Transcript Alcohol-attributable deaths in 2002 by disease and region

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
Patterns of drinking
Toxic and
benefical biochemical
effects*
Chronic
Disease
Average volume
Intoxication
Dependence
Accidents/Injuries
(acute disease)
* Independent of intoxication or dependence
Acute
Social
Chronic
Social
Adult per capita consumption in
litre pure alcohol 2000 (based on CRA)
Adult per capita consumption 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 of drinking
1.00 to 2.00
2.00 to 2.50
2.50 to 3.00
3.00 to 4.00
Drinking pattern
Volume of
drinking
hazard score
(predominance of
Estimation
of AAF for
different
disease
categories
intoxication)
Injuries
Alcoholattributable
conditions (by definition)
Coronary
heart
disease
Other chronic
Diseases (except
CHD and depression)
Depression from
psychiatric surveys
Alcohol related disease and injury
Chronic disease:
Cancer: Mouth & oropharyngeal cancer, Esophageal cancer, Liver cancer,
Female breast cancer, other neoplasms
Neuropsychiatric diseases: Alcohol use disorders, unipolar major
depression, epilepsy
Diabetes
Cardiovascular diseases: Hypertensive diseases, ischemic heart disease,
stroke
Gastrointestinal diseases: Liver cirrhosis
Conditions arising during perinatal period: Low birth weight
Injury:
Unintentional injury: Motor vehicle accidents, drownings, falls, poisonings,
other unintentional injuries
Intentional 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
Cat.I
0-0.25 g/d 0.25-40
Cat II
40-60
Cat III
60 +
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
Cat.I
0-0.25 g/d 0.25-20
Cat II
20-40
Cat III
40 +
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
15.0
10.0
females
males
5.0
Abstainer
-10.0
-15.0
-20.0
ro
Am A
ro
Am B
ro
-D
Am
-5.0
Cat.I
Am
ro
Am A
ro
Am B
ro
-D
0.0
Cat II
Cat III
Alcohol-attributable deaths in Americas 2002
by disease and region – epidemiological model
Amro A
M
Low birth weight
Cancer
Neuro-psychriatric
conditions
Vascular conditions
Other noncommunicable
diseases
Unintentional injury
Intentional Injury
All alcohol-related
deaths
% alcoholattributable of all
deaths
Amro B
F
M
Amro D
F
M
All of
America
F
Both
23
19
78
60
13
10
203
10365
6787
11117
7121
802
815
37006
6923
1872
14263
1835
2224
374
27492
-28231
-38285
45281
13203
3188
1595
-3249
9962
1878
25590
5928
2310
988
46657
17406
5942
53362
5871
4392
1435
88409
7352
1782
53519
3419
1807
299
68180
23800
-20003
203210
37438
14736
5515
264697
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
alcoholattributable
203
0.1%
3,057
0.2%
Cancer
37006
14.0%
377,968
21.2%
Neuro-psychriatric
conditions
27492
10.4%
113,603
6.4%
Vascular conditions
-3249
-1.2%
196,646
11.0%
Other non-communicable
diseases
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%
264697
100.0%
1,783,567
100.0%
Maternal perinatal
conditions
All alcohol-related deaths
% alcohol-attributable of all
deaths
4.4%
World
3.1%
% of all
alcoholattributable
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 alcoholrelated 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)
Amro A
M
Maternal perinatal
conditions
Amro B
F
M
Amro D
F
M
All of
America
F
Both
23
19
78
60
13
10
203
13012
11210
13114
8961
842
780
47920
7036
2096
14774
2174
2314
340
28733
-31354
-30331
39009
13841
2278
1404
-5154
Other noncommunicable
diseases
11005
4709
28272
5081
3119
371
52557
Unintentional injury
19723
5942
53362
5871
7029
733
92661
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
Cancer
Neuro-psychriatric
conditions
Vascular conditions
Intentional Injury
All alcohol-related
deaths
% alcoholattributable of all
Comparison chart on alcoholattributable deaths: best estimates 2002
versus 2000 estimates
America
2002 best
estimates
Maternal perinatal conditions
% of all
alcoholattributable
America
2000 CRA
estimates
% of all
alcoholattributable
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%
Other non-communicable
diseases
52557
18.4%
45540
16.3%
Unintentional injury
92661
32.4%
96201
34.5%
Intentional Injury
69430
24.3%
71871
25.8%
286346
100.0%
278856
100.0%
All alcohol-related deaths
% alcohol-attributable of all
deaths
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)
Amro A
M
Maternal perinatal
conditions
Cancer
Neuro-psychriatric
conditions
Vascular conditions
Other noncommunicable
diseases
Unintentional injury
Intentional Injury
All alcohol-related
deaths
% alcoholattributable of all
Amro B
F
M
Amro D
F
M
All of
America
F
Both
4.0
3.3
11.0
9.3
1.7
1.3
31.0
127.8
2209.3
138.8
673.8
148.4
3115.8
120.1
859.7
9.6
315.3
9.5
77.9
554.2
7318.1
-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
428.6
154.6
2884.2
106.1
36.2
865.3
1130.2
160.9
1065.5
103.3
6408.5 1528.9
184.7
71.7
669.2
20.1
5.8
135.6
2364.7
1984.9
13473.4
6.1
1.8
4.0
0.8
9.1
1.9
9.3
Comparison chart on alcoholattributable DALYs: best estimates
2002 versus 2000 estimates
America
2002 best
estimates
Maternal perinatal conditions
% of all
alcoholattributable
America
2000 CRA
estimates
% of all
alcoholattributable
31.0
0.2%
31.6
0.2%
554.2
4.1%
399.5
2.9%
7318.1
54.3%
6953.2
50.1%
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%
13473.4
100.0%
13883.3
100.0%
Cancer
Neuro-psychriatric conditions
Vascular conditions
All alcohol-related deaths
% 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
Total
deaths
in 1000
80+
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
Not meaningful, as there was a net beneficial effect,
but there were no net gains before age 60
Amr A
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