Health Outcomes due Health Outcomes due to Alcohol to Alcohol 14 July 2005 Kanitta Bundhamcharoen MOPH
Health Outcomes due to Health Outcomes due to AlcoholAlcohol
14 July 2005Kanitta
BundhamcharoenMOPH
Acknowledgement
• Ratchata Tangsiripat IHPP• Thaksapon Thamarangsi IHPP• and the Thai Working Group on burden
attributable to risk factor• Theo Vos• Majid Ezzati
Outline
• What are the effects of alcohol on health?• How do we measure the health loss?• How many healthy life years were lost due
to alcohol?
Consumption, Mediators & Effects
Pattern volume
Chronic disease
Accidents/ injuries
(Acute disease)
Acute social problems
Chronic social
problems
Intoxication
Toxic effect Dependence
Ref: Babor et al. (2003)
Basic CRA framework and goals
Risk factor levels• current distribution• counterfactual • distribution(s)
Disease burden
Risk factor-disease relationships
• risk accumulation• risk reversal
Attributable burdenAvoidable burden
Burden of Disease
• Burden of disease analysis provides a standardized framework for integrating all available information on mortality, causes of death, individual health status, and condition-specific epidemiology to provide an overview of the the levels and causes of population health
Disability-Adjusted Life Years (DALYs)
• One DALY is one lost year of ‘healthy’ life• DALY = YLL + YLD
– DALY (Disability-Adjusted Life Years) = YLL (Years Lost Due to Premature Death)+YLD (Years Lived With Disability)
• YLL = Dx * Ex (use standard life table (West level 26))
• YLD = Incidence * DW * Duration
birth
Death/Life expectancy
0 yr
80 yr
ill
death
person
Years lost due to premature death(YLLs)
Years lived with disability
(YLDs)
DALYs = YLDs + YLLs
Basic CRA framework and goals
Risk factor levels• current distribution• counterfactual • distribution(s)
Disease burden
Risk factor-disease relationships
• risk accumulation• risk reversal
Attributable burdenAvoidable burden
Burden of Disease and injuriesThailand, 1999
1 HIV/AIDS 960,087 17 HIV/AIDS 372,947 9
2 Traffic accidents 510,907 9 Stroke 280,673 7
3 Stroke 267,567 5 Diabetes 267,158 7
4 Liver cancer 248,083 4 Depression 145,336 4
5 Diabetes 168,372 3 Liver cancer 118,384 3
6 Ischaemic heart disease 164,094 3 Osteoarthritis 117,994 3
7 COPD (emphysema) 156,861 3 Traffic accidents 114,963 3
8 Homicide and violence 156,371 3 Anaemia 112,990 3
9 Suicides 147,988 3 Ischaemic heart dis 109,592 3
10 Drug dependence/Harmful use
137,703 2 Cataracts 96,091 2
Rank
Disease category
MALE DALYsloss
Disease category
FEMALE DALYsloss
% %
Source: Thai Working Group on BOD, 2002
11 Alcohol dependence/harmful use
130,654 2 COPD (emphysema) 93,387 2
12 Cirrhosis 117,527 2 Deafness 87,612 2 13 Lung cancer 106,120 2 Lower respiratory tract
infections 84,819 2
14 Drownings 98,464 2 Low birth weight 83,879 2 15 Depression 95,530 2 Dementia 70,191 2 16 Osteoarthritis 93,749 2 Anxiety disorders 66,835 2 17 Tuberculosis 93,695 2 Schizophrenia 60,800 2 18 Deafness 93,497 2 Tuberculosis 60,643 2 19 Low birth weight 91,934 2 Birth trauma & asphyxia 57,488 1 20 Anaemia 87,610 2 Nephritis & nephrosis 55,258 1
Burden of Disease and injuriesThailand, 1999
Source: Thai Working Group on BOD, 2002
Rank
Disease category MALE
DALYsloss
Disease category
FEMALE DALYsloss
% %
Risk Burden4.5
0.40.50.40.7
2.32.4
1.10.50.70.6
0.30.10.3
0.1
8.65.1
4.43.33.3
2.61.3
1.10.9
0.60.50.40.30.30.2
0 1 2 3 4 5 6 7 8 9 10
Unsafe sexAlcoholTobacco
Illicit drugsNot wearing helmet
Blood pressureObesity
CholesterolFruit & veggies
Air pollutionPhysical inactivity
Malnutrition – Int’l standardNot wearing seatbeltWater & sanitation
Malnutrition - Thai standard
FemaleMale
Source: Thai Working Group, MOPH, 2003
13.8%5.8%
5.1%5.0%
4.2%3.9%
3.6%2.3%
1.4%1.4%
1.2%0.7%0.7%
0.4%0.3%
0 0.02 0.04 0.06 0.08 0.1 0.12 0.14 0.16
Unsafe sexAlcohol
TobaccoBlood pressure
Not wearing helmetObesity
Illicit drugsCholesterol
Fruit & vegiesAir pollution
Physical inactivityMalnutrition - int standard
Water & sanitationNot wearing seatbelt
Malnutrition - Thai standard
Risk Burden
0 . 00 % 5 . 00 %
10 . 00 % 15 . 00 %
0 - 4 0 - 4 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 + 0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 + age group ( yrs )
%
Total DALYs
unsafe sex water and sanitation Tobacco Physical inactivity
malnutrition_international standard malnutrition_thai standard illicit drug use Non - Helmet No safety belts inadequate intake of fruit and vegetable cholesterol BMI Blood pressure alcohol
air pollution
Risk burden by age group
Alcohol
5%6%
14%
Stroke6%
Cirrhosis12%
Burden attributable to alcohol: M
Dependence 25%
Traffic accidents22%
SuicidesHomicide and violence
ca liver
Traffic accidents12%
ca liver13%
Alcohol dependence
44%
Burden attributable to alcohol: F
Alcohol dependence 44%
CA Liver
Cirrhosis 7%
Data Sources
Alcohol Consumption
• Prevalence – Inter Asia (2000) Data• Average volume drinking category II:
– females 20 – <40 g pure alcohol daily– males 40 – <60 g pure alcohol daily
• Average volume drinking category III: – females 40+ g pure alcohol daily – males 60+ g pure alcohol daily
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
30-44 45-59 60-69 70-79 80+
abstainerresponsiblehazardousharmful
Alcohol consumption: Male
Alcohol consumption: Female
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
30-44 45-59 60-69 70-79 80+
abstainerresponsiblehazardousharmful
Relative RiskM FHazard Harm Hazard Harm
CA mouth/ pharynx
1.85 5.39 1.85 5.39
CA oesophagus
2.38 4.36 2.38 4.36
CA liver 3.03 3.6 3.03 3.60CA larynx 3.9 4.93 3.90 4.93CA breast <45
1 1 1.41 1.46
CA breast 45+
1 1 1.38 1.62
Diabetes (NIDDM)
0.57 0.73 0.87 1.13
Ref: Ezzati et al (2004)
Relative RiskM FHazard Harm Hazard Harm
Epilepsy 7.52 6.83 7.22 7.52hypertension 2 4.1 2 2IHD 0.83 1 0.83 1.12Ischaemic stroke
1.33 1.65 0.64 1.06
Haemorrhagic stroke
2.19 2.38 0.65 7.98
Cirrhosis 9.5 13 9.5 13Cholelithiasis 0.68 0.5 0.68 0.5LBW 1.4 1.4 1.4 1.4
Ref: Ezzati et al (2004)
Injuries
• Fraction of alcohol related injuries from Injury surveillance data