Health Outcomes due to Health Outcomes due to AlcoholAlcohol

14 July 2005Kanitta

BundhamcharoenMOPH

Acknowledgement

• Ratchata Tangsiripat IHPP• Thaksapon Thamarangsi IHPP• and the Thai Working Group on burden

attributable to risk factor• Theo Vos• Majid Ezzati

Outline

• What are the effects of alcohol on health?• How do we measure the health loss?• How many healthy life years were lost due

to alcohol?

Consumption, Mediators & Effects

Pattern volume

Chronic disease

Accidents/ injuries

(Acute disease)

Acute social problems

Chronic social

problems

Intoxication

Toxic effect Dependence

Ref: Babor et al. (2003)

Basic CRA framework and goals

Risk factor levels• current distribution• counterfactual • distribution(s)

Disease burden

Risk factor-disease relationships

• risk accumulation• risk reversal

Attributable burdenAvoidable burden

Burden of Disease

• Burden of disease analysis provides a standardized framework for integrating all available information on mortality, causes of death, individual health status, and condition-specific epidemiology to provide an overview of the the levels and causes of population health

Disability-Adjusted Life Years (DALYs)

• One DALY is one lost year of ‘healthy’ life• DALY = YLL + YLD

– DALY (Disability-Adjusted Life Years) = YLL (Years Lost Due to Premature Death)+YLD (Years Lived With Disability)

• YLL = Dx * Ex (use standard life table (West level 26))

• YLD = Incidence * DW * Duration

birth

Death/Life expectancy

0 yr

80 yr

ill

death

person

Years lost due to premature death(YLLs)

Years lived with disability

(YLDs)

DALYs = YLDs + YLLs

Basic CRA framework and goals

Risk factor levels• current distribution• counterfactual • distribution(s)

Disease burden

Risk factor-disease relationships

• risk accumulation• risk reversal

Attributable burdenAvoidable burden

Burden of Disease and injuriesThailand, 1999

1 HIV/AIDS 960,087 17 HIV/AIDS 372,947 9

2 Traffic accidents 510,907 9 Stroke 280,673 7

3 Stroke 267,567 5 Diabetes 267,158 7

4 Liver cancer 248,083 4 Depression 145,336 4

5 Diabetes 168,372 3 Liver cancer 118,384 3

6 Ischaemic heart disease 164,094 3 Osteoarthritis 117,994 3

7 COPD (emphysema) 156,861 3 Traffic accidents 114,963 3

8 Homicide and violence 156,371 3 Anaemia 112,990 3

9 Suicides 147,988 3 Ischaemic heart dis 109,592 3

10 Drug dependence/Harmful use

137,703 2 Cataracts 96,091 2

Rank

Disease category

MALE DALYsloss

Disease category

FEMALE DALYsloss

% %

Source: Thai Working Group on BOD, 2002

11 Alcohol dependence/harmful use

130,654 2 COPD (emphysema) 93,387 2

12 Cirrhosis 117,527 2 Deafness 87,612 2 13 Lung cancer 106,120 2 Lower respiratory tract

infections 84,819 2

14 Drownings 98,464 2 Low birth weight 83,879 2 15 Depression 95,530 2 Dementia 70,191 2 16 Osteoarthritis 93,749 2 Anxiety disorders 66,835 2 17 Tuberculosis 93,695 2 Schizophrenia 60,800 2 18 Deafness 93,497 2 Tuberculosis 60,643 2 19 Low birth weight 91,934 2 Birth trauma & asphyxia 57,488 1 20 Anaemia 87,610 2 Nephritis & nephrosis 55,258 1

Burden of Disease and injuriesThailand, 1999

Source: Thai Working Group on BOD, 2002

Rank

Disease category MALE

DALYsloss

Disease category

FEMALE DALYsloss

% %

Risk Burden4.5

0.40.50.40.7

2.32.4

1.10.50.70.6

0.30.10.3

0.1

8.65.1

4.43.33.3

2.61.3

1.10.9

0.60.50.40.30.30.2

0 1 2 3 4 5 6 7 8 9 10

Unsafe sexAlcoholTobacco

Illicit drugsNot wearing helmet

Blood pressureObesity

CholesterolFruit & veggies

Air pollutionPhysical inactivity

Malnutrition – Int’l standardNot wearing seatbeltWater & sanitation

Malnutrition - Thai standard

FemaleMale

Source: Thai Working Group, MOPH, 2003

13.8%5.8%

5.1%5.0%

4.2%3.9%

3.6%2.3%

1.4%1.4%

1.2%0.7%0.7%

0.4%0.3%

0 0.02 0.04 0.06 0.08 0.1 0.12 0.14 0.16

Unsafe sexAlcohol

TobaccoBlood pressure

Not wearing helmetObesity

Illicit drugsCholesterol

Fruit & vegiesAir pollution

Physical inactivityMalnutrition - int standard

Water & sanitationNot wearing seatbelt

Malnutrition - Thai standard

Risk Burden

0 . 00 % 5 . 00 %

10 . 00 % 15 . 00 %

0 - 4 0 - 4 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 + 0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 + age group ( yrs )

%

Total DALYs

unsafe sex water and sanitation Tobacco Physical inactivity

malnutrition_international standard malnutrition_thai standard illicit drug use Non - Helmet No safety belts inadequate intake of fruit and vegetable cholesterol BMI Blood pressure alcohol

air pollution

Risk burden by age group

Alcohol

5%6%

14%

Stroke6%

Cirrhosis12%

Burden attributable to alcohol: M

Dependence 25%

Traffic accidents22%

SuicidesHomicide and violence

ca liver

Traffic accidents12%

ca liver13%

Alcohol dependence

44%

Burden attributable to alcohol: F

Alcohol dependence 44%

CA Liver

Cirrhosis 7%

Data Sources

Alcohol Consumption

• Prevalence – Inter Asia (2000) Data• Average volume drinking category II:

– females 20 – <40 g pure alcohol daily– males 40 – <60 g pure alcohol daily

• Average volume drinking category III: – females 40+ g pure alcohol daily – males 60+ g pure alcohol daily

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

30-44 45-59 60-69 70-79 80+

abstainerresponsiblehazardousharmful

Alcohol consumption: Male

Alcohol consumption: Female

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

30-44 45-59 60-69 70-79 80+

abstainerresponsiblehazardousharmful

Relative RiskM FHazard Harm Hazard Harm

CA mouth/ pharynx

1.85 5.39 1.85 5.39

CA oesophagus

2.38 4.36 2.38 4.36

CA liver 3.03 3.6 3.03 3.60CA larynx 3.9 4.93 3.90 4.93CA breast <45

1 1 1.41 1.46

CA breast 45+

1 1 1.38 1.62

Diabetes (NIDDM)

0.57 0.73 0.87 1.13

Ref: Ezzati et al (2004)

Relative RiskM FHazard Harm Hazard Harm

Epilepsy 7.52 6.83 7.22 7.52hypertension 2 4.1 2 2IHD 0.83 1 0.83 1.12Ischaemic stroke

1.33 1.65 0.64 1.06

Haemorrhagic stroke

2.19 2.38 0.65 7.98

Cirrhosis 9.5 13 9.5 13Cholelithiasis 0.68 0.5 0.68 0.5LBW 1.4 1.4 1.4 1.4

Ref: Ezzati et al (2004)

Injuries

• Fraction of alcohol related injuries from Injury surveillance data