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Alcohol grows as risk factor for death and disability in 2010 GBD Study

On December 14, 2012, The Lancet together with the Institute for Health Metrics and Evaluation (IHME) hosted an event at the Royal Society in London to present the findings of the Global Burden of Disease, Injuries, and Risk Factors Study 2010. The launch of the 2010 GBD Study featured discussion of comparable estimates of mortality, causes of death, years lived with disability (YLDs), and disability-adjusted life years (DALYs) for 291 conditions and 67 risk factors, for 21 regions and three time periods – 1990, 2005, and 2010. The results reveal substantial shifts in the burden of disease from children to younger adults, from premature mortality to morbidity and disability, from communicable, maternal, neonatal and nutritional conditions to noncommunicable diseases.

The 2010 analysis of 67 risk factors and risk factor clusters for death and disability reported in the special issue of The Lancet (Lim et al., 2012) found that alcohol was the third leading risk factor for death and disability accounting for 5.5% of disability adjusted life years (DALYs) lost globally, i.e. 136 million years of life lost through dying early or living with an alcohol-related disability. This is up from the 4.6% reported in 2004 and 4.0% in 2000 (Rehm et al., 2003, 2009), though it should be noted that these percentages are not entirely comparable due to the variations in the methodologies used. The increase is mainly accounted for by including the burden associated with alcohol use on infectious diseases such as tuberculosis and pneumonia. In terms of comparable results, the impact of alcohol use proportionally went up about 30% from 1990 to 2010, and in deaths alone in 2010 alcohol is estimated to be causally linked to 4.9 million deaths globally, up from 3.7 million in 1990.

Various outcomes were linked to alcohol use and heavy drinking including, among others, tuberculosis, lower respiratory infections, various cancers, ischaemic heart disease and ischaemic and non-ischaemic stroke, epilepsy, cirrhosis of the liver, pancreatitis, transport injuries, falls, drowning, poisonings, intentional sel-fharm, interpersonal violence and alcohol use disorders.

After reworking the data to ensure comparability, in 1990 alcohol was ranked as the 6th leading cause of death and disability. Based on 2010 data, alcohol is ranked 3rd in terms of risk after high blood pressure and smoking. This article, furthermore, indicates that alcohol was the leading risk factor for death and disability in large parts of the world including Southern sub-Saharan Africa, Eastern Europe and most of Latin America. In Southern sub-Saharan Africa alcohol-related road traffic, unintentional and intentional injuries together with alcohol-related tuberculosis played a key role in alcohol contributing so greatly to death and disability. If the impact of alcohol on HIV/AIDS had been included, alcohol-attributable burden in this region would have been even higher.

The Lancet article (Lim et al., 2012) also highlights the increasing burden globally caused by non-communicable diseases (NCDs). According to this article, 33% of ischaemic heart disease DALYs lost globally were individually attributable to alcohol. Globally, for persons aged 15-49 years the leading risk factor for death and disability was alcohol use followed by tobacco smoking, high blood pressure, high body mass index, a diet low in fruit and vegetables, drug use and occupational risk factors for injuries. These findings support the call by the World Health Organization for countries to give greater priority to addressing harmful alcohol via evidenced-based population level intervention strategies (World Health Organization, 2010).

Jürgen Rehm and members of the Alcohol Use Expert Group, Global Burden of Diseases, Injuries, and Risk Factors Study will be preparing a detailed paper on alcohol as a risk factor for death and disability using 2010 data.


• Lim, S.S., Vos, T., Flaxman, A.D., et al. (2012). The burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions 1990-2010: A systematic analysis. Lancet, 380, 2224-2260.

• Rehm, J., Mathers, C., Popova, S., Thavorncharoensap, M., Teerawattananon, Y., Patra, J. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet; 373: 2223- 2233.

• Rehm, J., Room, R., Monteiro, M., Gmel, G., Graham, K., Rehn, N., Sempos, C., & Jernigan, D. (2003) Alcohol as a risk factor for global burden of disease. European Addiction Research 9, 157-164.

• World Health Organization. (2010). Global Strategy to reduce the harmful use of alcohol. Geneva: Author.


Charles Parry Board Member, Global Alcohol Policy Alliance, and Director Alcohol & Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa

Jürgen Rehm Director, Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health, Toronto, Canada Head, Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany

Parry and Rehm were co-authors on the Lim et al. (2012) article