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      The relationship between different dimensions of alcohol use and the burden of disease—an update


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          Background and aims

          Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs).


          Systematic review of reviews and meta‐analyses on alcohol consumption and health outcomes attributable to alcohol use.

          For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others.


          In total, 255 reviews and meta‐analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD‐10 three‐digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in‐depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently.


          Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.

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          Most cited references280

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study.

            Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors. The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons. DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed. Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; non-communicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%; neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies. 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene. The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death. DALYs provide a common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.
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              The global burden for disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020


                Author and article information

                Addiction (Abingdon, England)
                John Wiley and Sons Inc. (Hoboken )
                20 February 2017
                June 2017
                : 112
                : 6 ( doiID: 10.1111/add.v112.6 )
                : 968-1001
                [ 1 ]Institute for Mental Health Policy Research, CAMH Toronto OntarioCanada
                [ 2 ]Campbell Family Mental Health Research Institute, CAMH Toronto OntarioCanada
                [ 3 ] Institute of Medical Science (IMS)University of Toronto Toronto OntarioCanada
                [ 4 ] Department of PsychiatryUniversity of Toronto Toronto OntarioCanada
                [ 5 ] Dalla Lana School of Public HealthUniversity of Toronto Toronto OntarioCanada
                [ 6 ]Institute for Clinical Psychology and Psychotherapy, TU Dresden DresdenGermany
                [ 7 ] Alcohol Treatment CenterLausanne University Hospital LausanneSwitzerland
                [ 8 ]Addiction Switzerland LausanneSwitzerland
                [ 9 ]University of the West of England BristolUK
                [ 10 ] Factor‐Inwentash Faculty of Social WorkUniversity of Toronto OntarioCanada
                [ 11 ] Centre for Alcohol Policy ResearchLa Trobe University Melbourne VictoriaAustralia
                [ 12 ] Centre for Social Research on Alcohol and DrugsStockholm University StockholmSweden
                [ 13 ] Section of Cancer SurveillanceInternational Agency for Research on Cancer LyonFrance
                Author notes
                [*] [* ] Correspondence to: Jürgen Rehm, Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada.

                E‐mail: jtrehm@ 123456gmail.com

                Author information
                ADD13757 ADD-16-1105.R1
                © 2017 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                : 11 November 2016
                : 19 December 2016
                : 09 January 2017
                Page count
                Figures: 1, Tables: 4, Pages: 34, Words: 10155
                Funded by: WHO Collaboration Centre on Mental Health and Addiction
                Custom metadata
                June 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.9 mode:remove_FC converted:17.05.2017

                Clinical Psychology & Psychiatry
                alcohol use,average volume,chronic disease,injury,patterns of drinking,risk‐relations,systematic review,unrecorded consumption


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