Professor Jennie Connor. Department of Preventive and Social Medicine University of Otago, Dunedin

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1 Professor Jennie Connor Department of Preventive and Social Medicine University of Otago, Dunedin New Zealand Population Health Congress 2014

2 acute and chronic effects benefits and harms pattern and volume of drinking effects on many conditions Summary of health impacts of alcohol at a population level missing information mental and social health harms to others lost opportunities for health

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4 GBD 2010 methodology Estimates mortality, YLLs and disability -adjusted life years (DALYs) lost that would have been avoided if no one had drunk any alcohol Includes conditions coded in ICD-10, with sufficient evidence of causal association, and adequate data to calculate alcohol attributable fractions (AAFs). Excludes drinking under 15 years of age NZ context restricted to under 80 years of age mortality by Māori/non Māori ethnicity, but not DALYs Not comparable to the previous Burden of death, disease and disability due to alcohol study Estimated mortality in 2007, and DALYs in 2004 Connor J, Kydd R, Shield K, Rehm J. (2012) Alcohol-attributable burden of disease and injury in New Zealand: 2004 and 2007 (Commissioned by the Alcohol Advisory Council of NZ, now HPA)

5 Cancers Conditions arising during pregnancy Mouth and oro-pharyngeal cancers - Low birth weight - Oesophagus cancer - Fetal alcohol syndrome - Colon cancer* - Respiratory disorders Rectum cancer* - Tuberculosis* - Liver cancer - LRTI: pneumonia* - Laryngeal cancer - Diabetes mellitus +/- Female breast cancer - Neuro-psychiatric disorders Unintentional injuries Alcohol use disorders - Road traffic injuries - Epilepsy - Alcohol poisonings - Cardiovascular disorders Non-alcohol poisonings - Hypertensive heart disease - Falls - Ischaemic heart disease +/- Fires* - Cardiac arrhythmias - Drownings - Ischaemic stroke +/- Other unintentional injuries - Haemorrhagic stroke - Intentional injuries Digestive disorders Self-inflicted injuries - Oesophageal varices - Assault - Alcoholic liver cirrhosis - Other intentional injuries - Cholelithiasis + Pancreatitis -

6 5.4% of all NZ deaths under 80 (n=802) 13,800 years of life lost 30.3% Cancer 26.6% Other Injury 43.1%

7 5.4% of all NZ deaths under 80 (n=802) Men (n=537) Women (n=265) Injuries Cancer Cancer Injury Other conditions Women (n = 265) Men (n = 538)

8 Causes of alcohol-attributable deaths by age (New Zealand, 2007). 100% 100% 80% 80% 60% 60% 40% 40% 20% 20% 0% % Males Females

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10 Top five causes of alcohol-attributable (AA) deaths (0 79 years; New Zealand 2007). Males % of AA deaths Females % of AA deaths Māori (N = 124) Māori (N = 62) Road traffic injuries 32.1% Female breast cancer 19.0% Other unintentional injuries 13.1% Road traffic injuries 17.4% Self-inflicted injuries 10.2% Ischaemic heart disease 16.3% Alcoholic liver cirrhosis 5.7% Alcoholic liver cirrhosis 6.5% Drownings 5.6% Haemorrhagic stroke 6.4% Non-Māori (N = 414) Non-Māori (N = 203) Road traffic injuries 15.8% Female breast cancer 29.3% Alcoholic liver cirrhosis 13.3% Haemorrhagic stroke 12.2% Self-inflicted injuries 10.6% Alcoholic liver cirrhosis 10.8% Other unintentional injuries 7.6% Colon cancer 8.5% Oesophagus cancer 7.4% Road traffic injuries 7.5%

11 6.5% of all DALYs lost in New Zealanders under 80 years old were attributable to alcohol (n = 28,403) Top five causes of alcohol attributable disability-adjusted life years (AA DALYs) lost under 80 years of age, 2004 % of AA DALYs % of AA DALYs Males (N = 18803) Females (N = 9601) Alcohol use disorders 42.5% Alcohol use disorders 50.0% Road traffic injuries 18.8% Female breast cancer 12.2% Self-inflicted injuries 7.8% Road traffic injuries 10.3% Other unintentional injuries 6.5% Cirrhosis of the liver 4.3% Cirrhosis of the liver 3.8% Other unintentional injuries 3.5%

12 Alcohol is an important cause of avoidable mortality and disability across the life course There are marked sex and ethnic disparities in health burden from alcohol Injury, including self-harm, is a major contributor to harm from alcohol especially for men. Breast cancer is the leading cause of alcohol-related death in women. No threshold of effect. Potential benefits are less convincing than ever, and not relevant to policy or advice

13 Physical violence Sexual violence Harm from other people s drinking Traffic injuries, fires Child abuse and neglect Wellbeing of drinkers families Effects on co-workers Property damage, neighbourhood amenity

14 Survey: Cross-sectional general population (n=3068). Response 64%. 29% had some relationship with a person who was a fairly heavy drinker or sometimes drinks a lot in last 12 months (7% reported 2 heavy drinkers, 2.3% had >2) Relative or partner not in the household (13%), a friend (13%), household member (6%) co-worker (2%) Of those identifying the single drinker with most impact (n=760) 84% reported at least one harm. Failed to do something counted on(55%), emotionally hurt or neglected (44%), threatened or scared (26%).physically hurt (7%), money stolen (9%) Exposure to heavy drinkers was associated with poorer health-related quality of life (EQ5-D) and personal wellbeing (PWI), independent of own drinking and socio-demographics

15 New Zealand adults Connor and Casswell, NZMJ, 2012

16 The dominant drinking culture affects the wellbeing of members of communities and the country as a whole. Opportunity costs of having a heavy drinking country Restriction of freedom and quality of life

17 Alcohol-attributable burden of disease and injury in New Zealand: 2004 and 2007 Funded by Alcohol Advisory Council of New Zealand Project Grant and the University of Otago Robyn Kydd Research Fellow, Preventive and Social Medicine, Otago University, Dunedin Kevin Shield and Jürgen Rehm Centre for Addiction and Mental Health, Toronto, and World Health Organization Global Burden of Disease 2010 Risk Factors Collaborating Group The range and magnitude of alcohol s harm to others Funded by HRC project grant Sally Casswell and Taisia Huckle SHORE, Massey University