Societal development and the alcohol-attributable burden of disease.

AIM

This study aimed to examine if there is an interaction between alcohol use and human development in terms of their associations with alcohol-attributable health harms.

DESIGN

Statistical modelling of global country- and region-specific data from 2016.

SETTING

Global.

PARTICIPANTS/CASES: The units of the analyses were countries (n = 180) and regions (n = 4) based on their Human Development Index (HDI).

MEASUREMENTS

Alcohol-attributable harms [deaths, years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALYs) lost] and risk relations were based on a recent study using World Health Organization (WHO) estimates for 2016. Human development was measured using the HDI, a summary score of life expectancy, education and gross national income from the United Nations Development Programme. Interactions between HDI and adult per-capita consumption (APC) affecting alcohol-attributable harms were assessed using likelihood ratio tests. Differences in alcohol-attributable harms per litre of APC between HDI groups were assessed using regression analyses and a reference group of low HDI.

FINDINGS

APC is associated with alcohol-attributable deaths, YLL, YLDs and DALYs lost, while HDI is associated with alcohol-attributable deaths, YLL and DALYs lost. Statistical analyses indicated there is an interaction between HDI and APC in their associations with alcohol-attributable deaths, YLL and DALYs lost per 100 000 people. The alcohol-attributable burden was highest in low HDI countries, with 11.65 [95% confidence interval (CI) = 10.75, 12.40] deaths and 495.61 (95% CI = 461.83, 569.23) DALYs lost per 100 000 people per litre of APC, and lowest in very high HDI countries, with 4.15 (95% CI = 2.46, 5.71) deaths and 200.31 (95% CI = 122.78, 265.10) DALYs lost per 100 000 people per litre of APC. However, no statistical differences between low and very high HDI groupings for these burdens were observed.

CONCLUSIONS

There appears to be an interaction between the Human Development Index and alcohol use in their associations with alcohol-attributable deaths, years of life lost and disability-adjusted life years lost but not with alcohol-attributable years lived with disability. Alcohol appears to have a stronger harmful impact per litre of alcohol consumed in lesser developed countries than in developed countries.