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Alcohol Research Current Reviews VOLUME 35 NUMBER 2 2013

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Alcohol Research Current Reviews VOLUME 35 NUMBER 2 2013 Reduce the Harmful Use of Alcohol, which was passed in Chronic Diseases and May 2010. Of growing concern are noncommunicable chronic diseases and conditions that have been shown to Conditions Related to contribute substantially to the alcohol-attributable burden of disease (Rehm et al. 2009). Specifically, in 2004 an estimated 35 million deaths and 603 million disability-adjusted life- Alcohol Use years (DALYs) lost were caused by chronic diseases and con- ditions globally (WHO 2008); alcohol was responsible for 3.4 percent of the deaths and 2.4 percent of DALYs caused by these conditions (Parry et al. 2011). To address the burden kevin D. Shield, M.H.Sc.; Charles Parry, Ph.D.; and of chronic diseases and conditions, the United Nation (UN) General Assembly passed Resolution 64/265 in May of Jürgen Rehm, Ph.D. 2010, calling for their prevention and control (UN 2010). This resolution is intended to garner multisectoral commitment alcohol consumption is a risk factor for many chronic diseases and facilitate action on a global scale to address the fact that and conditions. the average volume of alcohol consumed, alcohol (together with tobacco, lack of exercise, and diet) consumption patterns, and quality of the alcoholic beverages plays a significant role in chronic diseases and conditions. It consumed likely have a causal impact on the mortality and is noteworthy that cardiovascular diseases, cancers, and diabetes morbidity related to chronic diseases and conditions. twenty- in particular have been highlighted for targeted action (UN five chronic disease and condition codes in the international 2010) because alcohol is a risk factor for many cardiovascular Classification of Disease (iCD)-10 are entirely attributable to diseases and cancers and has both beneficial and detrimental alcohol, and alcohol plays a component-risk role in certain effects on diabetes and ischemic cardiovascular diseases,1 cancers, other tumors, neuropsychiatric conditions, and depending on the amount of alcohol consumed and the numerous cardiovascular and digestive diseases. Furthermore, patterns of consumption. alcohol has both beneficial and detrimental impacts on diabetes, Building on previous reviews concerning alcohol and disease ischemic stroke, and ischemic heart disease, depending on the (Rehm et al. 2003a, 2009), this article presents an up-to- overall volume of alcohol consumed, and, in the case of date and in-depth overview of the relationship of alcohol ischemic diseases, consumption patterns. however, limitations consumption and high-risk drinking patterns and the initia- exist to the methods used to calculate the relative risks and alcohol-attributable fractions. Furthermore, new studies and 1 ischemic cardiovascular diseases are those caused by a blockage of blood vessels, resulting in a confounders may lead to additional diseases being causally loss of blood supply to the tissue serviced by the affected blood vessels. linked to alcohol consumption, or may disprove the relationship between alcohol consumption and certain diseases that currently are considered to be causally linked. these limitations do not affect the conclusion that alcohol consumption significantly contributes to the burden of chronic diseases and kevin D. Shield, M.H.Sc., is a Ph.D. student in medical conditions globally, and that this burden should be a target for science at the University of Toronto. He also is affiliated intervention. kEY WoRDS: Alcohol consumption; alcohol use with the Centre for Addiction and Mental Health (CAMH) frequency; chronic diseases; disorders; mortality; morbidity; in Toronto, Canada. alcohol-attributable fractions (AAF); risk factors; relative risk; AoD-induced risk; cancers; neuropsychiatric disorders; Charles Parry, Ph.D., is the director of the Alcohol & cardiovascular diseases; digestive diseases; diabetes; Drug Abuse Research Unit at the South African Medical ischemic stroke; ischemic heart disease; burden of disease Research Council, Cape Town, South Africa, and extraordi- nary professor in the Department of Psychiatry, Stellenbosch University, Cape Town, South Africa. lcohol has been a part of human culture for all of recorded history, with almost all societies in which Jürgen Rehm, Ph.D., is director of the Social and Aalcohol is consumed experiencing net health and social Epidemiological Research Department at the Centre for problems (McGovern 2009; Tramacere et al. 2012b, c). Addiction and Mental Health, chair and professor in the With the industrialization of alcohol production and the Dalla Lana School of Public Health, University of Toronto, globalization of its marketing and promotion, alcohol con- Canada, and section head at the Institute for Clinical sumption and its related harms have increased worldwide (see Alcohol Consumption Trends, in this issue). This has Psychology and Psychotherapy, Technische Universität prompted the World Health Organization (WHO) to pass Dresden, Dresden, Germany. multiple resolutions to address this issue over the past few years, including the World Health Assembly’s Global Strategy to Chronic Diseases and Conditions Related to Alcohol Use 155 tion/exacerbation and treatment of various chronic diseases These include the following: and conditions. It also assesses the methods used to calculate • The toxic and beneficial biochemical effects of beverage the impact of alcohol consumption on chronic diseases and alcohol (i.e., ethanol) and other compounds found in conditions. alcoholic beverages; • The consequences of intoxication; and Alcohol Consumption As a Risk Factor for Chronic • The consequences of alcohol dependence. Diseases and Conditions These intermediate mechanisms have been reviewed in Figure 1 presents a conceptual model of the effects of alcohol more detail by Rehm and colleagues (2003a). consumption on morbidity and mortality and of the influ- ence of both societal and demographic factors on alcohol consumption and alcohol-related harms resulting in chronic Chronic Diseases and Conditions Related to Alcohol diseases and conditions (adapted from Rehm et al. 2010a). According to this model, two separate, but related, measures Chronic diseases and Conditions Entirely Attributable of alcohol consumption are responsible for most of the to Alcohol causal impact of alcohol on the burden of chronic diseases and conditions—overall volume of alcohol consumption Of the chronic diseases and conditions causally linked with and patterns of drinking. The overall volume of alcohol con- alcohol consumption, many categories have names indicat- sumption plays a role in all alcohol-related diseases, whereas ing that alcohol is a necessary cause—that is, that these drinking patterns only affect ischemic cardiovascular dis- particular diseases and conditions are 100 percent alcohol eases. In addition to the overall volume and pattern of con- attributable. Of these, alcohol use disorders (AUDs)—that sumption, the quality of the alcoholic beverages consumed is, alcohol dependence and the harmful use of alcohol as also may influence mortality and morbidity from chronic defined by the International Classification of Disease, Tenth diseases and conditions. However, this pathway is of less Edition (ICD–10)—certainly are the most important cate- importance from a public health perspective (Lachenmeier gories, but many other diseases and conditions also are and Rehm 2009; Lachenmeier et al. 2007) because it has a entirely attributable to alcohol (see table 1). much smaller impact than the other two factors. The effects of overall volume of alcohol consumed, con- Chronic diseases and Conditions for Which Alcohol sumption patterns, and quality of the alcoholic beverages Is a Component Cause consumed on mortality and morbidity from chronic diseases Alcohol is a component cause for more than 200 other dis- and conditions are mediated by three main mechanisms. eases and conditions with ICD–10 three-digit codes—that Figure 1 Causal model of alcohol consumption, intermediate mechanisms, and long-term consequences, as well as of the influence of societal and demographic factors on alcohol consumption and alcohol-related harms resulting in chronic diseases and conditions. souRCE: adapted from Rehm et al. 2010a. 156 Alcohol Research: Current Reviews is, alcohol consumption is not necessary for the diseases to Thus, two recent meta-analyses found no association between develop (Rehm et al. 2010a). For these conditions, alcohol alcohol drinking status (i.e., drinkers compared with non- shows a dose-response relationship, where the risk of onset of drinkers) and risk of gastric cardia adenocarcinoma (Tramacere or death from the disease or condition depends on the total et al. 2012a, d). However, one meta-analysis did find an volume of alcohol consumed (Rehm et al. 2003a). Table 2 association between heavy alcohol consumption and the risk outlines these chronic diseases and conditions that are associ- of this type of cancer (Tramacere et al. 2012a). ated with alcohol consumption and lists the source of the For several types of cancer investigators have found a relative risk (RR) functions if the chronic disease or condi- nonsignificant positive association with alcohol consump- tion is included as an alcohol-attributable harm in the 2005 tion, including endometrial (Bagnardi et al. 2001; Rota et al. Global Burden of Disease (GBD) Study.2 Several of these 2012), ovarian (Bagnardi et al. 2001), and pancreatic cancers chronic diseases and conditions are singled out for further (Bagnardi et al. 2001). However, because the
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