Alcohol among risk factors increasing

The Global Burden of Diseases (GBD) study is an ongoing project run by the Institute for Health Metrics and Evaluation (IHME). It provides a standardised and comprehensive assessment of risk factors and health burden. The regular updates are essential as a framework to understand both trends in risk exposure and the trends in the health burden attributable to risks. GBD 2019 incorporates major data additions and improvements, and methodological refinements. The report observes that “paying attention to which risk factors are declining, stagnating, or even increasing gives insights into where current efforts are working or are insufficient.”  

Increase in exposure

‘Alcohol use’ has been a risk-factor category in the GBD study since its inception in 1990. One explanation for WHO’s renewed interest for alcohol as a risk factor in the early 2000’s was that the GBD figures demonstrated how important alcohol use was for premature death and ill health. Since 1990 exposure to alcohol use and the ensuing health burden has increased. The increase was actually even higher in the 10 years since the WHO Global strategy to reduce the harmful use of alcohol was adopted in 2010.

The GBD study team points out that “concerning for both current and future health are exposures that are increasing at more than 0.5% per year.” Alcohol use is among them, together with ambient particulate matter pollution, drug use, and several metabolic risk factors. “If public health action and public policy could stop or reverse the trends in exposure to these risks, the benefits would be huge”, writes some of the key authors in an adjoining viewpoint article.  Alcohol use is increasing in all five groups of the “Socio-demographic Index”. The increase is however bigger in the ‘Middle’, ‘Low-Middle’ and ‘Low’ SDI groups.

Variations with age

The study shows that the pattern of risk-factor-attributable burden varied considerably by age and over time. Overall, in all ages alcohol use climbed on the list of risk factors for ill health measured as ‘Disability Adjusted Life Years’ (DALY) from number 15 in 1990 to number nine in 2019. In 1990 alcohol use accounted for 2.6% of DALYs while in 2019 this number had increased to 3,7%. Looking at different age groups, for 10-24 year olds alcohol use climbed from number four in 1990 to second on the list in 2019 and remained stable as the number one risk factor in the age group 25-49 years. In the age group 50-74 years, alcohol was stable as risk factor number seven.

There is a considerable difference between men and women in the number of deaths and DALYs attributable to alcohol. While alcohol use is number 14 on the list both for deaths and DALYs for women, it is number 8 on both lists for men.

Interpretation

The Global Burden of Disease study forms an important part of the knowledge base to improve the health of the population of the world. Still, the collaborating authors observe that the record of reducing exposure to harmful risks over the past three decades is poor. Along with alcohol this is the case for several metabolic risk factors such as obesity, high blood sugar and high blood pressure. Among the major NCD risks, only smoking has declined substantially. The authors point out that the regulatory policies in the tobacco field might point the way for a stronger role for public policy on other risks.

"One of the most important messages from the Global Burden of Disease 2019 is that over the past decade the world has done a poor job of reducing harmful risks and this is fueling a global chronic disease crisis. While communicable diseases are causing less illness, disability and death than in the past – with the obvious exception of Covid-19 – chronic diseases are on the rise," said Emmanuela Gakidou, one of the study's coauthors to CNN.

Links:

• The Lancet article about GBD-study, 17 October 2020
• The Lancet viewpoint article based on the study, 17 October 2020
• IHME press release: Latest global disease estimates reveal perfect storm of rising chronic diseases and public health failures fueling COVID-19 pandemic
• CNN: Global rise in chronic diseases combined with Covid-19 bodes ill for world health