Quantifying the global contribution of alcohol consumption to cardiomyopathy

Jakob Manthey,Jürgen Rehm,Sameer Imtiaz,Maria Neufeld,Margaret Rylett

doi:10.1186/s12963-017-0137-1

Abstract

BackgroundThe global impact of alcohol consumption on deaths due to cardiomyopathy (CM) has not been quantified to date, even though CM contains a subcategory for alcoholic CM with an effect of heavy drinking over time as the postulated underlying causal mechanism. In this feasibility study, a model to estimate the alcohol-attributable fraction (AAF) of CM deaths based on alcohol exposure measures is proposed.MethodsA two-step model was developed based on aggregate-level data from 95 countries, including the most populous (data from 2013 or last available year). First, the crude mortality rate of alcoholic CM per 1,000,000 adults was predicted using a negative binomial regression based on prevalence of alcohol use disorders (AUD) and adult alcohol per capita consumption (APC) (n = 52 countries). Second, the proportion of alcoholic CM among all CM deaths (i.e., AAF) was predicted using a fractional response probit regression with alcoholic CM crude mortality rate (from Step 1), AUD prevalence, APC per drinker, and Global Burden of Disease region as predictions. Additional models repeated these steps by sex and for the wider Global Burden of Disease study definition of CM.ResultsThere were strong correlations (>0.9) between the crude mortality rate of alcoholic CM and the AAFs, supporting the modeling strategy. In the first step, the population-weighted mean crude mortality rate was estimated at 8.4 alcoholic CM deaths per 1,000,000 (95% CI: 7.4–9.3). In the second step, the global AAFs were estimated at 6.9% (95% CI: 5.4–8.4%). Sex-specific figures suggested a lower AAF among females (2.9%, 95% CI: 2.3–3.4%) as compared to males (8.9%, 95% CI: 7.0–10.7%). Larger deviations between observed and predicted AAFs were found in Eastern Europe and Central Asia.ConclusionsThe model proposed promises to fill the gap to include AAFs for CM into comparative risk assessments in the future. These predictions likely will be underestimates because of the stigma involved in all fully alcohol-attributable conditions and subsequent problems in coding of alcoholic CM deaths.

Highlights

The global impact of alcohol consumption on deaths due to cardiomyopathy (CM) has not been quantified to date, even though CM contains a subcategory for alcoholic CM with an effect of heavy drinking over time as the postulated underlying causal mechanism
The selection of countries was guided by three considerations: 1) we wanted to ensure that the methodology could be used for global estimates, where 48 of the 50 most populous countries included 86% of the global population in 2015; 2) we wanted to include Eastern European countries, where attributable fraction (AAF) for CM can be high (e.g., 67% found in a city of Russia [30]; see Table 3 below); and 3) we wanted to ensure global spread
Alcohol exposure data were taken from the Global Information System on Alcohol and Health of World Health Organization (WHO) [31]; for the percentage of pure alcohol consumed by men and women, we relied on data from the Global Status Report on Alcohol and Health [2]

Summary

Introduction

The global impact of alcohol consumption on deaths due to cardiomyopathy (CM) has not been quantified to date, even though CM contains a subcategory for alcoholic CM with an effect of heavy drinking over time as the postulated underlying causal mechanism. In this feasibility study, a model to estimate the alcohol-attributable fraction (AAF) of CM deaths based on alcohol exposure measures is proposed. Alcohol consumption is a major risk factor for the global burden of disease [1,2,3] It has causal relationships with more than 200 three-digit International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10; [4]) disease and injury categories [3]. There are multiple forms of CM with different etiologies, but chronic, heavy alcohol consumption is associated with

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Conclusion