Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
School of Electrical Engineering and Telecommunications, University of New South Wales, Kensington, Australia.
Addiction. 2017 Sep;112(9):1535-1544. doi: 10.1111/add.13827. Epub 2017 Apr 26.
Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts.
The maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization.
The variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men.
If low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men, and some of the current European guidelines would require downward revision.
低风险饮酒指南需要有一个科学依据，而不仅仅是基于个人或群体对风险的判断。基于已确定的可接受风险阈值，终生死亡率风险可能为此类指南提供依据。因此，本研究的目的是基于七个欧洲国家不同的平均日酒精摄入量来估算酒精导致的死亡率风险。
最大可接受的自愿性过早死亡率风险被确定为 1/1000，同时还进行了 1/100 的敏感性分析。通过结合具有不同饮酒模式的七个欧洲国家（爱沙尼亚、芬兰、德国、匈牙利、爱尔兰、意大利和波兰）的特定疾病相对风险和死亡率数据，估算了不同酒精摄入量水平下的终生死亡率风险。酒精摄入量数据来自全球酒精与健康信息系统，相对风险数据来自荟萃分析，死亡率信息来自世界卫生组织。
在与指南设定相关的饮酒水平下，终生死亡率风险的变化小于在高饮酒水平下观察到的变化。在欧洲，女性中超过 1/1000 风险阈值的成年人比例为 20.6%至 32.9%，男性中为 35.4%至 54.0%。在目前的指南上限下，芬兰和爱沙尼亚的女性终生过早死亡风险分别为每 1000 人 2.5 至 44.8 人死亡，芬兰和爱沙尼亚的男性终生过早死亡风险分别为每 1000 人 2.9 至 35.8 人死亡。如果基于 1/1000 的可接受风险，欧洲的指南上限应为女性 8-10g/天，男性 15-20g/天。
如果低风险酒精指南基于 1/1000 的过早死亡可接受风险，那么欧洲的上限应为女性 8-10g/天，男性 15-20g/天，并且一些当前的欧洲指南将需要进行修订。
