Rehm Jürgen, Room Robin, Graham Kathryn, Monteiro Maristela, Gmel Gerhard, Sempos Christopher T
Addiction Research Institute, Zurich, Switzerland.
Addiction. 2003 Sep;98(9):1209-28. doi: 10.1046/j.1360-0443.2003.00467.x.
As part of a larger study to estimate the global burden of disease attributable to alcohol: to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and to combine exposure and risk estimates to determine regional and global alcohol-attributable fractions (AAFs) for major disease and injury categories. DESIGN, METHODS, SETTING: Systematic literature reviews were used to select diseases related to alcohol consumption. Meta-analyses of the relationship between alcohol consumption and disease and multi-level analyses of aggregate data to fill alcohol-disease relationships not currently covered by individual-level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi-level analyses with prevalence data.
Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed.
Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.
作为一项评估酒精所致全球疾病负担的大型研究的一部分：量化酒精平均消费量、饮酒模式与疾病及伤害结局之间的关系，并综合暴露和风险估计值，以确定主要疾病和伤害类别的区域和全球酒精归因分数（AAFs）。
设计、方法、背景：采用系统文献综述来选择与酒精消费相关的疾病。利用酒精消费与疾病关系的荟萃分析以及汇总数据的多层次分析来填补个体水平数据目前未涵盖的酒精-疾病关系，以确定酒精与疾病之间的风险关系。AAFs根据暴露患病率和相对风险进行估计，或通过将汇总的多层次分析与患病率数据相结合来估计。
发现酒精平均消费量会增加以下主要慢性病的风险：口腔和口咽癌；食管癌；肝癌；乳腺癌；单相重度抑郁症；癫痫；酒精使用障碍；高血压疾病；出血性中风；以及肝硬化。除了酒精平均消费量外，冠心病（CHD）、意外伤害和故意伤害还取决于饮酒模式。酒精对疾病的大多数影响是有害的，但对于某些饮酒模式，观察到对冠心病、中风和糖尿病有有益影响。
酒精与许多主要疾病结局相关，主要是以有害的方式。虽然平均消费量与所有考虑的疾病和伤害类别有关，但饮酒模式被发现是冠心病和伤害的另一个影响因素。饮酒模式的影响可能被低估了，因为许多流行病学研究未纳入模式测量。本分析中所使用的基础研究的方法学问题限制了结果的普遍性。未来的研究需要解决这些方法学问题，以获得更准确的风险估计。
