(University of Washington), Tone Bjørge(University of Washington), Guilherme Borges(University of Washington), Cristina Bosetti(University of Washington), Soufiane Boufous(University of Washington), Nicola Luigi Bragazzi(University of Washington), Hermann Brenner(University of Washington), Zahid A Butt(University of Washington), Lucero Cahuana-Hurtado(University of Washington), Bianca Calabria(University of Washington), Ismael Campos‐Nonato(University of Washington), Julio César Campuzano(University of Washington), Giulia Carreras(University of Washington), Juan Jesús Carrero(University of Washington), Félix Carvalho(University of Washington), Carlos A Castañeda-Orjuela(University of Washington), Jacqueline Castillo Rivas(University of Washington), Ferrán Catalá-López(University of Washington), Jung‐Chen Chang(University of Washington), Fiona Charlson(University of Washington), Aparajita Chattopadhyay(University of Washington), Pankaj Chaturvedi(University of Washington), Rajiv Chowdhury(University of Washington), Devasahayam Jesudas Christopher(University of Washington), Sheng‐Chia Chung(University of Washington), Liliana G Ciobanu(University of Washington), Rafael Moreira Claro(University of Washington), Sara Conti(University of Washington), Ewerton Cousin(University of Washington), Michael H Criqui(University of Washington), Berihun Assefa Dachew(University of Washington), Paul I. Dargan(University of Washington), Ahmad Daryani(University of Washington), José das Neves(University of Washington), Kairat Davletov(University of Washington), Filipa de Castro(University of Washington), Barbora de Courten(University of Washington), Jan‐Walter De Neve(University of Washington), Louisa Degenhardt(University of Washington), Gebre Teklemariam Demoz, Don C. Des Jarlais, Subhojit Dey(University of Washington), Rupinder Singh Dhaliwal(University of Washington), Samath Dhamminda Dharmaratne(University of Washington), Meghnath Dhimal(University of Washington), David Teye Doku(University of Washington), Kerrie Doyle(University of Washington), Manisha Dubey(University of Washington), Eleonora Dubljanin(University of Washington), Bruce Bartholow Duncan(University of Washington), Hedyeh Ebrahimi(University of Washington), Dumessa Edessa(University of Washington), Maysaa El Sayed Zaki(University of Washington), Ermakov Sp(University of Washington), Holly E Erskine(University of Washington), Alireza Esteghamati(University of Washington), Mahbobeh Faramarzi(University of Washington), Andrea Farioli(University of Washington), André Faro(University of Washington), Maryam S. Farvid(University of Washington), Farshad Farzadfar(University of Washington), Valery L. Feigin(University of Washington), Mariana Santos Felisbino-Mendes(University of Washington), Eduarda Fernandes(University of Washington), Alize J Ferrari(University of Washington), Cleusa P. Ferri(University of Washington), Daniel Obadare Fijabi(University of Washington), Irina Filip(University of Washington), Jonas D. Finger(University of Washington), Florian Fischer(University of Washington), Abraham D Flaxman(University of Washington), Richard C. Franklin(University of Washington), Neal D. Futran(University of Washington), Silvano Gallus(University of Washington), Morsaleh Ganji(University of Washington), Fortuné Gbètoho Gankpé(University of Washington), Gebremedhin Berhe Gebregergs(University of Washington), Tsegaye Tewelde Gebrehiwot(University of Washington), Johanna M. Geleijnse(University of Washington), Reza Ghadimi(University of Washington), Lilian Ghandour(University of Washington), Mamata Ghimire(University of Washington), Paramjit Gill(University of Washington), Ibrahim Ginawi(University of Washington), Ababi Zergaw Giref(University of Washington), Philimon Gona(University of Washington), Sameer Vali Gopalani(University of Washington), Carolyn Gotay(University of Washington), Alessandra C. Goulart(University of Washington), Felix Greaves(University of Washington), Giuseppe Grosso(University of Washington), Yuming Guo(University of Washington), Rahul Gupta(University of Washington), Rajeev Gupta(University of Washington), Vipin Gupta(University of Washington), Reyna Alma Gutiérrez(University of Washington), Murthy GVS(University of Washington), Nima Hafezi‐Nejad(University of Washington), Tekleberhan B Hagos, Gessessew Bugssa Hailu(University of Washington), Randah R Hamadeh(University of Washington), Samer Hamidi(University of Washington), Graeme J. Hankey(University of Washington), Hilda L Harb(University of Washington), S Harikrishnan(University of Washington), Josep María Haro(University of Washington), Hamid Yimam Hassen(University of Washington), Rasmus Havmoeller(University of Washington), Simon I Hay(University of Washington), Behzad Heibati(University of Washington), Andualem Henok(University of Washington), Ileana Heredia-Pi(University of Washington), Norberto Francisco Hernández-Llanes(University of Washington), Claudiu Herţeliu(University of Washington), Desalegn Ts Tsegaw Hibstu(University of Washington), Praveen Hoogar(University of Washington), Nobuyuki Horita(University of Washington), Hung Chak Ho(University of Washington), Mostafa Hosseini(University of Washington), Mihaela Hostiuc(University of Washington), Guoqing Hu(University of Washington), Hsiang Huang(University of Washington), Abdullatif Husseini(University of Washington), Bulat Idrisov(University of Washington), Bogdan Vasile Ileanu, Olayinka Stephen Ilesanmi(University of Washington), Seyed Sina Naghibi Irvani(University of Washington), Sheikh Mohammed Shariful Islam(University of Washington), Maria Jackson(University of Washington), Mihajlo Jakovljević(University of Washington), Moti Tolera Jalu(University of Washington), Achala Upendra Jayatilleke(University of Washington), Ravi Prakash Jha(University of Washington), Jost B. Jonas(University of Washington), Jacek Jerzy Jozwiak(University of Washington), Zubair Kabir(University of Washington), Rajendra Kadel(University of Washington), Amaha Kahsay(University of Washington), U Kapil(University of Washington), Amir Kasaeian(University of Washington), Tesfaye Kassa(University of Washington), Srinivasa Vittal Katikireddi(University of Washington), Norito Kawakami(University of Washington), Seifu Kebede(University of Washington), Adane Teshome Kefale(University of Washington), Peter Njenga Keiyoro(University of Washington), André Pascal Kengne(University of Washington), Yousef Khader(University of Washington), Morteza Abdullatif Khafaie(University of Washington), Ibrahim A Khalil(University of Washington), Md Nuruzzaman Khan(University of Washington), Young‐Ho Khang(University of Washington), Mona M Khater(University of Washington), Jagdish Khubchandani(University of Washington), Cho‐il Kim(University of Washington), Daniel Kim(University of Washington), Yun Jin Kim(University of Washington), Ruth W Kimokoti(University of Washington), Adnan Kısa(University of Washington), Mika Kivimäki(University of Washington), Sonali Kochhar(University of Washington), Soewarta Kosen(University of Washington), Parvaiz A Koul(University of Washington), Ai Koyanagi(University of Washington), Kewal Krishan(University of Washington), Barthélémy Kuate Defo(University of Washington), Burcu Küçük Biçer(University of Washington), Veena S. Kulkarni(University of Washington), Pushpendra Kumar(University of Washington), Alessandra Lafranconi(University of Washington), Arjun Lakshmana Balaji(University of Washington), Ratilal Lalloo(University of Washington), Tea Lallukka(University of Washington), Hilton Y. Lam(University of Washington), Faris Lami(University of Washington), Qing Lan(University of Washington), Justin J. Lang(University of Washington), Sônia Lansky(University of Washington), Anders Larsson(University of Washington), Arman Latifi(University of Washington), Janet L Leasher(University of Washington), Paul H. Lee(University of Washington), James Leigh(University of Washington), Mall Leinsalu, Janni Leung(University of Washington), Miriam Levi(University of Washington), Li Y(University of Washington), Lee‐Ling Lim(University of Washington), Shai Linn(University of Washington), Shiwei Liu(University of Washington), Andrea Lobato-Cordero(University of Washington), Alan D Lopez(University of Washington), Stefan Lorkowski(University of Washington), Paulo A. Lotufo(University of Washington), Erlyn Rachelle King Macarayan(University of Washington), Ísis Eloah Machado(University of Washington), Fabiana Madotto(University of Washington), Hassan Magdy Abd El Razek(University of Washington), Muhammed Magdy Abd El Razek, Marek Majdán(University of Washington), Reza Majdzadeh(University of Washington), Azeem Majeed(University of Washington), Reza Malekzadeh(University of Washington), Déborah Carvalho Malta(University of Washington), Chabila Christopher Mapoma(University of Washington), José Martı́nez-Raga(University of Washington), Pallab K Maulik(University of Washington), Mohsen Mazidi(University of Washington), Martin McKee(University of Washington), Varshil Mehta(University of Washington), Toni Meier(University of Washington), Tesfa Mekonen(University of Washington), Kidanu Gebremariam Meles(University of Washington), Addisu Melese(University of Washington), Peter Memiah(University of Washington), Walter Mendoza(University of Washington), Desalegn Tadese Mengistu(University of Washington), George A. Mensah(University of Washington), Tuomo J Meretoja(University of Washington), Haftay Berhane Mezgebe(University of Washington), Tomasz Miazgowski(University of Washington), Ted R. Miller(University of Washington), GK Mini(University of Washington), Andreea Mirică(University of Washington), Erkin М Мirrakhimov(University of Washington), Babak Moazen(University of Washington), Karzan Abdulmuhsin Mohammad(University of Washington), Noushin Mohammadifard(University of Washington), Shafiu Mohammed(University of Washington), Lorenzo Monasta(University of Washington), Paula Moraga(University of Washington), Lídia Morawska(University of Washington), Seyyed Meysam Mousavi(University of Washington), Satinath Mukhopadhyay(University of Washington), Kamarul Imran Musa(University of Washington), Aliya Naheed(University of Washington), Gurudatta Naik(University of Washington), Farid Najafi(University of Washington), Vinay Nangia(University of Washington), Jobert Richie Nansseu(University of Washington), Mudavath Siva Durga Prasad Nayak(University of Washington), Chakib Nejjari(University of Washington), Subas Neupane(University of Washington), Sudan Prasad Neupane(University of Washington), Josephine W Ngunjiri, Cuong Tat Nguyen(University of Washington), Long Hoang Nguyen(University of Washington), Trang Huyen Nguyen(University of Washington), Dina Nur Anggraini Ningrum(University of Washington), Yirga Legesse Nirayo(University of Washington), Jean Jacques Noubiap(University of Washington), Richard Ofori‐Asenso(University of Washington), Felix Akpojene Ogbo(University of Washington), In‐Hwan Oh(University of Washington), Olanrewaju Oladimeji(University of Washington), Andrew T Olagunju(University of Washington), Pedro R. Olivares(University of Washington), Bolajoko O. Olusanya(University of Washington), Jacob Olusegun Olusanya(University of Washington), Anu Mary Oommen(University of Washington), Eyal Oren(University of Washington), Heather Orpana(University of Washington), Doris V Ortega-Altamirano(University of Washington), Justin R. Ortiz(University of Washington), Erika Ota(University of Washington), Mayowa Owolabi(University of Washington), Abayomi Samuel Oyekale(University of Washington), P A Mahesh(University of Washington), Adrian Pană(University of Washington), Eun‐Kee Park(University of Washington), Charles Parry(University of Washington), Hadi Parsian(University of Washington), Ajay Patle(University of Washington), George Patton(University of Washington), Deepak Paudel(University of Washington), Max Petzold(University of Washington), Michael Phillips(University of Washington), Julian David Pillay(University of Washington), Maarten J. Postma(University of Washington), Farshad Pourmalek(University of Washington), Dorairaj Prabhakaran(University of Washington), Mostafa Qorbani(University of Washington), Amir Radfar(University of Washington), Anwar Rafay(University of Washington), Alireza Rafiei(University of Washington), Fakher Rahim(University of Washington), Afarin Rahimi‐Movaghar(University of Washington), Mahfuzar Rahman(University of Washington), Muhammad Aziz Rahman(University of Washington), Rajesh Kumar(University of Washington), Saša Rajšić(University of Washington), Sree Bhushan Raju(University of Washington), Usha Ram(University of Washington), Saleem M Rana(University of Washington), Chhabi Lal Ranabhat(University of Washington), David Laith Rawaf(University of Washington), Salman Rawaf(University of Washington), Robert C. Reiner(University of Washington), Cesar Reis(University of Washington), André M. N. Renzaho(University of Washington), Mohammad Sadegh Rezai(University of Washington), Leonardo Roever(University of Washington), Luca Ronfani(University of Washington), Robin Room(University of Washington), Gholamreza Roshandel(University of Washington), Ali Rostami(University of Washington), Gregory A. Roth(University of Washington), Ambuj Roy(University of Washington), Yogesh Sabde(University of Washington), Basema Saddik(University of Washington), Saeid Safiri(University of Washington), Amirhossein Sahebkar(University of Washington), Joseph S Salama(University of Washington), Zikria Saleem(University of Washington), Joshua A. Salomon(University of Washington), Sundeep Salvi(University of Washington), Juan Sanabria(University of Washington), María Dolores Sánchez-Niño(University of Washington), Damian Santomauro(University of Washington), Itamar S Santos(University of Washington), Milena M Santric-Milicevic(University of Washington), Abdur Razzaque Sarker(University of Washington), Rodrigo Sarmiento-Suárez(University of Washington), Nizal Sarrafzadegan(University of Washington), Benn Sartorius(University of Washington), Maheswar Satpathy(University of Washington), Monika Sawhney(University of Washington), Sonia Saxena(University of Washington), Mete Şaylan(University of Washington), Michael P Schaub(University of Washington), María Inês Schmidt(University of Washington), Ione Jayce Ceola Schneider(University of Washington), Ben Schöttker(University of Washington), Aletta E. Schutte(University of Washington), Falk Schwendicke(University of Washington), Sadaf G Sepanlou(University of Washington), Masood Ali Shaikh(University of Washington), Mehdi Sharif(University of Washington), Jun She(University of Washington), Aziz Sheikh(University of Washington), Jiabin Shen(University of Washington), Mekonnen Sisay Shiferaw(University of Washington), Mika Shigematsu(University of Washington), Rahman Shiri(University of Washington), Kawkab Shishani(University of Washington), Ivy Shiue(University of Washington), Sharvari Shukla(University of Washington), Inga Dóra Sigfúsdóttir(University of Washington), Diego Augusto Santos Silva(University of Washington), Natacha Torres da Silva(University of Washington), Dayane Gabriele Alves Silveira(University of Washington), Dhirendra Narain Sinha(University of Washington), Freddy Sitas(University of Washington), Adauto Martins Soares Filho(University of Washington), Moslem Soofi(University of Washington), Reed J D Sorensen(University of Washington), Joan B. Soriano(University of Washington), Chandrashekhar T Sreeramareddy(University of Washington), Nadine Steckling(University of Washington), Dan J. Stein(University of Washington), Mu’awiyyah Babale Sufiyan(University of Washington), Patrick John Sur(University of Washington), Bryan L. Sykes(University of Washington), Rafael Tabarés‐Seisdedos(University of Washington), Takahiro Tabuchi(University of Washington), Mohammad Tavakkoli(University of Washington), Arash Tehrani‐Banihashemi(University of Washington), Merhawi Gebremedhin Tekle(University of Washington), Subash Thapa(University of Washington), Nihal Thomas(University of Washington), Roman Topór-Mądry(University of Washington), Fotis Topouzis(University of Washington), Bach Xuan Tran(University of Washington), Christopher Troeger(University of Washington), Thomas Clement Truelsen(University of Washington), Nikolaos Tsilimparis(University of Washington), Stefanos Tyrovolas(University of Washington), Kingsley Nnanna Ukwaja(University of Washington), Irfan Ullah(University of Washington), Olalekan A. Uthman(University of Washington), Pascual Valdéz(University of Washington), Job F. M. van Boven(University of Washington), Tommi Vasankari(University of Washington), Narayanaswamy Venketasubramanian(University of Washington), Francesco Saverio Violante(University of Washington), Sergey Konstantinovitch Vladimirov(University of Washington), Vasily Vlassov(University of Washington), Stein Emil Vollset(University of Washington), Theo Vos(University of Washington), Fasil Wagnew(University of Washington), Yasir Waheed(University of Washington), Yuan‐Pang Wang(University of Washington), Elisabete Weiderpass(University of Washington), Fitsum Weldegebreal(University of Washington), Kidu Gidey Weldegwergs(University of Washington), Andrea Werdecker(University of Washington), Ronny Westerman(University of Washington), Harvey Whiteford(University of Washington), Justyna Widecka(University of Washington), Tissa Wijeratne(University of Washington), Grant M. A. Wyper(University of Washington), Gelin Xu(University of Washington), Tomohide Yamada(University of Washington), Yuichiro Yano(University of Washington), Pengpeng Ye(University of Washington), Ebrahim M Yimer(University of Washington), Paul Yip(University of Washington), Biruck Desalegn Yirsaw(University of Washington), Engida Yisma(University of Washington), Naohiro Yonemoto(University of Washington), Seok‐Jun Yoon(University of Washington), Marcel Yotebieng(University of Washington), Mustafa Z Younis, Geevar Zachariah, Zoubida Zaidi, Mohammad Zamani(University of Washington), Xueying Zhang, Sanjay Zodpey, Ali H. Mokdad, Mohsen Naghavi(University of Washington), Christopher J L Murray, Emmanuela Gakidou(University of Washington)
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Abstract
BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. METHODS: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. FINDINGS: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5-3·0) of age-standardised female deaths and 6·8% (5·8-8·0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2-4·3) of female deaths and 12·2% (10·8-13·6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2·3% (95% UI 2·0-2·6) and male attributable DALYs were 8·9% (7·8-9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0-1·7] of total deaths), road injuries (1·2% [0·7-1·9]), and self-harm (1·1% [0·6-1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2-33·3) of total alcohol-attributable female deaths and 18·9% (15·3-22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0-0·8) standard drinks per week. INTERPRETATION: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. FUNDING: Bill & Melinda Gates Foundation.