The Risk of Alcohol in Europe. Bridging the Gap June 2004

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1 The Risk of Alcohol in Europe Bridging the Gap June 2004

2 1. What is the relationship between alcohol and the risk of heart disease? 2. What is the relationship between alcohol and the risk of other diseases? 3. Is moderate drinking risk free? 4. Does per capita alcohol consumption matter? 5. How important is alcohol as a cause of illhealth in Europe?

3 1. What is the relationship between alcohol and the risk of heart disease? 2. What is the relationship between alcohol and the risk of other diseases? 3. Is moderate drinking risk free? 4. Does per capita alcohol consumption matter? 5. How important is alcohol as a cause of illhealth in Europe?

4 The risk of heart disease The risk of heart disease Relative risk Relative risk Grammes of alcohol per day Grammes of alcohol per day Source: Corrao et al 2000

5 The risk of heart disease The risk of heart disease 1.0 Most of the benefit Relative risk Relative risk.9 5g a day, or one drink every second day Grammes of alcohol per day Grammes of alcohol per day Source: Corrao et al 2000

6 Beverage type and heart protective biochemical changes % change HDL Cholesterol Fibrinogen Inflammation Biochemical indicator Beer/alcohol free beer Red wine/de-alcoholized red wine White wine/white grape juice Whisky Source: Sierksma 2003

7 Male depression and alcohol consumption Male depression and alcohol consumption 5 Goldberg depression score Non-drinkers Occasional Low Moderate High Alcohol consumption Source: Rodgers et al 2000

8 The risk of heart disease The risk of heart disease Relative risk Relative risk Grammes of alcohol per day Grammes of alcohol per day Source: Corrao et al 2000

9 The risk of heart disease The risk of heart disease Relative risk Realtive risk Grammes of alcohol per day Grammes of alcohol per day Source: Corrao et al 2000

10 1. In low doses, alcohol can reduce the risk of heart disease 2. Most of the benefit can be gained at 5g alcohol per day 3. Better studies find a smaller effect 4. Better studies find the benefit at a lower dose 5. Above 20g a day, alcohol increases the risk of heart disease

11 1. What is the relationship between alcohol and the risk of heart disease? 2. What is the relationship between alcohol and the risk of other diseases? 3. Is moderate drinking risk free? 4. Does per capita alcohol consumption matter? 5. How important is alcohol as a cause of illhealth in Europe?

12 The risk of getting into a physical fight The risk of getting into a physical fight Prevalence (%) Litres of alcohol per year Source: Wyllie et al 2000

13 The risk of being dependent on alcohol The risk of being dependent on alcohol 9 Relative risk Drinks per day Source: Caetano & Cunradi 2002

14 The risk of liver cirrhosis The risk of liver cirrhosis Relative risk Drinks per day Source: Corrao et al 1999

15 Incidence of breast cancer per 1,000 women Incidence of breast cancer per 1,000 women 150 Breast cancer by age Drinks per day Source: Collaborative group on Hormonal factors in Breast Cancer 2002

16 The risk of haemorrhagic stroke The risk of haemorrhagic stroke 6 5 Relative risk Drinks per day Source: Corrao et al 1999

17 1. Alcohol increases the risk of a wide range of diseases in a dose dependent manner

18 1. What is the relationship between alcohol and the risk of heart disease? 2. What is the relationship between alcohol and the risk of other diseases? 3. Is moderate drinking risk free? 4. Does per capita alcohol consumption matter? 5. How important is alcohol as a cause of illhealth in Europe?

19 Level of alcohol consumption with lowest risk of death, English men and women 40 Grammes alcohol/day Women Men Age (years)

20 Alcohol and social class differences in death Alcohol and social class differences in death 50 % differential due to alcohol (manual above non-manual) Age (years)

21 1. In younger people, moderate drinking is not risk free 2. In middle aged people, moderate drinking as defined as less than 5g a day might reduce the risk of premature death 3. In older people, moderate drinking as defined as less than 10g a day might be risk free 4. Alcohol can be an important cause of social class differences in death

22 1. What is the relationship between alcohol and the risk of heart disease? 2. What is the relationship between alcohol and the risk of other diseases? 3. Is moderate drinking risk free? 4. Does per capita alcohol consumption matter? 5. How important is alcohol as a cause of illhealth in Europe?

23 Death from liver disease by per capita alcohol consumption; 15 European countries Male liver disease mortality Per capita alcohol consumption Source: Ramstedt 2001

24 The proportion of heavy drinkers by alcohol consumption; 8 English regions % drinking >280g/week Mean population alcohol consumption (g/week) Source: Primatesta et al 2002

25 Reductions in male death rates when alcohol consumption reduced by 1 L Accidents Cirrhosis Homicide IHD Suicide All causes -12 % reduction in death rate when per capita alcohol consumption of 1L reduced per year Source: Norström & Skog 2001

26 The risk of heart disease The risk of heart disease Relative risk Relative risk Grammes of alcohol per day Grammes of alcohol per day Source: Corrao et al 2000

27 Pure alcohol consumption, litres per capita Portugal 2000 Luxembourg 2000 Ireland 2000 Czech Republic 2000 France 2000 Slovenia 2000 Germany 2000 Austria 2000 Lithuania 2001 Slovakia 2000 Spain 2000 Switzerland 2000 Denmark 2000 Hungary 2000 Finland 2000 Belgium 2000 United Kingdom 2000 Italy 2000 Greece 2000 Netherlands 2000 Latvia 2000 Estonia 2000 Poland 2000 Romania 2000 Bulgaria 2000 Sweden 2000 Norway 2000 Malta Last Available

28 Alcohol consumption and abstainers Alcohol consumption and abstainers % abstainers Per capita consumption Year % female abstainers % male abstainers Per capita consumption Source: Academy of Medical Sciences 2004

29 1. The lower the per capita alcohol consumption, the less the harm 2. The lower the per capita alcohol consumption, the smaller the number of heavier drinkers 3. All European countries are consuming in excess of a level of alcohol consumption that might reduce the risk of mortality from heart disease 4. Reductions in per capita consumption might not increase the numbers of abstainers

30 1. What is the relationship between alcohol and the risk of heart disease? 2. What is the relationship between alcohol and the risk of other diseases? 3. Is moderate drinking risk free? 4. Does per capita alcohol consumption matter? 5. How important is alcohol as a cause of illhealth in Europe?

31 The top 5 risk factors for ill health and premature death, Europe DALYs (000's) Tobacco High blood pressure Alcohol High cholesterol Overweight Source: World Health Organization 2004

32 Alcohol is more important than diabetes or asthma Every adult drinker loses 1 week of healthy life each year due to alcohol DALYs (000's) Alcohol Diabetes Asthma Source: World Health Organization 2004

33 The cause of alcohol-related ill-health and premature death Gastrointestinal 8% Cardiovascular 7% Cancers 7% Unintentional injuries 27% Neuropsychiatric 38% Intentional injuries 13% Source: World Health Organization 2004

34 1. Alcohol is one of the most important risk factors for European ill-health

35 1. Although 5g a day reduces the risk of heart disease, more than 20g increases the risk 2. Alcohol increases the risk of many diseases 3. Except, perhaps for older people, moderate drinking is not risk free 4. The lower the alcohol consumption, the less the harm 5. Alcohol is one of the most important causes of ill-health in Europe?

36 The basic message is: Less is better

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