Deaths Associated with High-Volume Drinking of Alcohol among Adults in Canada in 2002: A Need for Primary Care Intervention?
Patra, Jayadeep, Taylor, Benjamin, Rehm, Jürgen, Contemporary Drug Problems
This study estimates risks of mortality associated with high-volume drinking for Canada in 2002 by age and sex. Distribution of exposure was taken from a major Canadian survey and corrected for per capita consumption from production and sales. High-volume drinking was defined as a daily consumption of ≥40 grams of pure alcohol (at least 3 Canadian drinks) for men and ≥20 grams of pure alcohol (at least 1.5 Canadian drinks) for women. Risk relations were taken from the published literature and combined with exposure to calculate age-and sex-specific alcohol-attributable fractions for high-volume drinking. Information on mortality was obtained from Statistics Canada and combined with alcohol-attributable fractions to estimate the overall mortality due to alcohol. About 4,950 net deaths (3,236 in those below 70 years of age) were due to high-volume drinking of alcohol in Canada in 2002. This constituted 2.2% (5.0% among those below 70 years of age) of all deaths. The net deaths were composed of 5,717 deaths caused and 767 deaths prevented. There was an age gradient, with the net deaths highest in 45-59 years age group. About 70.6% (5,717/8,103) of the overall deaths caused by alcohol were the result of high-volume drinking. Overall, the net impact of high-volume drinking of alcohol consumption on mortality in Canada is high. Policies should strive to reduce the burden of high-volume alcohol consumption. In addition to alcohol control measures, individual level interventions should be implemented in primary care to significantly reduce such burden.
KEY WORDS: Alcohol, high-volume drinking, mortality, primary care, policy
Alcohol is causally related to many different causes of death, including different cancers, cardiovascular diseases, mental health conditions, digestive diseases and injury categories (English et al. 1995; Gutjahr et al. 2001; Rehm et al. 2003a; Ridolfo & Stevenson 2001; Single et al. 2000). The World Health Organization Comparative Quantification of Health Risks estimated that death caused by alcohol accounted for 3.2% of total global mortality in 2000 (WHO 2002), increasing from the previous estimate of 1.5% for 1990 (Murray & Lopez 1996). Approximately half of these deaths were due to acute causes, primarily from unintentional injury categories such as motor vehicle accidents, poisonings and falls. The remaining portion was due to chronic conditions, with cancer and cardiovascular diseases contributing the majority of deaths in this category (Rehm et al. 2004; WHO 2002).
Average daily volume of alcohol consumption is particularly important for studies of mortality (English et al. 1995; Gutjahr et al. 2001; Ridolfo & Stevenson 2001; Single et al. 2000). Previous work by English et al. (1995) has found high-volume drinking (20+ grams per day for women, 40+ grams per day for men) to be causally related to over 40 acute and chronic causes of death. Significant also is that the beneficial effects of alcohol, such as the protective effect of moderate drinking reported for ischemic heart disease, ischemic stroke, gallstones and diabetes, are much less pronounced in high-volume drinkers.
Despite identification of this higher-risk group, however, the alcohol literature to date has mostly reported the effects of total consumption rather than parsing out subpopulations of drinkers and analyzing mortality attributable to different average consumption scenarios separately. In Canada, a significant portion of the population makes up this group of drinkers, although the impact of their daily consumption on mortality has not been reported. Rehm and colleagues (Rehm et al. 2006a), using data from the Canadian Addiction Survey, reported that 12.8% of men and 8.2% of women fell into this group, with a higher prevalence reported in younger age groups.
This study aims to fill a gap in the literature by quantifying the impact of high-volume drinking on mortality in Canada for the year 2002. …