Alcohol Consumption In Germany Research Articles

Prevalence and characteristics of hazardous and harmful drinkers receiving general practitioners’ brief advice on and support with alcohol consumption in Germany: results of a population survey

ObjectiveThe German treatment guideline on alcohol-related disorders recommends that general practitioners (GPs) offer brief advice on, and support with, reducing alcohol consumption to hazardous (at risk for health events) and...

Can alcohol consumption in Germany be reduced by alcohol screening, brief intervention and referral to treatment in primary health care? Results of a simulation study.

Screening, brief intervention and referral to treatment (SBIRT) is a programme to reduce alcohol consumption for drinkers with high alcohol consumption levels. Only 2.9% of patients in primary health care (PHC) are screened for their alcohol use in Germany, despite high levels of alcohol consumption and attributable harm. We developed an open-access simulation model to estimate the impact of higher SBIRT delivery rates in German PHC settings on population-level alcohol consumption. A hypothetical population of drinkers and non-drinkers was simulated by sex, age, and educational status for the year 2009 based on survey and sales data. Risky drinking persons receiving BI or RT were sampled from this population based on screening coverage and other parameters. Running the simulation model for a ten-year period, drinking levels and heavy episodic drinking (HED) status were changed based on effect sizes from meta-analyses. In the baseline scenario of 2.9% screening coverage, 2.4% of the adult German population received a subsequent intervention between 2009 and 2018. If every second PHC patient would have been screened for alcohol use, 21% of adult residents in Germany would have received BI or RT by the end of the ten-year simulation period. In this scenario, population-level alcohol consumption would be 11% lower than it was in 2018, without any impact on HED prevalence. Screening coverage rates below 10% were not found to have a measurable effect on drinking levels. Large-scale implementation of SBIRT in PHC settings can yield substantial reductions of alcohol consumption in Germany. As high screening coverage rates may only be achievable in the long run, other effective alcohol policies are required to achieve short-term reduction of alcohol use and attributable harm in Germany. There is large potential to apply this open-access simulation model to other settings and for other alcohol interventions.

Robust prediction of domain compositions from uncertain data using isometric logratio transformations in a penalized multivariate Fay–Herriot model

Assessing regional population compositions is an important task in many research fields. Small area estimation with generalized linear mixed models marks a powerful tool for this purpose. However, the method has limitations in practice. When the data are subject to measurement errors, small area models produce inefficient or biased results since they cannot account for data uncertainty. This is particularly problematic for composition prediction, since generalized linear mixed models often rely on approximate likelihood inference. Obtained predictions are not reliable. We propose a robust multivariate Fay–Herriot model to solve these issues. It combines compositional data analysis with robust optimization theory. The nonlinear estimation of compositions is restated as a linear problem through isometric logratio transformations. Robust model parameter estimation is performed via penalized maximum likelihood. A robust best predictor is derived. Simulations are conducted to demonstrate the effectiveness of the approach. An application to alcohol consumption in Germany is provided.

Do smoking, nutrition, alcohol use, and physical activity vary between regions in Germany? - results of a cross-sectional study

BackgroundPrevious studies on lifestyle risk factors mainly focused on age- or gender-specific differences. However, lifestyle risk factors also vary across regions. Aim of the present study was to examine the extent to which prevalence rates of SNAP (smoking, nutrition, alcohol consumption, physical activity) vary between East and West Germany or North and South Germany.MethodsData came from the population-representative 2015 Epidemiological Survey of Substance Abuse (ESA) comprising 9204 subjects aged 18 to 64 years. To assess an east-west or south-north gradient, two binary logistic regression models were carried out for each SNAP factor.ResultsThe logistic regression models revealed statistically significant differences with higher rates of at-risk alcohol consumption and lower rates of unhealthy nutrition in East Germany compared to West Germany. Significant differences between North and South Germany were found for at-risk alcohol consumption with higher rates of at-risk alcohol consumption in South Germany. Daily smoking and low physical activity were equally distributed across regions.ConclusionsThe implementation of measures reducing at-risk alcohol consumption in Germany should take the identified east-west and south-north gradient into account. Since the prevalence of unhealthy nutrition was generally high, prevention and intervention measures should focus on Germany as a whole instead of specific regions.

Are German family practitioners and psychiatrists sufficiently trained to diagnose and treat patients with alcohol problems?

BackgroundHarmful alcohol consumption in Germany is a serious public health problem: About 7.7 million adults in Germany can be classified as risky alcohol consumers, about 74,000 deaths per year are related to alcohol consumption, and about 1.8 million adults in Germany (18–64 years) are classified as alcohol dependent. A treatment rate of 9% of all alcohol dependent patients in Germany implies a lack of supply and misuse of medical care. The aim of the study was to examine whether family practitioners (FPs) and psychiatrists have sufficient skills to diagnose and treat patients with alcohol problems.MethodsA total of 6324 FPs and psychiatrists in the states of Saxony and Rhineland-Palatinate in Germany were invited to participate in this survey. Nine hundred seventy-four participants (90.3%/FPs) could be included in the statistical analysis (response rate: 14.3%/FPs, 21.6%/psychiatrists). Data was analysed descriptively and logistical regressions were used to identify predictors for physicians’ ability to feel adequately trained to diagnose and treat patients with alcohol problems.ResultsIn comparison to psychiatrists, less FPs reported feeling sufficiently trained to counsel patients with alcohol problems (81.5% vs. 44.8%). Regression analysis revealed that FPs who felt not adequately trained had less experience with patients with alcohol dependence (OR 7.4), had attended fewer hours on alcohol addiction in continuing medical education (OR 4.8), and were more likely to be female (OR 1.9). A minimum of 10 h of training was associated with improved self-assessed competence.ConclusionHarmful drinking is a serious public health problem, and patients with alcohol dependence represent a large and demanding patient group in primary health care setting. Our study shows that the lack of training is a severe barrier in the work with this patient group in the primary care setting.

Decomposing social inequalities in alcohol consumption in Germany 1995-2015: an age-period-cohort analysis.

Background and aimsPrevious research indicates that compared with individuals with lower socio‐economic status (SES), individuals in higher SES groups are more often drinkers but those who drink report drinking smaller amounts more frequently. We aimed to decompose trends in self‐reported alcohol consumption in Germany into age, period and birth cohort effects and examine whether these effects varied by SES.DesignAge–period–cohort (APC) analysis using data from eight waves of the cross‐sectional German Epidemiological Survey of Substance Abuse (ESA) collected between 1995 and 2015.SettingGermany.ParticipantsThe analytical sample included n = 65 821 individuals aged 18–64 years reporting alcohol use within the last 30 days.MeasurementsAlcohol measures included drinking prevalence, alcohol volume and prevalence of episodic heavy drinking (EHD). Educational attainment was used as an indicator of SES. A series of generalized linear and logistic regression models, including both main and interaction effects of age, period and cohort with SES, were estimated.FindingsRegression models revealed significant interactions between APC effects and SES on two alcohol consumption measures. Higher SES was consistently associated with drinking prevalence across age (P < 0.001), period (P = 0.016) and cohort (P = 0.016), and with volume of drinking in younger cohorts (P = 0.002) and 50+‐year‐olds (P = 0.001). Model results were inconclusive as to whether or not APC effects on EHD prevalence differed by SES.ConclusionsIn Germany, there are positive associations between socio‐economic status and alcohol consumption during the life‐course, over time and among birth cohorts. Three groups appear vulnerable to risky drinking: high socio‐economic status young birth cohorts who drink high average quantities, low socio‐economic status young birth cohorts who show a risky drinking pattern and high socio‐economic status adults in their 50s and older who increase their drinking volume beyond that age.

Quantifying harms to others due to alcohol consumption in Germany: a register-based study

BackgroundThe consumption of alcohol increases the risk of drinkers harming others. The extent of alcohol’s morbidity and mortality harms to others in Germany in 2014 was estimated for (1) fetal alcohol syndrome (FAS) or fetal alcohol spectrum disorders (FASD) among newborns, (2) road traffic fatalities, and (3) interpersonal violence-related deaths.MethodsThe incidences of FAS and FASD were estimated by means of a meta-analytical approach, combining data on alcohol use during pregnancy and the risk relationship between alcohol consumption during pregnancy and FAS/FASD. In order to estimate alcohol-attributable road traffic fatalities and interpersonal violence due to the drinking of others, an attributable fraction methodology was applied to cause-of-death statistics for road traffic and interpersonal violence-related deaths.ResultsFor 2014, the incidences of FAS and FASD were estimated at 41 children per 10,000 live births (95% CI 24; 63) and 177 children per 10,000 live births (95% CI 135; 320), or 2930 (95% CI 1720; 4500) and 12,650 (95% CI 9650; 23,310) children, respectively. Furthermore, alcohol was estimated to be responsible for 1214 (95% CI 1141; 1287) third-party road traffic fatalities and 55 (95% CI 46; 64) deaths from interpersonal violence, representing 45.1% of all third-party road traffic fatalities and 14.9% of all interpersonal violence deaths.ConclusionThese study’s estimates indicate there is a substantial degree of health harm to third parties caused by alcohol in Germany. While more research on harms to others caused by alcohol is needed to provide comprehensive estimates, the results indicate a need for effective prevention.

Cancers Due to Smoking and High Alcohol Consumption.

Tobacco and alcohol consumption are known causes of cancer. We set out to estimate the absolute numbers and proportions of cancer attributable to smoking and high alcohol consumption in Germany in 2018. Numbers and proportions (population-attributable fractions, PAF) were calculated by sex and age group for ages 35 to 84 years based on population projections, national cancer incidence and exposure data, and published relative risks. For the year 2018 we estimated the smoking-attributable cancer burden to be 85 072 cases (men 58 760, women 26 312), corresponding to 19% of all incident cancers. The highest PAF was seen for lung cancer: 89% of male and 83% of female lung cancer cases are attributable to smoking. The cancer burden attributable to high alcohol consumption was estimated to be 9588 (men 8117, women 1471) cases (2% of all incident cancers). The highest PAF were observed for cancer of the oral cavity and pharynx (men 34%, women 6%) and squamous cell carcinoma of the esophagus (men 30%; women 5%). A considerable proportion of cancer cases are attributable to smoking and high alcohol consumption. More rigorous prevention efforts are required to achieve significant reductions in the prevalence of these risk factors and the attributable cancer burden.

Trends of Tobacco and Alcohol Consumption over 65 Years in Germany

No estimation was available for tobacco and for alcohol consumption in Germany based on sales data that were provided for public use and suited for time trend analysis. To estimate trends of tobacco and alcohol consumption rates for the years 1950-2014. Data on tobacco and alcohol consumption in the nation were retrieved from reports made by producers of beer, wine, or spirits to the Federal Statistics Office of Germany. Time trends over the 65 years were calculated using the program Joinpoint. Tobacco consumption rose from 1950 to 1972. Thereafter it decreased, mostly by 1.2-6.9 percentage points per year. Alcohol consumption rose until the year 1974 and decreased thereafter by 1.0 percentage points annually until the end of the time period under analysis in 2014. The findings may be explained, among others, by changes of social norms according to smoking and alcohol consumption after tax increases, nonsmoker and youth protection laws, and legislative measures against driving under the influence of alcohol. A steepening of the decrease in tobacco consumption occurred after laws including tax increases had come into effect. However, the tobacco and alcohol consumption levels were still high at the end of the observation period in 2014.

The costs of hazardous alcohol consumption in Germany.

Hazardous alcohol consumption in Germany is a main threat to health. By using insurance claim data from the German Statutory Health Insurance and a classification strategy based on ICD10 diagnoses-codes we analyzed a sample of 146,000 subjects with more than 19,000 hazardous alcohol consumers. Employing different regression models with a control function approach, we calculate life years lost due to alcohol consumption, annual direct and indirect health costs, and the burden of pain and suffering measured by the Charlson-Index and assessed pain diagnoses. Additionally, we simulate the net accumulated premium payments over expenses in the German Statutory Health Insurance and the Statutory Pension Fund for hazardous alcohol consumers from a lifecycle perspective. In total, €39.3billion each year result from hazardous alcohol consumption with an average loss of 7years in life expectancy. Hazardous alcohol consumers clearly do not "pay their way" in the two main German social security systems and also display a higher intangible burden according to our definitions of pain and suffering.

Incident cancers attributable to alcohol consumption in Germany, 2010.

Germany lacks an up-to-date assessment of the cancer burden attributable to alcohol. Therefore, cancer incidence attributable to this exposure was estimated for colorectal, liver, breast, and upper aerodigestive tract (UADT) cancer. Additionally, the impact of alcohol on UADT cancer was analyzed by smoking status, to account for synergistic interactions between these two risk factors. Alcohol consumption and smoking prevalence from a nationwide survey in Germany 2008-2011 were combined with relative risks of incident cancer from meta-analyses to obtain population attributable risks (PARs), indicating the proportion of cancers that could be avoided by eliminating a risk factor. Each PAR was multiplied with the respective cancer incidence for 2010 to calculate the absolute number of attributable cases. In Germany, for the year 2010, approximately 13,000 incident cancer cases could be attributed to alcohol consumption (3% of total cases). PAR was highest for esophageal cancer (men: 47.6% and women: 35.8%) and lowest for colorectal cancer in men (9.7%) and breast cancer in women (6.6%). Among women, moderate consumption levels account for the greatest PAR overall, whereas heavy drinking contributes considerably to overall PAR among men. Additionally, moderate-to-heavy drinking among smokers substantially contributes to the overall PAR of UADT cancers compared to drinking among non-smokers. In Germany, a substantial proportion of cases of common cancers can be attributed to alcohol consumption, even when consumed at moderate levels. Alcohol consumption with concurrent tobacco smoking is especially important for cancers of the UADT. These findings strengthen the rationale for prevention measures that address exposure at all levels.

Epidemiologie des Substanzkonsums und der Suchterkrankungen in Deutschland

The objective of this literature review was to investigate the epidemiological basis in public health and clinical treatment for four psychotropic substance groups (i.e., alcohol, tobacco, illegal drugs, and pharmaceuticals) in Germany. The following issues were addressed: (1) what impact does the consumption of these psychoactive substances have on the overall burden of diseases to the general public compared to other disorders? (2) What are the prevalences of these four substance groups regarding consumption, substance use disorders, and sequelae in Germany? (3) How many people with a substance-related diagnosis have been treated within the addiction help system? (4) What are the costs of substance-related disorders and problems? Epidemiological data, mainly representative samples in Germany about use and abuse of legal and illegal drugs, were analyzed. For cost-benefit analyses, only the most recent studies were used. Alcohol-related disorders are among the ten most common diseases with the strongest impact on the overall burden of disease. The prevalence rates of substance-related diagnoses in 2006 (based on the last 12 months for 18-64 year olds) were 7.3% for nicotine dependence, followed by alcohol dependence (2.4%), alcohol misuse (3.8%), and illegal substances (0.6%). Alcohol consumption in Germany, defined as the per capita consumption of pure alcohol, declined between 1980 and 2007. However, extreme alcohol abuse in adolescents has increased. Inpatient admissions due to acute alcohol disorders increased more in adolescents than in the general population. Particularly critical is the increasing number of 10- to 15-year-old girls. The availability of treatment to patients with pharmaceutical-related disorders and with nicotine disorders is very low. Cost-benefit studies for the consequences of consuming various substances show that netto costs regarding alcohol taxes were 316 Euro per capita of the German population between 18 and 65 years for alcohol disorders and 133 Euro for nicotine dependence. The availability of nicotine and pharmaceutical dependence assistance to patients should be improved in the primary and secondary care systems. The alcohol abuse of adolescents requires specific observation and intervention. In order to adequately plan treatment systems for addiction, an estimation of the need for help and the acceptance of the help should be explored and analyzed in scientific studies.

Direct and indirect costs attributable to alcohol consumption in Germany in 2002

Direct and indirect costs attributable to alcohol consumption in Germany in 2002

The Health and Economic Consequences of Moderate Alcohol Consumption in Germany 2002

Objective Moderate alcohol consumption is associated with both positive and negative health effects. This study aims to estimate the positive and negative consequences on mortality, years of potential life (YPL), quality-adjusted life-years (QALYs), resource utilization, and societal costs attributable to moderate alcohol consumption in Germany in 2002. Methods The concept of attributable risks and a prevalence-based approach was used to calculate age- and sex-specific alcohol attributable mortality and resource utilization for a wide range of disorders, and avoided mortality and resource utilization for diabetes mellitus, coronary heart disease, stroke, and cholelithiasis. The literature provided prevalence of moderate alcohol consumption in Germany by age and sex and relative risks. Direct costs were calculated using routine utilization and expenditure statistics. Indirect costs were calculated using the human capital approach. Results Due to moderate alcohol consumption, 14,457 lives, 205,691 YPL, and 179,964 QALYs were lost, whereas 29,918 lives, 300,382 YPL, and 258,284 QALYs were gained. Up to an age of 55 to 60 (62.5–67.5) years, more lives were lost than gained among men (women), whereas in older age groups more lives were gained than lost. Moderate alcohol consumption caused €3049 million of direct and €2630 million of indirect costs, whereas €2094 million of direct and €2604 million of indirect costs were avoided. Conclusion Despite considerable uncertainty, moderate alcohol consumption seems to result in an overall net effect of gained lives, YPL, and QALYs, realized among the elderly, but overall increased societal costs. Thus, moderate alcohol consumption should still be seen critical, especially among youths.

Direkte und indirekte Kosten des Alkoholkonsums in Deutschland

Aim To estimate the direct and indirect costs of morbidity and mortality attributable to alcohol consumption in Germany from a societal perspective in 2002.

Direct and Indirect Costs Attributable to Alcohol Consumption in Germany

To estimate the direct and indirect costs of morbidity and mortality attributable to alcohol consumption in Germany from a societal perspective in 2002. Using the concept of attributable risks and the prevalence-based approach, age- and gender-specific alcohol-attributable fractions for morbidity and mortality were calculated for alcoholic disorder, neoplasms, endocrinological, nervous, circulatory, digestive, skin and perinatal disorders, and injuries and poisonings. The literature provided data on alcohol consumption in Germany by age, gender and dose amount, and relative risks. Direct costs were calculated based on routine resource utilisation and expenditure statistics. Indirect costs were calculated based on the human capital approach using a discount rate of 5%. Alcohol consumption accounted for 5.5% of all deaths and 970,000 years of potential life lost. Total costs were euro24,398 million, amounting to 1.16% of Germany's GDP, or euro296 per person. Direct medical and non-medical costs were euro8441 million. Indirect costs were euro15,957 million (69% mortality and 31% morbidity costs). In contrast, protective health effects of alcohol consumption saved euro4839 million. The magnitude of alcohol-attributable morbidity and mortality and associated costs demands more preventive efforts.

High alcohol consumption in Germany: results of the German National Health Interview and Examination Survey 1998

To analyse the alcohol consumption behaviour of the German adult population, with a focus on the characteristics of persons drinking more than the tolerable upper alcohol intake level (TUAL) of 10-12 g day(-1) for healthy adult women and 20-24 g day(-1) for healthy adult men. For the German National Health Interview and Examination Survey 1998, a representative sample of free-living adults was drawn. A total of 7124 participants were interviewed comprehensively about their sociodemographic background, lifestyle and eating habits including alcohol consumption. A sub-sample of 4030 women and men, 18-79 years old, who were involved in the integrated German Nutrition Survey. About 16% of women and 31% of men had mean alcohol consumption above the TUAL. Among other factors, the inclination to exceed the TUAL was related to middle-age, high socio-economic status, smoking and use of soft drugs. Among both women and men, a high proportion of persons drinking above the TUAL was observed among those consuming low amounts of soft drinks, fruit, poultry, milk products, bread and cake/biscuits. Women preferred to drink wine, whereas men preferred to drink beer. Many Germans have an alcohol consumption level above the TUAL and thus are supposed to be at increased risk for alcohol-associated diseases.

Characteristics associated with alcohol consumption in Germany.

Knowledge about predictors of alcohol intake in Germany is scarce. The purpose of this study was to analyze the association of sociodemographic and lifestyle characteristics and quality of life with alcohol consumption among German adults. Analyses are based on cross-sectional data of the German adult population derived from the representative German National Health Interview and Examination Survey 1998 and the integrated German Nutrition Survey. In total, 1,925 women and 1,615 men, 18 to 79 years old, were included. Multiple linear regression analyses of alcohol intake were used to identify predictors of alcohol consumption. The analyses of drinkers were performed separately for women and men. Among women, alcohol consumption was associated with age, socioeconomic status, household size, smoking status, physical activity, use of soft drugs, body mass index, pregnancy and general health perception. The highest alcohol consumption was observed for women of middle age with high socioeconomic status. Among men, age, socioeconomic status, smoking status, physical activity, use of soft drugs, vegetarian diet, contentment with family or neighbors/friends, social functioning and physical functioning were associated with alcohol consumption, with age and smoking being the most important predictors. A variety of factors, including newly analyzed factors describing lifestyle and quality of life, are jointly associated with the higher alcohol consumption of German women and men. These findings may be valuable to focus health promotion projects on population groups with higher alcohol intake and, therefore, higher risk for harmful alcohol effects.

Alcohol in Danish and German Educational Print-Media (1990-1998): A Comparison

Denmark and Germany have similarities regarding their drinking patterns and alcohol policies, although they differ in their way of health promotion concerning alcohol consumption: the governmental health service in Denmark tending more towards a moderate consumption, and Germany tending rather towards near-total abstinence. The aim of this study is to demonstrate the influence of particular interest groups on alcohol policy by analyses of educational print-media about alcohol. The results show that German educational print-media denounce alcohol as a dangerous drug, while the Danish health service balances the positive effects of alcohol against its negative ones. Alcohol-related problems are related to harmful alcohol consumption in Denmark, and to any alcohol consumption in Germany. The ideological background for these strategies is connected to medical circles in Denmark, and temperance groups in Germany. In Germany, the strong position of the temperance groups supported by the then ruling conservative party, and the national virtuous attitude to temperance, most likely account for the more "restrictive" German approach.

Alcohol in Danish and German Educational Print-Media (1990-1998): A Comparison

Denmark and Germany have similarities regarding their drinking patterns and alcohol policies, although they differ in their way of health promotion concerning alcohol consumption: the governmental health service in Denmark tending more towards a moderate consumption, and Germany tending rather towards near-total abstinence. The aim of this study is to demonstrate the influence of particular interest groups on alcohol policy by analyses of educational print-media about alcohol. The results show that German educational print-media denounce alcohol as a dangerous drug, while the Danish health service balances the positive effects of alcohol against its negative ones. Alcohol-related problems are related to harmful alcohol consumption in Denmark, and to any alcohol consumption in Germany. The ideological background for these strategies is connected to medical circles in Denmark, and temperance groups in Germany. In Germany, the strong position of the temperance groups supported by the then ruling conservative party, and the national virtuous attitude to temperance, most likely account for the more "restrictive" German approach.