Alcohol‘s burden of disease in Australia

Burden of disease (BoD) analyses provide a powerful method to estimate the number of deaths, hospitalisations and Disability Adjusted Life Years (DALYs) due to different risk factors. Such studies combine estimates of exposure to a risk factor (e.g. the consumption of alcohol) with the relative risk of harm in a number of disease, illness and injury categories which may be classified as acute (e.g. motor vehicle accidents) or chronic (e.g. cancers). In this way, BoD studies paint a picture about the relative amounts of harm that are attributable to different risk factors.

In the 2010 Global BoD study, alcohol was estimated to be the eighth highest risk factor in Australia for disease, illness and injury, contributing to 2.1% of total deaths and 2.8% of total DALYs. Our novel study “Alcohol’s Burden of Disease in Australia” employed an improved methodology to estimate deaths, hospitalisations and DALYs in Australia and each Australian jurisdiction.

We estimate that alcohol was responsible for 3.9% of deaths and 4.1% of total DALYs in Australia in 2010, with significant differences across jurisdictions. Although these updated percentages are still lower than Global BoD estimates of some other risk factors such as smoking and physical inactivity, it does not mean that alcohol-related harm is less important. For example, 3,467 male deaths and 2,087 female deaths were attributable to alcohol in our analysis, and the overall number of alcohol-attributable hospitalisations were estimated to be 101,425 for males and 55,707 for females. In males, injuries were responsible for the highest proportion of alcohol-related deaths (36%), followed by cancers (25%) and digestive diseases (16%). For females the highest proportion of alcohol-attributable deaths was for cardiovascular diseases (34%) followed by cancers (31%) and injuries (12%).

Although this study adopted the most up to date methodology in the alcohol BoD literature, figures are likely an underestimation of total harm. Alcohol-attributable burden for many diseases are still difficult to estimate because of technical, methodological and co-morbidity issues.  Also for all conditions protected against by alcohol, detrimental effects co-exist (low level of drinking is protective, whereas high level of drinking is harmful). The current methodology cannot capture these detrimental effects in such conditions because they are masked at the population level.

Alcohol has diverse impacts on the human body causing negative effects in the circulatory, digestive, urinary as well as nervous systems, and often acts as an accelerator of development and progression of diseases in conjunction with other risk factors. However the current BoD methodology is still not able to evaluate these complicated causal relationships, causing a significant underestimation of alcohol attributable burden.

Even if we can obtain a more accurate estimation of alcohol attributable mortality and morbidity, it is still only a part of, or maybe a small part of, alcohol-related costs. Different from many major health risk factors, drinking alcohol contributes to both chronic and acute conditions including falls, assaults and self-harm, which contribute significant burden on a wide range of service providers in the community including hospitals, ambulance services, alcohol and drug treatment agents and police. There are also social costs related to alcohol misuse, which often transcend measurements reported in BoD studies. These include direct costs to the community (e.g. law enforcement and the social welfare system), and the individual (e.g. physical and psychological harm to the individual and others), in addition to indirect costs such as productivity lost at work.

Despite these caveats, the present report “Alcohol’s Burden of Disease in Australia” provides a useful, novel and relevant quantification of the burden of disease and injury in Australia for 2010. These estimates should form the basis for a future cost of illness study to assess how current funding is allocated to tackling alcohol-related burden in the Australian health care system.