Estimating alcohol’s role Estimating alcohol’s role in disease & disability: in disease & disability: the alcohol component in the alcohol component in WHO’s Global Burden of WHO’s Global Burden of Disease analysis for 2000 Disease analysis for 2000 David Jernigan David Jernigan Center on Alcohol Marketing and Center on Alcohol Marketing and Youth Youth Georgetown University Georgetown University [email protected][email protected]
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David Jernigan Center on Alcohol Marketing and Youth Georgetown University dhj@georgetown
Estimating alcohol’s role in disease & disability: the alcohol component in WHO’s Global Burden of Disease analysis for 2000. David Jernigan Center on Alcohol Marketing and Youth Georgetown University [email protected]. WHO’s Comparative Risk Assessment Collaborating Group. 27 groups: - PowerPoint PPT Presentation
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Estimating alcohol’s role in Estimating alcohol’s role in disease & disability: disease & disability:
the alcohol component in WHO’s the alcohol component in WHO’s Global Burden of Disease Global Burden of Disease
analysis for 2000analysis for 2000
David JerniganDavid JerniganCenter on Alcohol Marketing and YouthCenter on Alcohol Marketing and Youth
27 groups:27 groups:• Core, metholodology, etc. GroupCore, metholodology, etc. Group• 26 risk factor groups26 risk factor groups
Alcohol group:Alcohol group:• J Rehm, R Room, M Monteiro, G Gmel, K J Rehm, R Room, M Monteiro, G Gmel, K
Graham, N Rehn, C T Sempos, U Frick, D Graham, N Rehn, C T Sempos, U Frick, D Jernigan Jernigan
The 26 risk The 26 risk factorsfactors, roughly grouped, roughly grouped
Childhood and maternal undernutritionChildhood and maternal undernutrition: underweight, iron : underweight, iron deficiency, vitamin A deficiency, zinc deficiency; deficiency, vitamin A deficiency, zinc deficiency;
Other diet-related risks and physical inactivityOther diet-related risks and physical inactivity: blood : blood pressure, cholesterol, overweight, low fruit and vegetable pressure, cholesterol, overweight, low fruit and vegetable intake, physical inactivity;intake, physical inactivity;
Sexual and reproductive health risksSexual and reproductive health risks: unsafe sex, lack of : unsafe sex, lack of contraception;contraception;
urban air pollution, indoor smoke from solid fuels, lead urban air pollution, indoor smoke from solid fuels, lead exposure, climate change;exposure, climate change;
Other selected risks to healthOther selected risks to health: unsafe health care injections, : unsafe health care injections, childhood sexual abuse. childhood sexual abuse.
The epidemiological model
Attributable fractions
= f(prevalence, pattern weight, relative risk)
Defined as: With a given outcome exposure factor, and population, the attributable fraction is the proportion by which the incidence rate of the outcome would be reduced if the distribution of exposure would change to an alternative distribution:““When an exposure is When an exposure is believed to be a cause of believed to be a cause of a given disease, the a given disease, the attributable fraction is attributable fraction is the proportion of the the proportion of the disease in the specific disease in the specific population that would be population that would be eliminated in the absence eliminated in the absence of the exposure.”of the exposure.”
Four drinking categories (old English et al. terminology: abstainer, moderate, hazardous, harmful) are distinguished. Prevalence for all four categories are taken from surveys
Steps to derive at pattern weight:1. Determine pattern value from survey of key informants, and/or survey data where available.2. Conduct hierarchical linear analyses on mortality using per capita consumption gross-national product, year (level 1 variables) and pattern values (level 2 variable) as determining factors (separate by age and sex).3. Construct pattern weight based on intercept and regression weight for patterns.
Relative Risk estimates for each drinking category are either taken directly from meta-analyses (chronic diseases) or indirectly from meta-analyses of attributable fractions (injuries)
Patterns of drinking Patterns of drinking
Countries assigned hazardous Countries assigned hazardous drinking scores, a numeric indicator drinking scores, a numeric indicator of hazard per litre of alcohol of hazard per litre of alcohol consumedconsumed
Information drawn from research Information drawn from research literature supplemented by key literature supplemented by key informant questionnaires informant questionnaires
Applied to two areas: injuries and Applied to two areas: injuries and CHD.CHD.
Dimensions of patterns of drinkingDimensions of patterns of drinking
• High usual quantity of alcohol per occasion
• Festive drinking common – at fiestas or community celebrations
• Proportion of drinking occasions when drinkers get drunk
• Low proportion of drinkers who drink daily or nearly daily
• Less common to drink with meals• Common to drink in public places
Pattern of drinking 2000(based on CRA)
Patterns of drinking
1.00 to 2.00
2.00 to 2.50
2.50 to 3.00
3.00 to 4.00
Volume of drinking
Drinking patternhazard score
(predominance ofintoxication)
Prior alcohol dependence
DepressionInjuriesCoronary
heartdisease
Physicaldiseases
(except CHD)
Alcohol-attributableconditions*
Aspects of alcohol used in estimating alcohol Aspects of alcohol used in estimating alcohol attributable fraction (AAF) for different attributable fraction (AAF) for different
• Conditions arising during perinatal period*:Conditions arising during perinatal period*: low birth low birth weightweight
• Cancer*: Cancer*: lip & oropharyngeal cancer, esophageal cancer, lip & oropharyngeal cancer, esophageal cancer, liver cancer, laryngeal cancer, female breast cancerliver cancer, laryngeal cancer, female breast cancer
• Neuropsychiatric diseases: Neuropsychiatric diseases: alcohol use disorders, alcohol use disorders, unipolar major depression, epilepsyunipolar major depression, epilepsy
Injury:Injury:• Unintentional injury: Unintentional injury: motor vehicle accidents, motor vehicle accidents,
drownings, falls, poisonings, other unintentional injuriesdrownings, falls, poisonings, other unintentional injuries• Intentional injuryIntentional injury:: self-inflicted injuries, homicide, other self-inflicted injuries, homicide, other
intentional injuriesintentional injuries* AAF based on volume of drinking only * AAF based on volume of drinking only
2.2. Chronic health conditionsChronic health conditions
3.3. CHDCHD
4.4. DepressionDepression
5.5. InjuriesInjuries
Alcohol-related global burden of disease
Alcohol-attributable mortality
0.35 to 1.00
1.00 to 4.00
4.00 to 6.00
6.00 to 8.00
8.00 to 20.00
Leading risk factors Leading risk factors ffor disease (WHR 2002) in emerging or disease (WHR 2002) in emerging and established economiesand established economies ( (% % total DALYS)total DALYS)
Developing countriesDeveloping countriesDeveloped countriesDeveloped countries
High mortalityHigh mortality Low mortalityLow mortality