Rehm Jürgen, Gmel Gerhard E, Gmel Gerrit, Hasan Omer S M, Imtiaz Sameer, Popova Svetlana, Probst Charlotte, Roerecke Michael, Room Robin, Samokhvalov Andriy V, Shield Kevin D, Shuper Paul A
Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.
Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.
Addiction. 2017 Jun;112(6):968-1001. doi: 10.1111/add.13757. Epub 2017 Feb 20.
Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs).
Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others.
In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently.
Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
饮酒是导致伤害、死亡和疾病负担的主要因素。本综述更新了饮酒各维度与健康结局之间风险关系的知识，以供全球和国家层面的比较风险评估（CRA）使用。
对有关饮酒及饮酒所致健康结局的综述和荟萃分析进行系统回顾。对于暴露维度：研究了饮酒量、血液酒精浓度和饮酒模式，尤其着重研究了重度饮酒场合。对于肝硬化，还考虑了酒精的质量。对于所有结局（死亡率和/或发病率）：基于全球CRA中使用的国际疾病分类（ICD）编码的死亡原因和疾病/损伤类别；对他人的伤害。
共识别出255篇综述和荟萃分析。发现饮酒与许多疾病和损伤类别存在因果关系，超过40个ICD - 10三位数字类别完全可归因于饮酒。大多数部分可归因的疾病类别与饮酒量呈单调关系：饮酒越多，疾病或死亡风险越高。缺血性疾病和糖尿病为例外，它们呈曲线关系，且对于没有重度不规则饮酒场合的人，轻度至中度饮酒有有益影响。生物学途径表明重度饮酒场合对其他疾病有影响；然而，缺乏测量饮酒这一维度的医学流行病学研究，妨碍了深入分析。对于损伤，除自杀外，血液酒精浓度是饮酒最重要的维度。饮酒对他人造成了显著伤害，这方面尚未得到充分研究。
2010年以来的研究证实了饮酒作为疾病和损伤风险因素的重要性；对于某些健康结局，需要考虑不止一个饮酒维度。流行病学研究应根据生物学知识纳入对重度饮酒场合的测量。
Zotero 插件