volume of alcohol consumption, patterns of drinking and burden of disease in the americas 2002

Volume of alcohol consumption, patterns of drinking and burden of

disease in the Americas 2002

Jürgen Rehm 1,2,3 & Benjamin Taylor 2

1 Institut für Suchtforschung (ISF - Addiction Research Institute), Zurich, Switzerland

2 Centre for Addiction and Mental Health (CAMH), Toronto, Canada

3 University of Toronto, Canada

Causal model of alcohol consumption, intermediate mechanisms, and long-term consequences

Chronic Disease

Accidents/Injuries (acute disease)

Acute Social

ChronicSocial

IntoxicationToxic and

benefical biochemicaleffects*

Dependence

Patterns of drinking Average volume

* Independent of intoxication or dependence

Adult per capita consumption inlitre pure alcohol 2000 (based on CRA)

Adult per capita consum ption 2000

0.21 to 2 .85

2.85 to 4 .45

4.45 to 6 .41

6.41 to 9 .47

9.47 to 13.08

13.08 to 19.30

Pattern of drinking 2000(based on CRA)

Patterns o f drinking

1.00 to 2 .00

2.00 to 2 .50

2.50 to 3 .00

3.00 to 4 .00

Volume of drinking

Depression from psychiatric surveys

Drinking pattern

hazard score

(predominance of

intoxication)

Other chronicDiseases (except

CHD and depression)

Coronaryheart

diseaseInjuries

Alcohol-attributable

conditions (by definition)

Estimation of AAF for different disease categories

Alcohol related disease and injury

Chronic disease:

Cancer: Mouth & oropharyngeal cancer, Esophageal cancer, Liver cancer, Female breast cancer, other neoplasmsNeuropsychiatric diseases: Alcohol use disorders, unipolar major depression, epilepsyDiabetesCardiovascular diseases: Hypertensive diseases, ischemic heart disease, strokeGastrointestinal diseases: Liver cirrhosisConditions arising during perinatal period: Low birth weight

Injury:

Unintentional injury: Motor vehicle accidents, drownings, falls, poisonings, other unintentional injuriesIntentional injury: Self-inflicted injuries, homicide, other intentional injuries

Classification of countries in WHO European regions by childhood and adult mortality (WHO, 2000)

America A America B America D

very low childhood and very low adult

mortality

low high childhood and low adult mortality

high childhood and high adult mortality

USA

Canada

Cuba

Argentina, Barbados, Belize, Brazil, Chile,

Colombia, Costa Rica, Dominican republic, El

Salvador, Guyana, Honduras, Jamaica, Mexico, Paraguay,

Suriname, Trinidad and Tobago, Uruguay,

Venezuela

Bolivia, Ecuador, Guatemala, Haiti, Nicaragua, Peru

Definition of regions*: The regional subgroupings used were defined by WHO (World Health Report 2000) on the basis of high, medium or low levels of adult and of infant mortality.

Estimates of alcohol-related burden in South America

• Epidemiological developments (i.e. changes in distribution of disease such as chronic disease vs. infectious disease)

• Changes in drinking (average level and patterns of drinking) => slides with green background

Exposure: Characteristics of adult alcohol consumption in different

regions of WHO AMRO:

based on CRA 2000 (i.e. no new data on consumption included)

(population weighted averages across countries; cf. Rehm et al., 2003b, 2004; Babor et al., 2003)

Adult alcohol consumption in different categories 2000 in % - Americas - males

Males Abstainer

0-0.25 g/d

Cat.I0.25-

40

Cat II40-60

Cat III60 +

Amro-A

27.1 55.2 12.9 4.8

Amro-B

21.1 67.8 3.9 7.1

Amro-D

30.3 67.4 1.6 0.8

Adult alcohol consumption in different categories 2000 in % - Americas - females

Males Abstainer

0-0.25 g/d

Cat.I0.25-

20

Cat II20-40

Cat III40 +

Amro-A

42.1 52.8 3.4 1.7

Amro-B

46.0 46.8 2.7 4.5

Amro-D

44.5 52.8 2.3 0.8

And after GENACIS and World Health Surveys

and new per capita estimates (2002)….?

• Similar overall consumption rates• Different distributions between ages• Different distributions between drinking

categories:=> Higher proportions of people with heavy drinking

Adult alcohol consumption 2002 in % - Americas - Males

Males Abstainer

0-0.25 g/d

Cat.I

0.25-40

Cat II

40-60

Cat III

60 +

Amro-A 28.3 39.1 21.7 10.9

Amro-B 18.8 56.6 11.3 13.3

Amro-D 32.0 59.1 2.5 6.5

Adult alcohol consumption in 2002 in % - Americas - Females

Females Abstainer

0-0.25 g/d

Cat.I

0.25-20

Cat II

20-40

Cat III

40 +

Amro-A 38.6 36.8 16.4 8.2

Amro-B 40.2 41.0 10.1 8.7

Amro-D 50.2 47.8 0.6 1.5

Changes between 2000 and 2002 estimates in different categories of alcohol consumption

-20.0

-15.0

-10.0

-5.0

0.0

5.0

10.0

15.0

Amro

-A

Amro

-B

Amro

-D

Amro

-A

Amro

-B

Amro

-D

Abstainer

Cat.I

Cat II

Cat III

females males

Alcohol-attributable deaths in Americas 2002 by disease and region – epidemiological model

Amro A Amro B Amro D All of America

M F M F M F Both

Low birth weight 23 19 78 60 13 10 203

Cancer 10365 6787 11117 7121 802 815 37006

Neuro-psychriatric conditions

6923 1872 14263 1835 2224 374 27492

Vascular conditions

-28231 -38285 45281 13203 3188 1595 -3249

Other non-communicable diseases

9962 1878 25590 5928 2310 988 46657

Unintentional injury 17406 5942 53362 5871 4392 1435 88409

Intentional Injury 7352 1782 53519 3419 1807 299 68180

All alcohol-related deaths

23800 -20003 203210 37438 14736 5515 264697

% alcohol-attributable of all deaths

0.9 -0.7 7.5 1.4 2.7 1.0 4.4

Alcohol-attributable mortality 2002 (number of deaths) – America epidemiological model vs. world

America % of all alcohol-

attributable

World % of all alcohol-

attributable

Maternal perinatal conditions

203 0.1% 3,057 0.2%

Cancer 37006 14.0% 377,968 21.2%


27492 10.4% 113,603 6.4%

Vascular conditions -3249 -1.2% 196,646 11.0%


46657 17.6% 237,985 13.3%

Unintentional injury 88409 33.4% 585,553 32.8%

Intentional Injury 68180 25.8% 269,155 15.1%

All alcohol-related deaths 264697 100.0% 1,783,567 100.0%

% alcohol-attributable of all deaths 4.4% 3.1%

Comparison of alcohol-related deaths of 2002 to 2000 –

epidemiological model only • For all of America, the relative size of

mortality of alcohol-related deaths decreased slightly (4.4% in 2002; 4.7% in 2000).

• The numbers of alcohol-related deaths -decreased in all three regions, with biggest decreases in America Region D.

• For the world, the relative size of alcohol-related deaths stayed at about the same level (3.2% in 2000; 3.1% in 2002).

Alcohol-attributable deaths 2002 (basis: new alcohol prevalence estimates and epidemiological shifts in COD)


M F M F M F BothMaternal perinatal conditions

23 19 78 60 13 10 203

Cancer 13012 11210 13114 8961 842 780 47920


7036 2096 14774 2174 2314 340 28733

Vascular conditions -31354 -30331 39009 13841 2278 1404 -5154


11005 4709 28272 5081 3119 371 52557

Unintentional injury 19723 5942 53362 5871 7029 733 92661

Intentional Injury 7352 1782 53519 3420 3120 237 69430


26797 -4574 202124 39407 18716 3874 286346


1.0 -0.2 7.5 1.5 3.5 0.7 4.8

Comparison chart on alcohol-attributable deaths: best estimates 2002

versus 2000 estimates

America

2002 best estimates

% of all alcohol-

attributable

America

2000 CRA estimates

% of all alcohol-

attributable

Maternal perinatal conditions 203 0.1% 873 0.3%

Cancer 47920 16.7% 35989 12.9%

Neuro-psychriatric conditions 28733 10.0% 26815 9.6%

Vascular conditions -5154 -1.8% 1567 0.6%


52557 18.4% 45540 16.3%

Unintentional injury 92661 32.4% 96201 34.5%

Intentional Injury 69430 24.3% 71871 25.8%

All alcohol-related deaths 286346 100.0% 278856 100.0%


4.8% 4.7%

Comparison of alcohol-related deaths from 2000 to 2002 – best

estimates for 2002• There are no major changes in estimates of

alcohol-related mortality from 2000 to 2002• Two developments:

– Epidemiological change -> less deaths in alcohol-related categories

– More heavy drinking -> more deaths….

• Americas continue to have a high mortality burden from alcohol

• Please note, that this is a net burden, after subtracting cardio-protective effects

Alcohol-attributable BOD in DALYs 2002 (basis: new alcohol prevalence estimates and epidemiological shifts in COD)


M F M F M F BothMaternal perinatal conditions

4.0 3.3 11.0 9.3 1.7 1.3 31.0

Cancer 127.8 138.8 148.4 120.1 9.6 9.5 554.2


2209.3 673.8 3115.8 859.7 315.3 77.9 7318.1

Vascular conditions -192.5 -174.0 386.1 152.0 23.1 12.9 215.8


154.6 81.0 562.3 123.6 63.1 8.2 1004.7

Unintentional injury 428.6 106.1 1130.2 160.9 184.7 20.1 2364.7

Intentional Injury 154.6 36.2 1065.5 103.3 71.7 5.8 1984.9


2884.2 865.3 6408.5 1528.9 669.2 135.6 13473.4


6.1 1.8 9.1 1.9 4.0 0.8 9.3

Comparison chart on alcohol-attributable DALYs: best estimates

2002 versus 2000 estimates

America

2002 best estimates

% of all alcohol-

attributable

America

2000 CRA estimates

% of all alcohol-

attributable

Maternal perinatal conditions 31.0 0.2% 31.6 0.2%Cancer 554.2 4.1% 399.5 2.9%Neuro-psychriatric conditions 7318.1 54.3% 6953.2 50.1%Vascular conditions 215.8 1.6% 266.3 1.9%Other non-communicable diseases

1004.7 7.5% 89.6 6.5%

Unintentional injury 2364.7 17.6% 2906.1 20.9%Intentional Injury 1984.9 14.7% 2430.4 17.5%All alcohol-related deaths 13473.4 100.0% 13883.3 100.0%% alcohol-attributable of all deaths 9.3 9.7

Comparison of alcohol-related DALYs from 2000 to 2002 – best

estimates for 2002

• There are no major changes in estimates of alcohol-related burden of disease from 2000 to 2002

• Americas continue to have a burden of disease from alcohol

• Please note, that this is a net burden, after subtracting cardio-protective effects

Relative impact of alcohol for different age groups

• For all three regions, for both genders, with one small exception, the relative weight of alcohol on deaths is strongest in the age group 15-29 years of age

• In this age group, there are no beneficial effects of alcohol on mortality

Age and sex distribution among alcohol-related deaths in WHO America regions and in World

for the year 2002 (own calculations)

0 to 14 15 to 29 30 to 44 45 to 59 60 to 69 70 to 79 80+Total deaths in 1000

Males

AmrA 2.5% 28.9% 47.7% 48.9% 9.0% -10.1% -27.0% 23.8

Amr B 1.1% 24.7% 22.6% 21.4% 13.4% 10.0% 6.8% 203.2

Amr D 2.9% 6.5% 27.2% 22.8% 18.8% 13.2% 8.8% 14.7

World 1.2% 15.2% 20.6% 26.1% 18.6% 12.9% 5.3% 1636

Females

Amr ANot meaningful, as there was a net beneficial effect,

but there were no net gains before age 60

Amr B 2.1% 9.3% 13.4% 21.0% 17.5% 17.0% 19.7% 37.4

Amr D 15.0% 6.8% 12.8% 17.5% 18.0% 16.1% 13.1% 5.5

World 5.4% 21.8% 31.9% 47.1% 31.3% 11.2% -48.7% 165

Conclusion for policy -> main targets based on epidemiology

This is the major aim of this conference, but from an epidemiological side, policies to reduce health burden in the following areas should be considered:

• Heavy drinking occasions • Overall level of consumption• Youth• Injury• Alcohol use disorders

volume of alcohol consumption, patterns of drinking and burden of disease in the americas 2002

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