Elsevier

The Lancet

Volume 373, Issue 9682, 27 June–3 July 2009, Pages 2223-2233
The Lancet

Series
Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders

https://doi.org/10.1016/S0140-6736(09)60746-7Get rights and content

Summary

Alcohol consumption has been identified as an important risk factor for chronic disease and injury. In the first paper in this Series, we quantify the burden of mortality and disease attributable to alcohol, both globally and for ten large countries. We assess alcohol exposure and prevalence of alcohol-use disorders on the basis of reviews of published work. After identification of other major disease categories causally linked to alcohol, we estimate attributable fractions by sex, age, and WHO region. Additionally, we compare social costs of alcohol in selected countries. The net effect of alcohol consumption on health is detrimental, with an estimated 3·8% of all global deaths and 4·6% of global disability-adjusted life-years attributable to alcohol. Disease burden is closely related to average volume of alcohol consumption, and, for every unit of exposure, is strongest in poor people and in those who are marginalised from society. The costs associated with alcohol amount to more than 1% of the gross national product in high-income and middle-income countries, with the costs of social harm constituting a major proportion in addition to health costs. Overall, we conclude that alcohol consumption is one of the major avoidable risk factors, and actions to reduce burden and costs associated with alcohol should be urgently increased.

Section snippets

Alcohol as a risk factor for disease

Alcohol has been a part of human culture since the beginning of recorded history.1 Almost all societies that consume alcohol show related health and social problems. The industrialisation of production and globalisation of marketing and promotion of alcohol have increased both the amount of worldwide consumption and the harms associated with it. These developments have led to several resolutions by the World Health Assembly and WHO Regional Committees, outlining the public health problems

Indicators of alcohol consumption, mortality, and burden of disease

The exposure data for recorded and unrecorded alcohol consumption per adult for 2003—the most recent year of available comprehensive data—were taken from the WHO Global Status Report on Alcohol 200414 and the WHO Global Information System on Alcohol and Health, which provides regular updates on these data. Recorded alcohol consumption per adult was based on government records (taxation) and industry publications for the production and sales of alcohol, and data from the Food and Agriculture

Exposure to alcohol

Overall, there is wide variation around the worldwide consumption average of 6·2 L of pure alcohol (defined as 100% ethanol) per adult per year (figure 1). The countries with the highest overall consumption are in eastern Europe around Russia, but other areas of Europe also have high overall consumption (WHO Europe region 11·9 L per adult). The Americas are the region with the next highest overall consumption (WHO Americas region 8·7 L per adult). Apart from a few countries, some of them in

Conclusions

Our analysis does have some general limitations, such as the data quality of health outcomes relevant to all global studies—ie, mortality and burden of disease and specific limitations for a CRA for alcohol (Murray and Frenk53 provide a general discussion of the limitations). Furthermore, we refer only to ongoing discussions on DALY assumptions17 including the derivation of the DALY weights,54 and on data quality for global mortality.19

Our approach also has some specific limitations. First,

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