No amount of alcohol is safe, global study shows

A new study finds there’s no safe level of drinking alcohol.

The study shows that in 2016, nearly 3 million deaths globally were due to alcohol use, including 12 percent of deaths in males between the ages of 15 and 49. The report was published Thursday in the medical journal The Lancet.

“The health risks associated with alcohol are massive,” said Emmanuela Gakidou, Ph.D., professor of global health at the University of Washington School of Public Health and the senior author of the study. “Our findings are consistent with other recent research, which found clear and convincing correlations between drinking and premature death, cancer, and cardiovascular problems. Zero alcohol consumption minimizes the overall risk of health loss.”

The study doesn’t distinguish between beer, wine, and liquor due to a lack of evidence when estimating the disease burden, Gakidou said. However, researchers used data on all alcohol-related deaths generally and related health outcomes to determine their conclusions.

Alcohol use patterns vary widely by country and by sex, the average consumption per drinker, and the disease burden. Globally, more than 2 billion people were current drinkers in 2016; 63 percent were male.

“Average consumption” refers to a standard drink, defined in the study as 10 grams of pure alcohol, consumed by a person daily, about the equivalent of:

• A small glass of red wine – 100 ml or 3.4 fluid ounces – at 13 percent alcohol by volume.
• A can or bottle of beer – 375 ml or 12 fluid ounces – at 3.5 percent alcohol by volume.
• A shot of whiskey or other spirits – 30 ml or 1 fluid ounce – at 40 percent alcohol by volume.

“Standard drinks” vary by country. For example, in the United Kingdom, a standard drink is 8 grams of alcohol, but in Australia, it’s 10 grams, the United States 14 grams, and Japan 20 grams.

The study, part of the annual Global Burden of Disease evaluation, assesses alcohol-related health outcomes and patterns between 1990 and 2016 for 195 countries and territories and by age and sex.

It provides findings on current drinking, abstention, alcohol consumption among current drinkers, and deaths and overall poor health caused by alcohol for 23 health outcomes including:

• Cardiovascular diseases: atrial fibrillation and flutter, hemorrhagic stroke, ischemic stroke, hypertensive heart disease, ischemic heart disease, and alcoholic cardiomyopathy.
• Cancers: breast, colorectal, liver, esophageal, larynx, lip and oral cavity, and nasal.
• Other non-communicable diseases: cirrhosis of the liver due to alcohol use, diabetes, epilepsy, pancreatitis, and alcohol use disorders.
• Communicable diseases: lower respiratory infections and tuberculosis.
• Intentional injuries: interpersonal violence and self-harm.
• Unintentional injuries: exposure to mechanical forces; poisonings; fire, heat, and hot substances; drowning; and other unintentional injuries.
• Transportation-related injuries.

“We now understand that alcohol is one of the major causes of death in the world today,” said Richard Horton, editor at Lancet. “We need to act now. We need to act urgently to prevent these millions of deaths. And we can.”

The researchers built a database of more than a thousand alcohol studies and data sources, as well as death and disability records from 195 countries and territories.

More than 500 Global Burden of Disease staff, such as researchers, academics, and others from more than 40 nations contributed to the study, according to Max Griswold, senior researcher, and lead author.

“With the largest collected evidence base to date, our study makes the relationship between health and alcohol clear – drinking causes substantial health loss, in myriad ways, all over the world,” Griswold said.

In 2016, eight of the leading 10 countries with the lowest death rates caused by alcohol use among 15- to 49-year-olds were in the Middle East: Kuwait, Iran, Palestine, Libya, Saudi Arabia, Yemen, Jordan, and Syria. The other two were Maldives and Singapore.

Seven of the leading 10 countries with the highest death rates were in the Baltic, Eastern European, or Central Asian regions, specifically Russia, Ukraine, Lithuania, Belarus, Mongolia, Latvia, and Kazakhstan. The other three were Lesotho, Burundi, and the Central African Republic.

Health officials in those nations, Gakidou said, would be well served by examining the study’s findings to inform their policies and programs to improve the health and well-being of their constituents.

“There is a compelling and urgent need to overhaul policies to encourage either lowering people’s levels of alcohol consumption or abstaining entirely,” she said. “The myth that one or two drinks a day are good for you is just that – a myth. This study shatters that myth.”

Alcohol-attributable death rates per 100,000 people, 15-49 years, both sexes, 2016

Highest rates:

1. Lesotho: 145.3
2. Russia: 118.4
3. Central African Republic: 108.8
4. Ukraine: 92.2
5. Burundi: 81.1
6. Lithuania: 76.1
7. Belarus: 71.2
8. Mongolia: 67.6
9. Latvia: 65.5
10. Kazakhstan: 62.2

Lowest rates:

1. Kuwait: 0.3
2. Iran: 0.4
3. Palestine: 0.4
4. Libya: 0.7
5. Saudi Arabia: 0.7
6. Yemen: 0.9
7. Jordan: 1.3
8. Maldives: 1.4
9. Singapore: 1.6
10. Syria: 1.7

Percent of current drinkers, all ages, 2016

Males

Highest percentage:

1. Denmark: 97.1
2. Norway: 94.3
3. Argentina: 94.3
4. Germany: 94.3
5. Poland: 93.8
6. France: 93.1
7. South Korea: 91.3
8. Switzerland: 91.2
9. Greece: 90.8
10. Iceland: 90.3

Lowest percentage:

1. Pakistan: 0.9
2. Bangladesh: 1
3. Egypt: 1.1
4. Mali: 2.5
5. Morocco: 3
6. Senegal: 3.2
7. Mauritania: 3.2
8. Syria: 5
9. Indonesia: 7.2
10. Palestine: 7.9

Females

Highest percentage:

1. Denmark: 95.3
2. Norway: 91.4
3. Germany: 90.0
4. Argentina: 89.9
5. New Zealand: 88.5
6. Switzerland: 88.4
7. Slovakia: 87.2
8. France: 86.9
9. Sweden: 86.1
10. Iceland: 84.8

Lowest percentage:

1. Bangladesh: 0.3
2. Morocco: 1.1
3. Pakistan: 1.5
4. Egypt: 1.5
5. Nepal: 1.5
6. Syria: 1.6
7. Bhutan: 1.9
8. Myanmar: 2.3
9. Tunisia: 2.3
10. Senegal: 2.6

Population average of standard drinks daily, all ages, 2016

Males

The greatest number of drinks:

1. Romania: 8.2
2. Portugal: 7.3
3. Luxembourg: 7.3
4. Lithuania: 7
5. Ukraine: 7
6. Bosnia and Herzegovina: 6.5
7. Belarus: 6
8. Estonia: 6
9. Spain: 5.8
10. Hungary: 5.5

Lowest numbest of drinks:

1. Pakistan: 0.0008
2. Iran: 0.004
3. Kuwait: 0.02
4. Comoros: 0.02
5. Libya: 0.02
6. Bangladesh: 0.03
7. Palestine: 0.04
8. Mauritania: 0.05
9. Yemen: 0.05
10. Saudi Arabia: 0.05

Females

The highest number of drinks:

1. Ukraine: 4.2
2. Andorra: 3.4
3. Luxembourg: 3.4
4. Belarus: 3.4
5. Sweden: 3.2
6. Denmark: 3.2
7. Ireland: 3.1
8. United Kingdom: 3
9. Germany: 2.9
10. Switzerland: 2.8

Lowest number of drinks:

1. Iran: 0.0003
2. Kuwait: 0.01
3. Mauritania: 0.02
4. Libya: 0.02
5. Pakistan: 0.03
6. Timor-Leste: 0.04
7. Palestine: 0.04
8. Yemen: 0.04
9. Tunisia: 0.04
10. Syria: 0.05

Comments

[Tom Sightings]

I read another story about this study as well ... and frankly, I don't get it. The study seems to show that, in general, drinking causes a lot of health problems. That's very convincing. But there's nothing showing that a small amount of alcohol -- a couple of drinks a week, say -- causes any negative effects. Is there something in the study that addresses this issue -- the one in the headline -- in particular? Thanks!

[Rita]

Hi Tom,

The global study is consistent with other studies that show that even small amounts of alcohol are related to bad health effects. For example, I've written two articles about the link between alcohol consumption and breast cancer. One reported a study that showed one glass of alcohol a day could increase the risk of breast cancer in women by 7 percent.

The confusion comes from attempts by the alcohol industry to get people to believe that drinking red wine has health benefits. Due to the industry efforts, the 1995 Dietary Guidelines for Americans published by the Department of Agriculture removed language indicating that alcohol had “no net health benefit” and stated that, for some people, moderate alcohol consumption might reduce the risk of heart disease. The department removed language suggesting that alcohol may lower the risk of heart disease in the most recent U.S. Dietary Guidelines.

Rita

[Jennifer]

I'm confused by this study since the countries that have the highest amount of drinking aren't all showing up on the list of highest deaths. Makes me wonder if we're also talking about the quality of alcohol that is being made. I would like to know how poverty and access to healthcare and drinking ages had an impact on this study.

[Rita]

Hi Jennifer,

Here's a link to the article on the study and other information about it: http://www.healthdata.org/research-article/alcohol-use-and-burden-195-countries-and-territories-1990%E2%80%932016-systematic-analysis

Maybe that will help answer your questions.

Rita

[Rebecca Forstadt Olkowski]

I'm currently dealing with someone who is experiencing the health effects of heavy drinking and it's pretty awful. However, I also sat and drank a glass of Sangria with a man who was 103 and met a 102-year-old man who said he drank a little whiskey every day. In general, I think many people drink way too much but maybe a little every once in a while doesn't hurt as long as there isn't a previous history of alcohol abuse.

[Rita]

Hi Rebecca,

I'm so sorry about your friend or relative who is experiencing the health effects of heavy drinking.

I think the information in this study is helpful. Alcohol is a carcinogen and drinking even one glass a day may increase your changes of getting some types of cancer.

If people know this, then they can make an informed decision about how much alcohol to drink. I know that when I became aware several years ago about the link between breast cancer and moderate alcohol consumption, I cut the amount of alcohol I was drinking.

In addition to cancer, the study looks at the deaths and overall poor health caused by alcohol for other health outcomes. This may be what your friend or relative is experiencing.

Rita