Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

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Author(s)
Griswold, Max G
Fullman, Nancy
Hawley, Caitlin
Arian, Nicholas
Zimsen, Stephanie RM
Tymeson, Hayley D
Venkateswaran, Vidhya
Tapp, Austin Douglas
Forouzanfar, Mohammad H
Salama, Joseph S
Abate, Kalkidan Hassen
Abate, Degu
Abay, Solomon M
Abbafati, Cristiana
Abdulkader, Rizwan Suliankatchi
Abebe, Zegeye
Aboyans, Victor
Abrar, Mohammed Mehdi
Acharya, Pawan
Adetokunboh, Olatunji O
Adhikari, Tara Ballav
Adsuar, Jose C
Afarideh, Mohsen
Agardh, Emilie Elisabet
Agarwal, Gina
Aghayan, Sargis Aghasi
Agrawal, Sutapa
Ahmed, Muktar Beshir
Akibu, Mohammed
Akinyemiju, Tomi
Akseer, Nadia
Al Asfoor, Deena H
Al-Aly, Ziyad
Alahdab, Fares
Alam, Khurshid
Albujeer, Ammar
Alene, Kefyalew Addis
Ali, Raghib
Ali, Syed Danish
Alijanzadeh, Mehran
Aljunid, Syed Mohamed
Alkerwi, Ala'a
Allebeck, Peter
Alvis-Guzman, Nelson
Amare, Azmeraw T
Aminde, Leopold N
Ammar, Walid
Amoako, Yaw Ampem
Amul, Gianna Gayle Herrera
Andrei, Catalina Liliana
Angus, Colin
Ansha, Mustafa Geleto
Antonio, Carl Abelardo T
Aremu, Olatunde
Arnlov, Johan
Artaman, Al
Aryal, Krishna K
Assadi, Reza
Ausloos, Marcel
Avila-Burgos, Leticia
Avokpaho, Euripide FGA
Awasthi, Ashish
Ayele, Henok Tadesse
Ayer, Rakesh
Ayuk, Tambe B
Azzopardi, Peter S
Badali, Hamid
Badawi, Alaa
Banach, Maciej
Barker-Collo, Suzanne Lyn
Barrero, Lope H
Basaleem, Huda
Baye, Estifanos
Bazargan-Hejazi, Shahrzad
Bedi, Neeraj
Bejot, Yannick
Belachew, Abate Bekele
Belay, Saba Abraham
Bennett, Derrick A
Bensenor, Isabela M
Bernabe, Eduardo
Bernstein, Robert S
Beyene, Addisu Shunu
Beyranvand, Tina
Bhaumik, Soumyadeeep
Bhutta, Zulfiqar A
Biadgo, Belete
Bijani, Ali
Bililign, Nigus
Birlik, Sait Mentes
Birungi, Charles
Bizuneh, Hailemichael
Bjerregaard, Peter
Bjorge, Tone
Borges, Guilherme
Bosetti, Cristina
Boufous, Soufiane
Bragazzi, Nicola Luigi
Brenner, Hermann
Butt, Zahid A
Cahuana-Hurtado, Lucero
Calabria, Bianca
Campos-Nonato, Ismael R
Campuzano Rincon, Julio Cesar
Carreras, Giulia
Carrero, Juan J
Carvalho, Felix
Castaneda-Orjuela, Carlos A
Castillo Rivas, Jacqueline
Catala-Lopez, Ferran
Chang, Jung-Chen
Charlson, Fiona J
Chattopadhyay, Aparajita
Chaturvedi, Pankaj
Chowdhury, Rajiv
Christopher, Devasahayam J
Chung, Sheng-Chia
Ciobanu, Liliana G
Claro, Rafael M
Conti, Sara
Cousin, Ewerton
Criqui, Michael H
Dachew, Berihun Assefa
Dargan, Paul
Daryani, Ahmad
Das Neves, Jose
Davletov, Kairat
De Castro, Filipa
De Courten, Barbora
De Neve, Jan-Walter
Degenhardt, Louisa
Demoz, Gebre Teklemariam
Des Jarlais, Don C
Dey, Subhojit
Dhaliwal, Rupinder Singh
Dharmaratne, Samath Dhamminda
Dhimal, Meghnath
Doku, David Teye
Doyle, Kerrie E
Dubey, Manisha
Dubljanin, Eleonora
Duncan, Bruce B
Ebrahimi, Hedyeh
Edessa, Dumessa
Zaki, Maysaa El Sayed
Ermakov, Sergei Petrovich
Erskine, Holly E
Esteghamati, Alireza
Faramarzi, Mahbobeh
Farioli, Andrea
Faro, Andre
Farvid, Maryam S
Farzadfar, Farshad
Feigin, Valery L
Felisbino-Mendes, Mariana Santos
Fernandes, Eduarda
Ferrari, Alize J
Ferri, Cleusa P
Fijabi, Daniel Obadare
Filip, Irina
Finger, Jonas David
Fischer, Florian
Flaxman, Abraham D
Franklin, Richard Charles
Futran, Neal D
Gallus, Silvano
Ganji, Morsaleh
Gankpe, Fortune Gbetoho
Gebregergs, Gebremedhin Berhe
Gebrehiwot, Tsegaye Tewelde
Geleijnse, Johanna M
Ghadimi, Reza
Ghandour, Lilian A
Ghimire, Mamata
Gill, Paramjit Singh
Ginawi, Ibrahim Abdelmageed
Giref, Ababi Zergaw Z
Gona, Philimon N
Gopalani, Sameer Vali
Gotay, Carolyn C
Goulart, Alessandra C
Greaves, Felix
Grosso, Giuseppe
Guo, Yuming
Gupta, Rahul
Gupta, Rajeev
Gupta, Vipin
Alma Gutierrez, Reyna
Gvs, Murthy
Hafezi-Nejad, Nima
Hagos, Tekleberhan Beyene
Hailu, Gessessew Bugssa
Hamadeh, Randah R
Hamidi, Samer
Hankey, Graeme J
Harb, Hilda L
Harikrishnan, Sivadasanpillai
Maria Haro, Josep
Hassen, Hamid Yimam
Havmoeller, Rasmus
Hay, Simon
Heibati, Behzad
Henok, Andualem
Heredia-Pi, Ileana
Francisco Hernandez-Llanes, Norberto
Herteliu, Claudiu
Hibstu, Desalegn Ts Tsegaw
Hoogar, Praveen
Horita, Nobuyuki
Hosgood, H Dean
Hosseini, Mostafa
Hostiuc, Mihaela
Hu, Guoqing
Huang, Hsiang
Husseini, Abdullatif
Idrisov, Bulat
Ileanu, Bogdan Vasile
Ilesanmi, Olayinka Stephen
Irvani, Seyed Sina Naghibi
Islam, Sheikh Mohammed Shariful
Jackson, Maria D
Jakovljevic, Mihajlo
Jayatilleke, Achala Upendra
Jha, Ravi Prakash
Jonas, Jost B
Jozwiak, Jacek Jerzy
Kabir, Zubair
Kadel, Rajendra
Kahsay, Amaha
Kapil, Umesh
Kasaeian, Amir
Kassa, Tesfaye D Dessale
Katikireddi, Srinivasa Vittal
Kawakami, Norito
Kebede, Seifu
Kefale, Adane Teshome
Keiyoro, Peter Njenga
Kengne, Andre Pascal
Khader, Yousef
Khafaie, Morteza Abdullatif
Khalil, Ibrahim A
Khan, Md Nuruzzaman
Khang, Young-Ho
Khater, Mona M
Khubchandani, Jagdish
Kim, Cho-Il
Kim, Daniel
Kim, Yun Jin
Kimokoti, Ruth W
Kisa, Adnan
Kivimaki, Mika
Kochhar, Sonali
Kosen, Soewarta
Koul, Parvaiz A
Koyanagi, Ai
Krishan, Kewal
Defo, Barthelemy Kuate
Bicer, Burcu Kucuk
Kulkarni, Veena S
Kumar, Pushpendra
Lafranconi, Alessandra
Balaji, Arjun Lakshmana
Lalloo, Ratilal
Lallukka, Tea
Lam, Hilton
Lami, Faris Hasan
Lan, Qing
Lang, Justin J
Lansky, Sonia
Larsson, Anders O
Latifi, Arman
Leasher, Janet L
Lee, Paul H
Leigh, James
Leinsalu, Mall
Leung, Janni
Levi, Miriam
Li, Yichong
Lim, Lee-Ling
Linn, Shai
Liu, Shiwei
Lobato-Cordero, Andrea
Lotufo, Paulo A
King Macarayan, Erlyn Rachelle
Machado, Isis Eloah
Madotto, Fabiana
Abd El Razek, Hassan Magdy
Abd El Razek, Muhammed Magdy
Majdan, Marek
Majdzadeh, Reza
Majeed, Azeem
Malekzadeh, Reza
Malta, Deborah Carvalho
Mapoma, Chabila Christopher
Martinez-Raga, Jose
Maulik, Pallab K
Mazidi, Mohsen
Mckee, Martin
Mehta, Varshil
Meier, Toni
Mekonen, Tesfa
Meles, Kidanu Gebremariam
Melese, Addisu
Memiah, Peter TN
Mendoza, Walter
Mengistu, Desalegn Tadese
Mensah, George A
Meretoja, Tuomo J
Mezgebe, Haftay Berhane
Miazgowski, Tomasz
Miller, Ted R
Mini, GK
Mirica, Andreea
Mirrakhimov, Erkin M
Moazen, Babak
Mohammad, Karzan Abdulmuhsin
Mohammadifard, Noushin
Mohammed, Shafiu
Monasta, Lorenzo
Moraga, Paula
Morawska, Lidia
Jalu, Moti Tolera
Mousavi, Seyyed Meysam
Mukhopadhyay, Satinath
Musa, Kamarul Imran
Naheed, Aliya
Naik, Gurudatta
Najafi, Farid
Nangia, Vinay
Nansseu, Jobert Richie
Nayak, Mudavath Siva Durga Prasad
Nejjari, Chakib
Neupane, Subas
Neupane, Sudan Prasad
Ngunjiri, Josephine W
Cuong, Tat Nguyen
Long, Hoang Nguyen
Trang, Huyen Nguyen
Ningrum, Dina Nur Anggraini
Nirayo, Yirga Legesse
Noubiap, Jean Jacques
Ofori-Asenso, Richard
Ogbo, Felix Akpojene
Oh, In-Hwan
Oladimeji, Olanrewaju
Olagunju, Andrew T
Olivares, Pedro R
Olusanya, Bolajoko Olubukunola
Olusanya, Jacob Olusegun
Oommen, Anu Mary
Oren, Eyal
Orpana, Heather M
Ortega-Altamirano, Doris D
Ortiz, Justin R
Ota, Erika
Owolabi, Mayowa Ojo
Oyekale, Abayomi Samuel
Mahesh, PA
Pana, Adrian
Park, Eun-Kee
Parry, Charles DH
Parsian, Hadi
Patle, Ajay
Patton, George C
Paudel, Deepak
Petzold, Max
Phillips, Michael R
Pillay, Julian David
Postma, Maarten J
Pourmalek, Farshad
Prabhakaran, Dorairaj
Qorbani, Mostafa
Radfar, Amir
Rafay, Anwar
Rafiei, Alireza
Rahim, Fakher
Rahimi-Movaghar, Afarin
Rahman, Mahfuzar
Rahman, Muhammad Aziz
Rai, Rajesh Kumar
Rajsic, Sasa
Raju, Sree Bhushan
Ram, Usha
Rana, Saleem M
Ranabhat, Chhabi Lal
Rawaf, David Laith
Rawaf, Salman
Reiner, Robert C
Reis, Cesar
Renzaho, Andre MN
Rezai, Mohammad Sadegh
Roever, Leonardo
Ronfani, Luca
Room, Robin
Roshandel, Gholamreza
Rostami, Ali
Roth, Gregory A
Roy, Ambuj
Sabde, Yogesh Damodar
Saddik, Basema
Safiri, Saeid
Sahebkar, Amirhossein
Saleem, Zikria
Salomon, Joshua A
Salvi, Sundeep Santosh
Sanabria, Juan
Dolores Sanchez-Nino, Maria
Santomauro, Damian Francesco
Santos, Itamar S
Milicevic, Milena MM Santric
Sarker, Abdur Razzaque
Sarmiento-Suarez, Rodrigo
Sarrafzadegan, Nizal
Sartorius, Benn
Satpathy, Maheswar
Sawhney, Monika
Saxena, Sonia
Saylan, Mete
Schaub, Michael P
Schmidt, Maria Ines
Schneider, Ione JC
Schoettker, Ben
Schutte, Aletta Elisabeth
Schwendicke, Falk
Sepanlou, Sadaf G
Shaikh, Masood A Ali
Sharif, Mehdi
She, Jun
Sheikh, Aziz
Shen, Jiabin
Shiferaw, Mekonnen Sisay
Shigematsu, Mika
Shiri, Rahman
Shishani, Kawkab
Shiue, Ivy
Shukla, Sharvari Rahul
Sigfusdottir, Inga Dora
Santos Silva, Diego Augusto
Da Silva, Natacha Torres
Alves Silveira, Dayane Gabriele
Sinha, Dhirendra Narain Narain
Sitas, Freddy
Soares Filho, Adauto Martins
Soofi, Moslem
Sorensen, Reed JD
Soriano, Joan B
Sreeramareddy, Chandrashekhar T
Steckling, Nadine
Stein, Dan J
Sufiyan, Mu'awiyyah Babale
Sur, Patrick J
Sykes, Bryan L
Tabares-Seisdedos, Rafael
Tabuchi, Takahiro
Tavakkoli, Mohammad
Tehrani-Banihashemi, Arash
Tekle, Merhawi Gebremedhin
Thapa, Subash
Thomas, Nihal
Topor-Madry, Roman
Topouzis, Fotis
Tran, Bach Xuan
Troeger, Christopher E
Truelsen, Thomas Clement
Tsilimparis, Nikolaos
Tyrovolas, Stefanos
Ukwaja, Kingsley Nnanna
Ullah, Irfan
Uthman, Olalekan A
Valdez, Pascual R
Van Boven, Job FM
Vasankari, Tommi Juhani
Venketasubramanian, Narayanaswamy
Violante, Francesco S
Vladimirov, Sergey Konstantinovitch
Vlassov, Vasily
Vollset, Stein Emil
Vos, Theo
Wagnew, Fasil Wagnew Shiferaw
Waheed, Yasir
Wang, Yuan-Pang
Weiderpass, Elisabete
Weldegebreal, Fitsum
Weldegwergs, Kidu Gidey
Werdecker, Andrea
Westerman, Ronny
Whiteford, Harvey A
Widecka, Justyna
Wijeratne, Tissa
Wyper, Grant MA
Xu, Gelin
Yamada, Tomohide
Yano, Yuichiro
Ye, Pengpeng
Yimer, Ebrahim M
Yip, Paul
Yirsaw, Biruck Desalegn
Yisma, Engida
Yonemoto, Naohiro
Yoon, Seok-Jun
Yotebieng, Marcel
Younis, Mustafa Z
Zachariah, Geevar
Zaidi, Zoubida
Zamani, Mohammad
Zhang, Xueying
Zodpey, Sanjay
Mokdad, Ali H
Naghavi, Mohsen
Murray, Christopher JL
Gakidou, Emmanuela
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2018
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Abstract

BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. METHODS: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. FINDINGS: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5-3·0) of age-standardised female deaths and 6·8% (5·8-8·0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2-4·3) of female deaths and 12·2% (10·8-13·6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2·3% (95% UI 2·0-2·6) and male attributable DALYs were 8·9% (7·8-9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0-1·7] of total deaths), road injuries (1·2% [0·7-1·9]), and self-harm (1·1% [0·6-1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2-33·3) of total alcohol-attributable female deaths and 18·9% (15·3-22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0-0·8) standard drinks per week. INTERPRETATION: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. FUNDING: Bill & Melinda Gates Foundation.

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Lancet

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392

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10152

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© 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Biomedical and clinical sciences

Clinical sciences

Science & Technology

Life Sciences & Biomedicine

Medicine, General & Internal

General & Internal Medicine

ALL-CAUSE MORTALITY

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Griswold, MG; Fullman, N; Hawley, C; Arian, N; Zimsen, SRM; Tymeson, HD; Venkateswaran, V; Tapp, AD; Forouzanfar, MH; Salama, JS; Abate, KH; Abate, D; Abay, SM; Abbafati, C; Abdulkader, RS; Abebe, Z; Aboyans, V; Abrar, MM; Acharya, P; Adetokunboh, OO; Adhikari, TB; Adsuar, JC; Afarideh, M; Agardh, EE; Agarwal, G; Aghayan, SA; Agrawal, S; Ahmed, MB; Akibu, M; Akinyemiju, T; Akseer, N; Al Asfoor, DH; Al-Aly, Z; Alahdab, F; Alam, K; Albujeer, A; Alene, KA; Ali, R; Ali, SD; Alijanzadeh, M; Aljunid, SM; Alkerwi, A; Allebeck, P; Alvis-Guzman, N; Amare, AT; Aminde, LN; Ammar, W; Amoako, YA; Amul, GGH; Andrei, CL; Angus, C; Ansha, MG; Antonio, CAT; Aremu, O; Arnlov, J; Artaman, A; Aryal, KK; Assadi, R; Ausloos, M; Avila-Burgos, L; Avokpaho, EFGA; Awasthi, A; Ayele, HT; Ayer, R; Ayuk, TB; Azzopardi, PS; Badali, H; Badawi, A; Banach, M; Barker-Collo, SL; Barrero, LH; Basaleem, H; Baye, E; Bazargan-Hejazi, S; Bedi, N; Bejot, Y; Belachew, AB; Belay, SA; Bennett, DA; Bensenor, IM; Bernabe, E; Bernstein, RS; Beyene, AS; Beyranvand, T; Bhaumik, S; Bhutta, ZA; Biadgo, B; Bijani, A; Bililign, N; Birlik, SM; Birungi, C; Bizuneh, H; Bjerregaard, P; Bjorge, T; Borges, G; Bosetti, C; Boufous, S; Bragazzi, NL; Brenner, H; Butt, ZA; Cahuana-Hurtado, L; Calabria, B; Campos-Nonato, IR; Campuzano Rincon, JC; Carreras, G; Carrero, JJ; Carvalho, F; Castaneda-Orjuela, CA; Castillo Rivas, J; Catala-Lopez, F; Chang, J-C; Charlson, FJ; Chattopadhyay, A; Chaturvedi, P; Chowdhury, R; Christopher, DJ; Chung, S-C; Ciobanu, LG; Claro, RM; Conti, S; Cousin, E; Criqui, MH; Dachew, BA; Dargan, P; Daryani, A; Das Neves, J; Davletov, K; De Castro, F; De Courten, B; De Neve, J-W; Degenhardt, L; Demoz, GT; Des Jarlais, DC; Dey, S; Dhaliwal, RS; Dharmaratne, SD; Dhimal, M; Doku, DT; Doyle, KE; Dubey, M; Dubljanin, E; Duncan, BB; Ebrahimi, H; Edessa, D; Zaki, MES; Ermakov, SP; Erskine, HE; Esteghamati, A; Faramarzi, M; Farioli, A; Faro, A; Farvid, MS; Farzadfar, F; Feigin, VL; Felisbino-Mendes, MS; Fernandes, E; Ferrari, AJ; Ferri, CP; Fijabi, DO; Filip, I; Finger, JD; Fischer, F; Flaxman, AD; Franklin, RC; Futran, ND; Gallus, S; Ganji, M; Gankpe, FG; Gebregergs, GB; Gebrehiwot, TT; Geleijnse, JM; Ghadimi, R; Ghandour, LA; Ghimire, M; Gill, PS; Ginawi, IA; Giref, AZZ; Gona, PN; Gopalani, SV; Gotay, CC; Goulart, AC; Greaves, F; Grosso, G; Guo, Y; Gupta, R; Gupta, R; Gupta, V; Alma Gutierrez, R; Gvs, M; Hafezi-Nejad, N; Hagos, TB; Hailu, GB; Hamadeh, RR; Hamidi, S; Hankey, GJ; Harb, HL; Harikrishnan, S; Maria Haro, J; Hassen, HY; Havmoeller, R; Hay, S; Heibati, B; Henok, A; Heredia-Pi, I; Francisco Hernandez-Llanes, N; Herteliu, C; Hibstu, DTT; Hoogar, P; Horita, N; Hosgood, HD; Hosseini, M; Hostiuc, M; Hu, G; Huang, H; Husseini, A; Idrisov, B; Ileanu, BV; Ilesanmi, OS; Irvani, SSN; Islam, SMS; Jackson, MD; Jakovljevic, M; Jayatilleke, AU; Jha, RP; Jonas, JB; Jozwiak, JJ; Kabir, Z; Kadel, R; Kahsay, A; Kapil, U; Kasaeian, A; Kassa, TDD; Katikireddi, SV; Kawakami, N; Kebede, S; Kefale, AT; Keiyoro, PN; Kengne, AP; 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