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

• Published in: Addiction (Abingdon, England) Vol. 112; no. 6; pp. 968 - 1001
• Main Authors: Rehm, Jürgen, Gmel, Gerhard E., Gmel, Gerrit, Hasan, Omer S. M., Imtiaz, Sameer, Popova, Svetlana, Probst, Charlotte, Roerecke, Michael, Room, Robin, Samokhvalov, Andriy V., Shield, Kevin D., Shuper, Paul A.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-06-2017; John Wiley and Sons Inc
• Subjects: Alcohol use; Alcoholic beverages; Alcoholism - epidemiology; average volume; Blood alcohol level; Blood levels; Causality; chronic disease; Chronic Disease - epidemiology; Cirrhosis; Classification; Comorbidity; Cost of Illness; Death & dying; Diabetes; Diabetes mellitus; Disease; Diseases; Drinking; Drinking behavior; Ethanol; Exceptions; Health risks; Health Status; Humans; Injuries; injury; Injury analysis; Liver; Liver cirrhosis; Measurement; Meta-analysis; Morbidity; Mortality; patterns of drinking; Review; Reviews; Risk Assessment; Risk factors; risk-relations; Suicide; Suicides & suicide attempts; Systematic review; unrecorded consumption; Wounds and Injuries - epidemiology; risk-relations; patterns of drinking; chronic disease; unrecorded consumption; injury; average volume; systematic review; Alcohol use
• ISSN: 0965-2140; 1360-0443; 1360-0443
• DOI: 10.1111/add.13757

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).
Methods
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.
Results
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.
Conclusions
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.