Abstract
The existence and potential level of cardioprotection from alcohol use is contested in alcohol studies. Assumptions regarding the risk relationship between alcohol use and ischaemic heart disease (IHD) are critical when providing advice for national drinking guidelines and for designing alcohol harm monitoring systems. We use three meta-analyses regarding alcohol use and IHD risk to investigate how varying assumptions lead to differential estimates of alcohol-attributable (AA) deaths and weighted relative risk (RR) functions, in Australia and Canada. Alcohol exposure and mortality data were acquired from administrative sources and AA fractions were calculated using the International Model of Alcohol Harms and Policies. We then customized a recent Global Burden of Disease (GBD) analysis to inform drinking guidelines internationally. Australians drink slightly more than Canadians, per person, but are also more likely to identify as lifetime abstainers. Cardioprotective scenarios resulted in substantial differences in estimates of net AA deaths in Australia (between 2933 and 4570) and Canada (between 5179 and 8024), using GBD risk functions for all other alcohol-related conditions. Country-specific weighted RR functions were analyzed to provide advice toward drinking guidelines: Minimum risk was achieved at or below alcohol use levels of 10 g/day ethanol, depending on scenario. Consumption levels resulting in ‘no added’ risk from drinking were found to be between 10 and 15 g/day, by country, gender, and scenario. These recommendations are lower than current guidelines in Australia, Canada, and some other high-income countries: These guidelines may be in need of downward revision.
Highlights
Alcohol consumption has been proven to cause a significant burden of disease and to be causally linked to dozens of serious health conditions [1,2]
Differences were seen in the prevalence of the population who identify as lifetime abstainers and as former drinkers
As ischaemic heart disease (IHD) is the leading cause of mortality in many high-income countries, differential assumptions regarding the risk relationship between alcohol use and IHD are hugely influential in estimating alcohol-caused mortality and weighted relative risk (RR) functions
Summary
Alcohol consumption has been proven to cause a significant burden of disease and to be causally linked to dozens of serious health conditions [1,2]. Drinking was estimated to cause nearly three million deaths globally in 2016; these deaths would not have occurred in the absence of alcohol consumption [1]. In high-income countries, such as Australia and Canada, alcohol-caused death and disability is proportionally greater, as people in these countries drink more alcohol than the global average [1]. National alcohol harm monitoring systems in Australia [3,4] and Canada [5] have revealed. Res. Public Health 2019, 16, 4956; doi:10.3390/ijerph16244956 www.mdpi.com/journal/ijerph
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