For all ages, alcohol was associated with 2.8 million deaths that year.
Those
deaths include alcohol-related cancer and cardiovascular diseases,
infectious diseases such as tuberculosis, intentional injury such as
violence and self-harm, and traffic accidents and other unintentional
injuries such as drowning and fires.
"The most surprising finding
was that even small amounts of alcohol use contribute to health loss
globally," said senior study author Emmanuela Gakidou, a professor at
the University of Washington's Institute for Health Metrics and
Evaluation. "We're used to hearing that a drink or two a day is fine.
But the evidence is the evidence."
Not
surprisingly due to their large populations, China, India and Russia
led the world in the total number of alcohol-related deaths in men and
women. The US ranked fifth among men and seventh among women on that
list; the UK ranked 21st for men and ninth for women.
"This
study is a stark reminder of the real, and potentially lethal, dangers
that too much alcohol can have on our health and that even the lowest
levels of alcohol intake increase our risks," Helen Stokes-Lampard,
chair of the Royal College of General Practitioners in the UK, said in a
statement. She was not involved in the study.
However,
countered David Spiegelhalter, the Winton Professor for the Public
Understanding of Risk at the University of Cambridge, "Given the
pleasure presumably associated with moderate drinking, claiming there is
no 'safe' level does not seem an argument for abstention.
"There
is no safe level of driving, but governments do not recommend that
people avoid driving," Spiegelhalter, who also was not involved in the
research, said in a statement. "Come to think of it, there is no safe
level of living, but nobody would recommend abstention."
'State-of-the-art' study
The Lancet study, funded by the Bill and Melinda Gates Foundation, used data from the 2016
Global Burden of Disease report, which captured information on premature death and disability
from over 300 diseases by sex and age in 195 countries or territories between 1990 and 2016.
Researchers
analyzed the impact of alcohol on 23 health conditions and
alcohol-related risks on people between the ages of 15 and approximately
95 for the year 2016.
Drinking under the age of 15, a
growing problem in the US and other
countries, was not included.
For
purposes of the study, a standard alcoholic drink was defined as 10
grams or approximately 12 milliliters of alcohol. That measurement
varies around the world; for example, a standard drink is 8 grams in the
UK and 14 grams in US. It's
even higher in Italy, Portugal and Spain.
Over
1,300 studies on alcohol use by country and the accompanying disease
burden, measured by both deaths and disability-adjusted life years, were
analyzed by the Global Burden of Disease collaborators.
For
the first time, Gakidou said, in an attempt to improve on previous
research, the new analysis adjusted for the impact of tourism on local
statistics in liquor sales and attempted to control for unrecorded
drinking, such as home brewing or illicit trade. Another improvement
over past studies, she said, was a new meta-analysis of the effects of
alcohol on the 23 health outcomes, which was then used to access risk.
In
independent comments published alongside the study, King's College
London alcohol researcher Robyn Burton called the study
"state-of-the-art."
"The
conclusions of the study are clear and unambiguous: alcohol is a
colossal global health issue," Burton wrote, suggesting that policy
makers put a priority on programs that focus on decreasing alcohol
consumption.
However, the Alcohol
Information Partnership, a group comprising eight of the world's biggest
liquor companies, said in a statement that "Nothing in this study
challenges the array of studies suggesting that choosing to drink
moderately is associated with a decreased risk of some health issues and
a lower risk of death. We advocate sensible drinking by those who
choose to drink and support consistent, evidence-based advice, which
enables people to make their own informed choices about alcohol."
The
Distilled Spirits Council echoed that in its own statement. "Claims in
the study disputing the research on potential benefits of moderate
consumption do not comport with the body of scientific evidence,
including a recent study in the American Heart Association Journal
Circulation that found that moderate alcohol consumption is one of 'five
low-risk lifestyle-related factors' that could help people live longer.
"The
researchers make clear that they are advocating for worldwide
abstention from alcohol. A more reasonable and effective approach is to
address issues surrounding alcohol abuse country by country, taking into
account the culture, individual alcohol consumption patterns and the
marketplace."
Globally, the study found
that about 2.4 billion people drink alcohol. Twenty-five percent are
women, who consumed 0.73 drinks each day. Thirty-nine percent are men,
who drink an average of 1.7 drinks a day.
The
countries with the highest percentage of men and women who reported
drinking in the previous year were Denmark, Norway and Germany. Although
they didn't make the top 10, 85.3% of men and 81.3% of women in the UK
said they had tippled in the previous 12 months. In the US, 68.8% of men
and 56.8% of women said they had done so.
Countries with the lowest percentage of drinking citizens were typically Arab and Middle Eastern nations.
For
ages 50 and up, cancers were the leading cause of alcohol-related
deaths; road injuries, self-harm and tuberculosis were the top causes of
death around the world in the 15-to-49 age group.
However,
in terms of total numbers, Gakidou said, "most deaths from alcohol come
from cardiovascular disease and cancers when you look at average
consumption by age and sex within countries."
Potential benefits outweighed by overall risk
The results appear to fly in the face of
research
that indicates moderate drinking -- in the United States, that's one
drink a day for women and two a day for men -- might reduce the risk of
heart disease and
Type 2 diabetes. That might be true in isolation, Gakidou said, but the picture changes when all risks are considered.
"We
too found some protective effects for Type 2 diabetes and ischemic
heart disease at low levels of alcohol consumption," she said. "But
those benefits are outweighed by the overall adverse health impact of
alcohol, even at moderate levels."
Jeremy
Pearson, associate medical director at the British Heart Foundation,
agreed, saying in a statement, "While there may be a slight benefit to
heart and circulatory health from modest drinking, many studies have
shown that the overall health risks of drinking alcohol outweigh any
benefits."
University of Cambridge epidemiologist Steven Bell co-authored a
separate
study published in April in The Lancet that found drinking is
beneficial
in lowering the risk for heart attack. However, that study's big
takeaway was that even one drink a day could shorten life expectancy;
long-term reduction in alcohol use added one to two years to life
expectancy at age 40.
He points
out that his study looked only at drinkers, but the new research
compared drinkers to non-drinkers in accessing risk and is one of the
first to look at data from low- and middle-income countries.
"Based
on these findings," Bell said, "at no point ... is there a level of
consumption that appears to lower the overall risk of developing any of
the wide array of diseases investigated in comparison to non-drinking.
"The
take-home message being that people shouldn't drink under the belief
that it will lower their risk of disease," he said, "and those of us who
opt to drink should minimize our intake if we wish to prolong our life
and well-being."
