Additional file 1: of Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview

Web appendix 1. Uncertainty. Web appendix 2. Algorithms for the prevalence of former drinkers. Web appendix 3. Countries in each World Health Organization region. Web appendix 4. Estimating age-specific risk relations for Russia and surrounding countries. (DOCX 22 kb

Mortality and Potential Years of Life Lost Attributable to Alcohol Consumption by Race and Sex in the United States in 2005

<div><h3>Background</h3><p>Alcohol has been linked to health disparities between races in the US; however, race-specific alcohol-attributable mortality has never been estimated. The objective of this article is to estimate premature mortality attributable to alcohol in the US in 2005, differentiated by race, age and sex for people 15 to 64 years of age.</p> <h3>Methods and Findings</h3><p>Mortality attributable to alcohol was estimated based on alcohol-attributable fractions using indicators of exposure from the National Epidemiologic Survey on Alcohol and Related Conditions and risk relations from the Comparative Risk Assessment study. Consumption data were corrected for undercoverage (the observed underreporting of alcohol consumption when using survey as compared to sales data) using adult <em>per capita</em> consumption from WHO databases. Mortality data by cause of death were obtained from the US Department of Health and Human Services. For people 15 to 64 years of age in the US in 2005, alcohol was responsible for 55,974 deaths (46,461 for men; 9,513 for women) representing 9.0% of all deaths, and 1,288,700 PYLL (1,087,280 for men; 201,420 for women) representing 10.7% of all PYLL. Per 100,000 people, this represents 29 deaths (29 for White; 40 for Black; 82 for Native Americans; 6 for Asian/Pacific Islander) and 670 PYLL (673 for White; 808 for Black; 1,808 for Native American; 158 for Asian/Pacific Islander). Sensitivity analyses showed a lower but still substantial burden without adjusting for undercoverage.</p> <h3>Conclusions</h3><p>The burden of mortality attributable to alcohol in the US is unequal among people of different races and between men and women. Racial differences in alcohol consumption and the resulting harms explain in part the observed disparities in the premature mortality burden between races, suggesting the need for interventions for specific subgroups of the population such as Native Americans.</p> </div

Population standardized Potential Years of Life Lost per 100,000 people attributable to alcohol consumption by race and sex.

<p>Population standardized Potential Years of Life Lost per 100,000 people attributable to alcohol consumption by race and sex.</p

Percentage of all Potential Years of Life Lost attributable to alcohol consumption by race and sex for people aged 15 to 64 years.

<p>Percentage of all Potential Years of Life Lost attributable to alcohol consumption by race and sex for people aged 15 to 64 years.</p

Population standardized deaths per 100,000 people attributable to alcohol consumption by race and sex.

<p>Population standardized deaths per 100,000 people attributable to alcohol consumption by race and sex.</p

Deaths attributable to alcohol consumption by cause, race, age and sex for the US in 2005.

<p>Deaths attributable to alcohol consumption by cause, race, age and sex for the US in 2005.</p

Percentage of all deaths attributable to alcohol consumption by race and sex for people aged 15 to 64 years.

<p>Percentage of all deaths attributable to alcohol consumption by race and sex for people aged 15 to 64 years.</p

Key alcohol consumption indicators for the United States for 2005 by race, age and sex.

<p>Key alcohol consumption indicators for the United States for 2005 by race, age and sex.</p

Potential Years of Life Lost attributable to alcohol consumption by cause, race, age and sex for the US in 2005.

<p>Potential Years of Life Lost attributable to alcohol consumption by cause, race, age and sex for the US in 2005.</p

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

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