Alcohol-attributable Mortality Research Articles

Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview.

BackgroundAlthough alcohol consumption has long been considered as a risk factor for chronic disease, the relationship to cardiovascular disease (CVD) is complex and involves at least two dimensions: average volume of alcohol consumption and patterns of drinking. The objective of this contribution was to estimate the burden of CVD mortality caused by alcohol consumption.MethodsRisk assessment modelling with alcohol-attributable CVD mortality as primary outcome. The mortality burden of ischaemic heart disease (IHD) and ischaemic stroke (IS) attributable to alcohol consumption was estimated using attributable-fraction methodology. Relative Risk (RR) data for IHD and IS were obtained from the most comprehensive meta-analyses (except for Russia and surrounding countries where alcohol RR data were obtained from a large cohort study). Age-group specific RRs were calculated, based on large studies. Data on mortality were obtained from the World Health Organization’s Global Health Estimates and alcohol consumption data were obtained from the Global Information System on Alcohol and Health. Risk of former drinkers was modelled taking into account global differences in the prevalence of sick quitters among former drinkers. Alcohol-attributable mortality estimates for all other CVD causes except IHD and IS were obtained from the 2014 Global Status Report on Alcohol and Health.ResultsAn estimated 780,381 CVD deaths (441,893 and 338,490 CVD deaths among men and women respectively) were attributable to alcohol consumption globally in 2012, accounting for 1.4 % of all deaths and 26.6 % of all alcohol-attributable deaths. This is in contrast to the previously estimated 1,128,273 CVD deaths attributable to alcohol consumption globally, and represents a decrease of 30.8 % in alcohol-attributable CVD mortality and of 10.6 % in the global burden of all alcohol-attributable deaths.ConclusionsWhen the most comprehensive and recent systematic reviews and meta-analyses are taken as bases, the net impact of alcohol consumption on CVD is lower than previously estimated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3026-9) contains supplementary material, which is available to authorized users.

The importance of age groups in estimates of alcohol-attributable mortality: impact on trends in Switzerland between 1997 and 2011.

Monitoring trends of alcohol-attributable mortality is an integral part of the global strategy to reduce the harmful use of alcohol. However, mortality estimates based on different age ranges come to different conclusions. This study examined the impact of including different age ranges in terms of directions of trends of alcohol-attributable mortality during 14 years in Switzerland. Alcohol-attributable mortality was estimated at four time-points between 1997 and 2011 using the Global Burden of Disease 2010 methodology. Estimates were obtained for two age groups: 15-64 years and the total adult population (15 years and older). Alcohol-attributable mortality among 15-64-year-olds decreased [1997: 1334 deaths, confidence interval (CI) = 1237-1432; 2011: 1019 deaths, CI = 964-1073; trend per year odds ratio (OR) = 0.99, P < 0.001]. In contrast, alcohol-attributable mortality among those 65 and older increased in the same time-period (1997: 581 deaths, CI = -196 to 1357; 2011: 1664 deaths, CI = 957-2372; OR = 1.07, P< 0.001), resulting in an overall increase of alcohol-attributable mortality for 15+ year-olds (1997: 1915 deaths, CI = 1133-2697; 2011: 2683, CI = 1973-3393; OR = 1.02, P < 0.001). The main shift in trends was due to changes in the mixture (e.g. hypertension, ischaemic heart disease) of cardiovascular diseases over time among those 65+ years old. Trends in alcohol-attributable mortality may yield qualitatively different results based on the upper age limit for deaths set for these estimates. Global trends of alcohol-attributable mortality between 1997 and 2011 were influenced heavily by changes in the mixture of deaths across cardiovascular diseases. Trends for alcohol-attributable mortality and cross-country comparisons should be reported separately for 15-64 and 65+ year-olds.

Stosunek lekarzy rodzinnych do interwencji związanych z używaniem alkoholu – polskie wyniki międzynarodowego projektu badawczego ODHIN

BackgroundBrief interventions for alcohol use are considered an effective method of reducing alcohol drinking and alcohol-attributable mortality. The aim of the study was to document the attitudes of Polish general practitioners (GPs) to alcohol and alcohol problems, and examine how these attitudes are associated with self-reported activity in managing patients for alcohol use and alcohol-related problems. MethodsA total of 276 GPs were surveyed. The questionnaire included items on the GP's reported education and training on alcohol, attitudes and self-confidence in managing alcohol problems and self-reported estimates of patient numbers managed for alcohol and alcohol problems during the previous year. In addition, potential barriers and facilitators for conducting brief interventions in GP setting were investigated. ResultsMore than half of GPs (55.3%) reported 6 or less patients managed for alcohol and alcohol problems during the previous year. GPs reporting higher levels of education for alcohol problems declared more emphasis on disease prevention, felt more secure in managing patients with alcohol problems and delivered a higher number of brief interventions. DiscussionQualifications and positive experiences rather than declarations about importance and preparation towards conducting brief interventions are associated with higher number of patients managed for drinking alcohol. ConclusionGeneral practitioners in Poland very rarely manage patients for alcohol use and alcohol-related problems. Complex interventions, with special emphasis on training on alcohol reduction strategies, are needed to improve this situation.

Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany

Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18-64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

Tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities in a cohort of homeless adults in Boston.

We quantified tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities among homeless adults. We ascertained causes of death among 28 033 adults seen at the Boston Health Care for the Homeless Program in 2003 to 2008. We calculated population-attributable fractions to estimate the proportion of deaths attributable to tobacco, alcohol, or drug use. We compared attributable mortality rates with those for Massachusetts adults using rate ratios and differences. Of 1302 deaths, 236 were tobacco-attributable, 215 were alcohol-attributable, and 286 were drug-attributable. Fifty-two percent of deaths were attributable to any of these substances. In comparison with Massachusetts adults, tobacco-attributable mortality rates were 3 to 5 times higher, alcohol-attributable mortality rates were 6 to 10 times higher, and drug-attributable mortality rates were 8 to 17 times higher. Disparities in substance-attributable deaths accounted for 57% of the all-cause mortality gap between the homeless cohort and Massachusetts adults. In this clinic-based cohort of homeless adults, over half of all deaths were substance-attributable, but this did not fully explain the mortality disparity with the general population. Interventions should address both addiction and non-addiction sources of excess mortality.

Geographical distribution of alcohol-attributable mortality in Chile: A Bayesian spatial analysis

ObjectiveTo describe the distribution of alcohol-attributable mortality (AAM) at the local level (345 municipalities) in Chile, including fully and partially attributable causes in 2009. MethodsAAM was estimated for the population 15years of age and older using per capita alcohol consumption combined with survey estimates. The effect of alcohol on each cause of death was extracted from the published scientific literature. We used Bayesian hierarchical models to smooth the Standardized Mortality Ratio for each municipality for six groups of causes related to alcohol consumption (total, neuro-psychiatric, cardiovascular, cancer, injuries and other causes). ResultsThe percentage of municipalities with high risk for any group of causes in each region ranges from 0% to 87.0%. Municipalities with high risk were concentrated in south-central and southern Chile for all groups of causes related to alcohol. ConclusionsAAM risk shows marked geographic concentrations, mainly in south-central and southern regions of Chile. This combination of methods for small-area estimates of AAM is a powerful tool to identify high risk regions and associated factors, and may be used to inform local policies and programs.

The effects of alcohol price increases on mortality in Kazakhstan in 2008-2012

Issue/problem Earlier studies have established the crucial role of alcohol consumption in sharp fluctuations of cardiovascular (CVD) and other alcohol-attributable mortality in Russia in the 1980s and 1990s. Making alcohol more expensive has been identified as an effective strategy to reduce harm, but some studies have pointed out that this applies more to vodka and other strong spirits, and less to beer or wine. Description of the problem With the aim …

Gender differences in socioeconomic inequality of alcohol-attributable mortality: A systematic review and meta-analysis.

The present analysis contributes to understanding the societal distribution of alcohol-attributable harm by investigating socioeconomic inequality and related gender differences in alcohol-attributable mortality. A systematic literature search was performed on Web of Science, MEDLINE, PsycINFO and ETOH from their inception until February 2013. Articles were included when they reported data on alcohol-attributable mortality by socioeconomic status (SES), operationalised as education, occupation, employment status or income. Gender-specific relative risks (RR) comparing low with high SES were pooled using random effects meta-analyses. Gender differences were additionally investigated in random effects meta-regressions. Nineteen articles from 14 countries were included. For women, significant RRs across all measures of SES, except employment status, were found, ranging between 1.75 [95% confidence interval (CI) 1.21-2.54; occupation] and 4.78 (95% CI 2.57-8.87; income). For men, all measures of SES showed significant RRs ranging between 2.88 (95% CI 2.45-3.40; income) and 12.25 (95% CI 11.45-13.10; employment status). While RRs for men were in general slightly higher, only for occupation this gender difference was above chance (P = 0.01). Results refer to deaths 100% attributable to alcohol. The results are predominantly based on data from high-income countries, limiting generalisability. Alcohol-attributable mortality is strongly distributed to the disadvantage of persons with a low SES. Marked gender differences in this inequality were found for occupation. Possibly male-dominated occupations of low SES were more strongly related to risky drinking cultures compared with female-dominated occupations of the same SES.

Research methods on alcohol-related harm in the population

The aim of this paper is to describe the available methods to quantify the main health and social harms related to alcohol consumption in the population and to provide recommendations to improve research on these issues. Methods using individual and aggregate level data for the study of the relationship between alcohol consumption and related harms are taken into account, highlighting their strengths and weaknesses. Methodological aspects to quantify the magnitude and trends of alcohol-related and alcohol-attributable mortality, including alcohol dependence, acute intoxication, injury, violent behavior, disease burden and social costs are widely considered. There are often discrepancies between the study results mainly due to the difficulty of adequately measuring alcohol consumption and its relationship to health conditions. In the future we must strengthen research on the effect of drinking patterns and context in chronic diseases using appropriate controls, clarify the relationship of alcohol use disorders and other mental disorders , improve the measurement of alcohol intoxication when acute problems occurs, periodically quantify the disease burden and social costs attributable to alcohol (using country- specific attributable fractions) and develop valid and comparable methods and indicators for monitoring alcohol-related harm.

Alcohol-attributable mortality among American Indians and Alaska Natives in the United States, 1999-2009.

We describe the relative burden of alcohol-attributable death among American Indians/Alaska Natives (AI/ANs) in the United States. National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN. We calculated age-adjusted alcohol-attributable death rates from 1999 to 2009 for AI/AN and White persons by sex, age, geographic region, and leading causes; individuals of Hispanic origin were excluded. AI/AN persons had a substantially higher rate of alcohol-attributable death than Whites from 2005 to 2009 in IHS Contract Health Service Delivery Area counties (rate ratio = 3.3). The Northern Plains had the highest rate of AI/AN deaths (123.8/100,000), and the East had the lowest (48.9/100,000). For acute causes, the largest relative risks for AI/AN persons compared with Whites were for hypothermia (14.2) and alcohol poisoning (7.6). For chronic causes, the largest relative risks were for alcoholic psychosis (5.0) and alcoholic liver disease (4.9). Proven strategies that reduce alcohol consumption and make the environment safer for excessive drinkers should be further implemented in AI/AN communities.

Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: a systematic review and meta-analysis

Factors underlying socioeconomic inequalities in mortality are not well understood. This study contributes to our understanding of potential pathways to result in socioeconomic inequalities, by examining alcohol consumption as one potential explanation via comparing socioeconomic inequalities in alcohol-attributable mortality and all-cause mortality. Web of Science, MEDLINE, PsycINFO and ETOH were searched systematically from their inception to second week of February 2013 for articles reporting alcohol-attributable mortality by socioeconomic status, operationalized by using information on education, occupation, employment status or income. The sex-specific ratios of relative risks (RRRs) of alcohol-attributable mortality to all-cause mortality were pooled for different operationalizations of socioeconomic status using inverse-variance weighted random effects models. These RRRs were then combined to a single estimate. We identified 15 unique papers suitable for a meta-analysis; capturing about 133 million people, 3 741 334 deaths from all causes and 167 652 alcohol-attributable deaths. The overall RRRs amounted to RRR = 1.78 (95% confidence interval (CI) 1.43 to 2.22) and RRR = 1.66 (95% CI 1.20 to 2.31), for women and men, respectively. In other words: lower socioeconomic status leads to 1.5-2-fold higher mortality for alcohol-attributable causes compared with all causes. Alcohol was identified as a factor underlying higher mortality risks in more disadvantaged populations. All alcohol-attributable mortality is in principle avoidable, and future alcohol policies must take into consideration any differential effect on socioeconomic groups.

Income Differences in Life Expectancy

Social differences in mortality have increased in high-income countries, but the causes of these changes remain unclear. We quantify the contribution of alcohol and smoking to trends in income differences in life expectancy from 1988 through 2007 in Finland. An 11% sample from the population registration data of Finns 25 years and older was linked with an 80% oversample of death records. Alcohol-attributable mortality was based on underlying and contributory causes of death on individual death certificates and smoking-attributable mortality on an indirect method that used lung cancer mortality as an indicator for the impact of smoking on mortality. Alcohol- and smoking-attributable deaths reduced life expectancy by about 4.5 years among men. Alcohol-attributable mortality increased and smoking-attributable mortality decreased over the period 1988-2007, leaving the joint contribution stable. Among women, the contribution of these risk factors to life expectancy over the same period increased from 0.7 to 1.2 years. In 2003-2007, life expectancy differentials between the lowest and highest income quintile were 11.4 years (men) and 6.3 years (women). In the absence of alcohol and smoking, these differences would have been 60% less for men and 36% less for women. Life expectancy differentials increased rapidly over the study period; without alcohol and smoking, the increase would have been 69% less among men and 85% less among women. Alcohol and smoking have a major influence on income differences in mortality and, with the exception of smoking among men, their contribution is increasing. Without alcohol and smoking, there would have been little change in life expectancy differentials.

Small area associations between social context and alcohol-attributable mortality in a middle income country

BackgroundLittle is known about the association between alcohol-attributable mortality and small area socioeconomic variables when considering causes both wholly and partially attributable to alcohol. MethodsAn ecological study was conducted of the entire Chilean population aged 15 and older in 345 municipalities nationwide between 2004 and 2009. Deaths were attributed to alcohol consumption either wholly or partially, along with the estimated attributable fractions for each specified cause. Each municipality was characterized according to its average income and educational attainment. Estimates of the ecological associations were produced using a hierarchical Bayesian model, separating out deaths caused by alcohol and dividing them into seven groups of causes. ResultsAlcohol-attributable mortality risk showed an inverse association with income and education at the ecological level. A one-quintile increase in income was associated with an average decrease in risk of 10% (CI 95%: 10–20%) for cardiovascular deaths, 8% (6–10%) for intentional injuries and 7% (3–11%) for unintentional injuries. No associations were found between deaths due to cancers and other causes with income and education. ConclusionsMunicipalities with lower income and education have higher risk of alcohol-attributable mortality in Chile.

Alcohol-Related Morbidity and Mortality Following Involuntary Job Loss: Evidence From Swedish Register Data

The purpose of this study was to assess the association between involuntary job loss and alcohol-attributable morbidity and mortality. Swedish linked employee-employer data were used to identify all establishment closures during 1990-1999, as well as the employees who were laid off and a comparison group. These data were merged with information on alcohol-attributable deaths and hospital admissions from the Causes of Death Register and the National Patient Register. The associations between job loss and alcohol-attributable morbidity and mortality during a follow-up period of 12 years were estimated by propensity score weighting methods. An excess risk of both alcohol-related hospitalization and mortality was found among both displaced men and women. For women, the wholly alcohol-attributable health problems were mainly limited to alcohol use disorders, whereas men also had an increased risk of hospitalization from poisoning and alcohol-induced liver disease and pancreatitis. The findings support previous evidence of increased risks of alcohol-related morbidity/mortality following involuntary job loss, although the estimates presented herein are more conservative. In addition, the findings suggest that alcohol-related problems manifest somewhat differently in men and women.

Alcohol-attributable and alcohol-preventable mortality in Denmark: an analysis of which intake levels contribute most to alcohol’s harmful and beneficial effects

The aim of the study was to quantify alcohol-attributable and -preventable mortality, totally and stratified on alcohol consumption in Denmark 2010, and to estimate alcohol-related mortality assuming different scenarios of changes in alcohol distribution in the population. We estimated alcohol-attributable and -preventable fractions based on relative risks of conditions causally associated with alcohol from meta-analyses and information on alcohol consumption in Denmark obtained from 14,458 participants in the Danish National Health Survey 2010 and corrected for adult per capita consumption. Cause-specific mortality data were obtained from the Danish Register of Causes of Death. In total, 1,373 deaths among women (5.0% of all deaths) and 2,522 deaths among men (9.5% of all deaths) were attributable to alcohol, while an estimated number of 765 (2.8%) and 583 (2.2%) deaths were prevented by alcohol. Of the alcohol-attributable deaths, 73 and 81% occurred within the high alcohol consumption group (>14/21 drinks/week for women/men). A reduction of 50% in the alcohol consumption was associated with a decrease of 1,406 partly alcohol-attributable deaths (46%) and 37 alcohol-preventable deaths (3%). Total compliance with sensible drinking guidelines with a low risk limit (<7/14 drinks/week) and a high risk limit (<14/21 drinks/week) was associated with a reduction of 2,380 and 1,977 alcohol-attributable deaths, respectively. In summary, 5.0% of deaths among women and 9.5 % of deaths among men were attributable to alcohol in Denmark 2010. The minority of Danish women and men had high alcohol consumption (16 and 26%). However, the majority of all alcohol-attributable deaths among women and men were caused by high consumption (73 and 81%).

Are alcohol-attributable mortality estimates reliable?

The paper by Guerin et al. 1 on alcohol-attributable mortality in France deals with a major public health issue. It shows higher estimates than recent ones obtained in France2 or by the World Health Organization.3,4 In this paper, and this is the case in similar studies, the main part of accounted deaths is due to conditions that are not directly but only partly attributable to alcohol. Attributable fractions are obtained by means of a statistical calculation. Data used to perform such a calculation are of three different types: 1. Risk functions putting alcohol consumption level into relation with mortality incidence from a given cause, obtained from epidemiological studies, 2. Alcohol consumption distribution in the general population, obtained from population surveys, 3. Mortality by cause of death, obtained from the national mortality register. Many sources of uncertainty lead to the use of these data with care: First, the data types (i) and (ii) have to be compatible to be combined, i.e. alcohol consumption data have to be measured in a comparable manner in both sources. The international literature systematically identifies a strong under-estimation of alcohol consumption in self-reported surveys.5 To take this …

S01 * NURTURING ADDICTION RESEARCH AND HARMONISING ALCOHOLISM TREATMENT IN EUROPE SYMPOSIUM OF THE EUROPEAN FEDERATION OF ADDICTION SOCIETES (EUFAS) I

# S01.1 A BIBLIOMETRIC ANALYSIS OF EUROPEAN VS. USA RESEARCH IN THE ADDICTION FIELD. RESEARCH ON ALCOHOL, NARCOTICS, PRESCRIPTION DRUG ABUSE, TOBACCO AND STEROIDS 2001–2011 {#article-title-2} Background. To compare the publication and citation rate within the areas of drug abuse and dependence research in Europe with that in the USA. Methods. This is a bibliometric study using the Thomson Reuters Web of Knowledge as data source, 40 key words were used as search terms, but certain scientific publications not concerning the issue were excluded. Scientific publications from Denmark, England, Finland, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the USA were studied. The number of publications in each country and in each year in addition to the citation indices for these publications was retrieved. Results: Approximately two thirds of the publications came from the USA. Both in absolute and relative figures Europe lagged behind. The trend over the last decade was a greater gap between the amount of research performed in Europe vs. the USA. There were thematic differences. Smaller European countries had a greater relative publication rate. The citations were relatively evenly distributed. Conclusions. It has been claimed that 85 % of the world's research within the field of drug abuse and dependence is carried out in the USA. This study challenges this figure, but European research within this field is lagging behind. # S01.2 ALCOHOL INTERVENTION GUIDELINES IN THE UK: NICE AND BEYOND {#article-title-3} The National Institute for Health and Care Excellence (NICE) in the UK has published a series of comprehensive guidelines on alcohol interventions in 2010–2011 supported by a range of implementation tools. The guidelines describe a wide range of alcohol interventions that are effective and cost effective. This presentation will describe the process by which the guidelines were developed, what they are saying that is new, and discuss the challenges and opportunities for implementation. The main conclusion is that guidelines are a necessary but not sufficient element of the implementation process. # S01.3 TREATMENT APPROACHES IN EUROPE. A VIEW FROM THE AMPHORA PROJECT {#article-title-4} In the frame of the Amphora project, a comparative study was conducted in six European countries (Austria, United Kingdom, Germany, Italy, Spain and Switzerland to assess early diagnosis and treatment of alcohol use disorders in Europe. The study identified low positive screening rates for alcohol use disorders in Primary Health Care (0.8%) and showed relevant differences across countries concerning barriers and facilitators for both screening and brief interventions. The gap between need and treatment for alcohol use disorders was also studied in all 6 countries. The prevalence-service utilisation ratio ranged from 3,8 to 23,3%, overall showing a large gap between the need for treatment and the access to it. # S01.4 TREATMENT DECREASES MORTALITY IN ALCOHOL DEPENDENT PATIENTS {#article-title-5} The aim of this presentation is to estimate the health burden attributable to heavy drinking and alcohol dependence. In addition, we estimated the potential effects of increasing the treatment rate on reducing alcohol-attributable mortality. Attributable fractions were used to estimate the proportion of mortality that was attributable to the exposure under consideration. The effects of treatment interventions were estimated by means of simulations. Heavy drinking was responsible for 62% and 69% of all alcohol-attributable deaths among women and men, respectively, in the age group 15-64 in the EU in 2004. In this age group, alcohol dependence was estimated to be linked to 44% and 66% of all alcohol-attributable deaths in women and men, respectively. For alcohol-attributable net mortality (i.e., after subtracting the protective effects on ischemic disease), the respective proportions were considerably higher. It should be noted that the groups of heavy drinkers and people with alcohol dependence overlap considerably. If the proportion of people with alcohol dependence undergoing the most effective treatment rose to 40%, 9% of female and 13% of male alcohol-attributable net deaths could be prevented within one year. Alcohol consumption and, more specifically, alcohol dependence are responsible for a large proportion of the burden of disease in the EU. Increasing the availability of effective treatment interventions to people with alcohol dependence could reduce this burden.

No and low alcohol intake may have differential effects on risk of overall and cause-specific mortality

Dear Sir: We read with great interest the article by Vergnaud et al (1) on the relation between adherence to the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) guidelines and risk of death in Europe. This well-crafted, large-scale study conducted in participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort offers valuable data regarding the impact of the WCRF/AICR recommendations on reducing total and cause-specific mortality and suggests that the utility of these guidelines may extend beyond the scope of cancer prevention. We are, however, keen on gaining additional understanding of the results presented in their Table 4: namely, the risk of death associated with alcohol consumption. The authors found that adherence to the WCRF/AICR recommendation for daily alcohol intake (≤2 drinks for men and 1 drink for women) was protective against all-cause mortality in men but not in women. This result was based on a scoring system that operationalized this alcohol-specific guideline into 3 categories of ethanol intake: ≤20, >20 to ≤30, and >30 g/d for men and ≤10, >10 to ≤20, and >20 g/d for women. Among the 257,421 male study participants, the men whose ethanol intake was >20 to ≤30 g/d had a significantly reduced risk of death compared with men whose consumption exceeded 30 g/d (HR: 0.80), as did men who limited their intake to ≤20 g/d compared with the same referent (HR: 0.89). However, significant associations between risk of death and the alcoholic drinks component of the WCRF/AICR recommendations were not observed among the 121,443 female study participants. We are highly curious both to learn whether making the distinction between no and low ethanol intake would alter the results of this analysis and to see the stratification of HRs by cause of death. Whereas it is widely acknowledged that, unlike in cardiovascular disease, the lowest alcohol-related cancer risk is in fact conferred in the absence of alcohol consumption (2), there remains uncertainty regarding whether the protective effect of abstinence on cancer risk translates to survival outcomes. The most current estimate of alcohol-attributable cancer mortality in the United States to our knowledge suggests that alcohol consumption at any level not only increases cancer risk but, more critically, is a major factor behind cancer-related death in men and women (3). Interestingly, the number of alcohol-attributable deaths was highest for female breast cancer in this investigation. A meta-analysis by Bagnardi et al (4) that included 222 articles concerning alcohol consumption and cancer found that light alcohol drinking (≤1 drink/d) was associated with breast cancer death. In contrast and illustrative of the ambiguity related to drinking and cancer mortality, another recent study reported that any alcohol consumption either before or after breast cancer diagnosis had no adverse impact on survival from breast cancer, cardiovascular disease, or other cause, and that moderate consumption may even have a survival benefit (5). The robust data set of Vergnaud et al presents an opportunity for additional analyses that could shed further light on the advantages or lack thereof of teetotaling in the prevention of cancer or other chronic diseases. As such, we appreciate the authors’ consideration of our request that they both reoperationalize the alcohol-specific WCRF/AICR score such that 0 g/d of ethanol intake is assigned its own category and evaluate alcohol-specific mortality by cause of death and share these results.

Alcohol-Attributable Mortality and Years of Potential Life Lost in Chile in 2009

The aim of the study was to estimate mortality and years of potential life lost (YPLL) attributable to alcohol consumption in 2009 in Chile. The population considered for this study included those 15 years and over. Exposure to alcohol in the population was estimated by triangulating the records of alcohol per capita consumption in Chile with information from the Eighth National Study of Drugs in the General Population (2008). The effect of alcohol consumption on each cause of death (relative risk) was extracted from previously published meta-analyses. With this information we estimated the alcohol-attributable fraction (AAF) and deaths and YPLL due to alcohol consumption. The confidence intervals for the AAF were estimated with Monte Carlo sampling using the estimated variances of the exposure prevalence and relative effect. The estimated total number of deaths attributable to alcohol consumption was 8753 (95% CI: 6257, 11,584) corresponding to 9.8% (95% CI: 7.01%, 12.98%) of all deaths in Chile in 2009. The total estimated YPLL attributable to alcohol were 195,475 (95% CI: 164,287, 227,726), corresponding to 21.5% (95% CI: 18.1%, 25.0%) of total YPLL for that year in Chile. Alcohol consumption is a major risk factor and accounts for nearly one of ten deaths in Chile. These results may be used to guide the design of public health policies and evaluations.

Trends in alcohol-attributable morbidity and mortality for Victoria, Australia from 2000/01 to 2009/10

To examine trends in alcohol-attributable morbidity (AAMorb) (2000/01-2009/10) and mortality (AAMort) (2000-07) by age, sex and region. Time-series analyses of population data for Victoria, Australia. We used joinpoint regression to quantify trends by estimating quarterly percent change (QPC) for rates of morbidity and mortality. We present the average QPC (AQPC) as a weighted average of QPCs. A test of parallelism was used to examine pairwise differences. AAMorb increased significantly over time for Victoria (AQPC = 1.0%, 95% confidence interval 0.8-1.2). While females (1.6, 1.1-2.0), age groups 25-44 (1.0, 0.9-1.1) and 45-64 (1.2, 0.2-2.2), and metropolitan population (1.2, 0.5-1.9) were broad subgroups more at risk, multivariate analysis detected specific increases for metropolitan females aged 15-44 (1.8, 1.0-2.6) and 45+ (1.6, 0.2-3.0). Relatively greater increases in morbidity among metropolitan subgroups were widespread. AAMort remained stable for Victoria and for most subgroups, although significant declines in mortality were specifically experienced by metropolitan 15-24 (-2.0, -2.9 to -1.0) and 25-44 (-1.0, -1.7 to -0.3) age groups, and by regional males aged 45+ (-0.8, -1.3 to -0.3). Metropolitan males aged 45+ were a special high-risk population. Our study has identified overlooked subgroups as being at increasing risk for alcohol-attributable chronic harm necessitating their inclusion in future policies for harm reduction.