International Scientific Forum on Alcohol Research Critique 127: Estimation of Alcohol-Attributable and Alcohol-Preventable Mortality in Denmark
By International Scientific Forum on Alcohol Research | 7 November 2013
The latest critique from ISFAR looks at recent research from Denmark on the effect of alcohol on health
In an attempt to judge the harmful and beneficial health effects related to alcohol consumption, scientists in Denmark have carried out analyses comparing alcohol-attributable and alcohol-preventable mortality in the country.
The scientists have used estimates of the potentially harmful effects of alcohol use on more than 20 diseases, giving 100% values to “alcohol use disorders,” although the specific causes of death are not known for this category. Most of the other attributions for harm are realistic, but the alcohol preventable attributions for diabetes and ischemic heart disease appear to be low.
The authors conclude that, in 2010, 5% of deaths among women and 9.5% of deaths among men were attributable to alcohol in Denmark, with the majority of all alcohol-attributable deaths caused by high consumption. They attribute only between 2% and 3% of deaths to be preventable by alcohol.
Previous estimates of alcohol-attributable and alcohol-preventable effects have varied widely, emphasising the importance of the assumptions made by the investigators in any set of analyses. For example, an analysis of deaths in Germany by Konnopka et al (Konnopka A, Hans-Helmut König H-H. The health and economic consequences of moderate alcohol consumption in Germany 2002. Value in Health 2009;12:253-261) concluded that there were more alcohol-preventable deaths than alcohol-attributable deaths.
Meanwhile, a report from the UK also estimated much lower rates for alcohol-attributable deaths (White IR, Altmann DR, Nanchahal K. Mortality in England and Wales attributable to any drinking, drinking above sensible limits and drinking above lowest-risk level. Addiction 2004;99:749–756).
Further, a previous report that included data for Denmark gave very different results for net alcohol effects, estimating that less than 1% of deaths were attributable to alcohol (Britton A, Nolte E, White IR, Gronbaek M, Powles J, Cavallo F, McPherson K. A comparison of the alcohol-attributable mortality in four European countries. Eur J Epidemiol. 2003;18:643–51). It is probable that different underlying assumptions of alcohol effects on various diseases are the prime reason for such differences.
There is no question that heavy alcohol consumption contributes to a large number of disease conditions, and the findings of this study emphasise the magnitude of the problem. On the other hand, if the potentially beneficial effects of moderate alcohol consumption on many common diseases are underestimated, a net unfavourable result, as in the present study, is unavoidable.
It will be interesting to see what assumptions are made in other studies such as this, and how such assumptions affect the outcome of analyses.
To read the full critique, click here.
These critiques are published with the permission of The ISFAR.
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