Infectious diseases have alcohol link

Researchers have studied the link between alcohol use and the transmission and development of infectious diseases. The study establishes the causal impact between alcohol use and the risk of contracting TB and pneumonia, as well as influence from alcohol use on the progression of TB and HIV. The report also explores the social and biological pathways involved, the role of development, impact of alcohol-attributable infectious diseases on the Global Burden of Disease figures, and policy implications.

The report "Alcohol, Social Development and Infectious Disease" by Jürgen Rehm, P. Anderson, F. Kanteres, C.D. Parry, A.V. Samokhvalov and J. Patra was presented during the Global Expert Meeting on Alcohol hosted by Sweden in Stockholm 22-23 October.

Previously only non-communicable diseases were included in estimates of alcohol as a risk factor for the global burden of disease. The researchers point out that this might be surprising when Benjamin Rush already in 1785 observed a causal impact of heavy spirits consumption on tuberculosis and pneumonia. After having reviewed existing evidence the researchers have concluded that alcohol consumption, , increases the risk of contracting TB and pneumonia, as well as the progression of TB and HIV. Especially heavy drinking and alcohol use disorders, show this link. The risk increases in a dose-response manner and heavy drinking or alcohol use disorders may impair the use of preventive services for infectious diseases and treatment compliance, and as well may create risk to others by those already affected. The relationship between alcohol and the risk of infectious diseases can be confounded by poverty, social exclusion, and social mixing patterns, including frequenting specific drinking establishments.

The impact of alcohol consumption on burden of disease and injury is largest in low income countries with relatively high consumption in Saharan Africa or South America, where on average 30% of all the alcohol-attributable burden is due to infectious diseases. In some countries, such as South Africa or Nigeria, infectious diseases make up about 50% of the overall alcohol-attributable disease burden.

The role of development
The report points out that the relationship between alcohol consumption, social and economic development, and disease burden is complex. In general, even though for low to middle income countries, the higher the economic development, the higher the adult per capita consumption, alcohol-attributable mortality and mortality per litre of pure alcohol per capita are highest in countries with the lowest incomes. Part of this relationship can be explained by the clustering of infectious disease in poor crowded regions, often characterized by malnutrition, where alcohol’s effects on the immune system can be enhanced.

The researchers point out that infectious disease is a special case: they are not only more common (in terms of both incidence and prevalent) in less developed countries, but also more common in poorer populations within these countries. Overall, these populations on average have less heavy alcohol consumption than in high-income countries. However, for those who consume alcohol, the risk of infectious disease is considerably increased. This explains why, in countries with overall high incidence or prevalence of infectious diseases and relatively high consumption of alcohol, alcohol contributes over-proportionally to infectious disease burden.

The final part of the report explores the policy implications pointing out that alcohol policy that reduces the volume of alcohol consumption, heavy drinking and episodic heavy drinking will be likely to reduce the incidence and progression of alcohol-related infectious diseases.

The report is available along with other documentation from the Expert Meeting at the web site for the Swedish Presidency of the European Union