2016, we generated improved estimates of alcohol use andalcohol-attributable deaths and disability-adjusted life-

years (DALYs) for 195 locations from 1990 to 2016, for bothsexes and for 5-year age groups between the ages of

15 years and 95 years and older.

概要

背景：酒精使用是导致死亡和残疾的主要因素，鉴于适度饮酒对某些情况可能产生的保护作用，酒精与健康仍是息息相关的。

通过我们对全球疾病，伤害和风险因素研究中的综合法，2016年，我们对1990年至2016年195个地点酒精使用和酒精引起的死亡和残疾调整行了统计 - 男女性别和5岁以下年龄组15岁和95岁以上。

Methods Using 694data sources of individual and population-level alcohol consumption, along with592 prospective

and retrospective studies on the risk of alcohol use, weproduced estimates of the prevalence of current drinking,

abstention, the distribution of alcohol consumption amongcurrent drinkers in standard drinks daily (defined as 10 g

of pure ethyl alcohol), and alcohol-attributable deaths andDALYs. We made several methodological improvements

compared with previous estimates: first, we adjusted alcoholsales estimates to take into account tourist and

unrecorded consumption; second, we did a new meta-analysis ofrelative risks for 23 health outcomes associated with

alcohol use; and third, we developed a new method to quantifythe level of alcohol consumption that minimises the

overall risk to individual health.

方法

通过对个人和人群饮酒量的694个数据来源，以及592个预期关于酒精使用风险的回顾性研究，我们预估了当前饮酒的患病率。每日标准饮料中当前饮酒者的饮酒量分布（定义为10克纯乙醇）和酒精引起的死亡。我们做了几个方法上的改进与之前的数据相比：首先，我们调整了酒精销售预测，以考虑到游客和未记录的消费; 第二，我们对与23个相关健康结果的相对风险进行了新的分析，第三，我们开发了一种新的方法来量化酒精消费水平，最大限度地减少酒精摄入量对个人健康的整体风险。

Findings Globally,alcohol use was the seventh leading risk factor for both deaths and DALYs in2016, accounting for

2•2% (95% uncertainty interval [UI] 1•5–3•0) ofage-standardised female deaths and 6•8% (5•8–8•0) of age-

standardised male deaths. Among the population aged 15–49years, alcohol use was the leading risk factor globally in

2016, with 3•8% (95% UI 3•2–4•3) of female deaths and 12•2%(10•8–13•6) of male deaths attributable to alcohol

use. For the population aged 15–49 years, female attributableDALYs were 2•3% (95% UI 2•0–2•6) and male

attributable DALYs were 8•9% (7•8–9•9). The three leadingcauses of attributable deaths in this age group were

tuberculosis (1•4% [95% UI 1•0–1•7] of total deaths), roadinjuries (1•2% [0•7–1•9]), and self-harm (1•1% [0•6–1•5]).

For populations aged 50 years and older, cancers accountedfor a large proportion of total alcohol-attributable deaths

in 2016, constituting 27•1% (95% UI 21•2–33•3) of totalalcohol-attributable female deaths and 18•9% (15•3–22•6) of

male deaths. The level of alcohol consumption that minimisedharm across health outcomes was zero (95% UI 0•0–0•8)

standard drinks per week

.结果

在全球范围内，酒精使用是2016年死亡和DALYs(疾病负担的综合性指标伤残调整生命年)的第七大风险因素，占龄标准化女性死亡的2.2％，男性死亡的6.8％。在15-49岁的人口中，酗酒是全球的主要风险因素。在15~49岁的人群中，3.8%的女性死亡要归因于酒精，男性占12.2％。结核病（1.4%）、交通事故（1.2%）和自我伤害（1.1%）是与酒精有关的主要死亡原因。

而对于年龄在50岁及以上的人来说，癌症是导致酒精相关死亡的主要原因，女性占27. 1%，男性占18.9%。

总的来说，与不饮酒的人相比，每天一杯会使相关健康风险增加0.5%，每天饮酒5杯风险则增加37％。

Interpretation Alcohol use is a leading risk factor forglobal disease burden and causes substantial health loss. We

found that the risk of all-cause mortality, and of cancersspecifically, rises with increasing levels of consumption, and

the level of consumption that minimises health loss is zero.These results suggest that alcohol control policies might

need to be revised worldwide, refocusing on efforts to loweroverall population-level consumption.

Funding Bill & Melinda Gates Foundation.

Copyright © 2018 The Author(s). Published by Elsevier Ltd.This is an Open Access article under the CC BY 4.0 license.

解释

酒精使用是全球疾病负担的主要风险因素，并导致严重的健康损失。我们

研究发现，全因死亡率和癌症的风险随着消费水平的提高而上升

最小化健康损失的消费水平为零。这些结果表明，酒精控制政策可能会

需要在全球范围内进行修订，重新关注降低总体人口消费水平。

比尔和梅琳达盖茨基金会资助。

版权所有©2018作者。由Elsevier Ltd.出版。这是CC BY 4.0许可下的Open Access文章

Introduction

Alcohol use has a complex association with health.

Researchers have recognised alcohol use as a leading risk

factor for disease burden, and studies link its consumption

to 60 acute and chronic diseases. 1–3 Additionally, some

research suggests that low levels of alcohol consumption

can have a protective effect on ischaemic heart disease,

diabetes, and several other outcomes. 4–6 This finding

remains an open question, and recent studies have

challenged this view by use of mendelian randomisation

and meta-analy

介绍

酒精使用与健康有着复杂的联系。

研究人员已将酒精使用视为主要风险

疾病负担因素，研究发现其与60种急慢性疾病。 1-3节，一些

研究表明，饮酒量低可以对缺血性心脏病有保护作用，

4-6节说明这一发现仍然是一个悬而未决的问题。最近的研

通过使用孟德尔随机化和元分析来证明这种观点。

Determination of harm due to alcohol use is com-

plicated further by the multiple mechanisms through

which alcohol use affects health: through cumulative

consumption leading to adverse effects on organs and

tissues; by acute intoxication leading to injuries or

poisoning; and by dependent drinking leading to

impairments and potentially self-harm or violence. These

effects are also influenced by an individual’s consumption

volume and pattern of drinking. 2 Measuring the health

effects of alcohol use requires careful consideration of all

these factor

确定酒精使用造成的危害是通过多种机制进一步复杂化的。

哪些酒精使用影响健康：通过累积消费导致器官和器官的不良影响器官组织; 急性中毒导致伤害或中毒; 依赖饮酒导致损伤和潜在的自我伤害或暴力。这些效果也受个人消费的影响饮酒的量和模式影响。衡量酒精使用健康状况的影响需要仔细考虑所有这些因素。

《柳叶刀》创刊号

《柳叶刀》于1823年由英国外科医生，同时也是一名国会议员的汤姆·魏克莱（Thomas Wakley）所创刊，他以外科手术刀“柳叶刀”（Lancet）的名称来为这份刊物命名，主要涉及糖尿病、肿瘤、传染病等医学领域的研究。

2

Research in context

Evidence before this study

Although researchers recognise alcohol use as a leading riskfactor

for premature death and disability, some evidence suggeststhat

low intake might have a protective effect on specificconditions

such as ischaemic heart disease and diabetes. Monitoring of

consumption behaviour is required to analyse the healtheffects of

alcohol use. Historically, researchers have relied onself-reported

survey data to estimate consumption levels and trends.However,

these data have systematic biases that make cross-country

comparisons unreliable. The Global Status Report on Alcoholand

Health, as well as previous iterations of the Global Burdenof

Diseases, Injuries, and Risk Factors Study, have sought toproduce

harmonised, cross-country comparisons of alcohol consumption

and its harms, by leveraging data on alcohol sales, theprevalence

of current drinking and abstention, and self-reports of

consumption amounts.

Added value of this study

In this analysis we improved available estimates of alcoholuse and

its associated health burden in five ways. First, weconsolidated

694 individual and population-level data sources to estimate

alcohol consumption levels among current drinkers. Second,

we developed a method to adjust population-level consumption

for alcohol consumed by tourists. Third, we improvedpre-existing

methods that account for unrecorded population-level

consumption. Fourth, we did a new systematic review and

meta-analysis of alcohol use and 23 associated healthoutcomes,

which we used to estimate new dose–response curves ofrelative

risk. Fifth, using the new relative risk curves and a newanalytical

method, we estimated the exposure of alcohol consumption that

minimises an individual’s total attributable risk.

Implications of all the available evidence

The total attributable burden of alcohol use was larger than

previous evidence has indicated and increases monotonically

with consumption. Based on weighted relative risk curves for

each health outcome associated with alcohol use, the level of

consumption that minimises health loss due to alcohol use is

zero. These findings strongly suggest that alcohol control

policies should aim to reduce total population-level

consumption. To potentially reduce the effects of alcohol use

on future health loss, there is a need for countries torevisit

their alcohol control policies and assess how they can be

modified to further lower population-level consumption.

研究背景

虽然研究人员认为对于过早死亡和残疾酒精使用是一个主要的风险因素。一些证据表明

低摄入量可能对特定条件有保护作用，如缺血性心脏病和糖尿病。监测饮酒行为来分析健康的影响。从历史上看，研究人员一直依赖于自我报道调查数据以估算消费水平和趋势。然而，这些数据具有跨国的系统性偏见比较不可靠。关于酒精和饮酒的健康全球状况报告，以及之前的全球负担迭代疾病，伤害和风险因素研究，利用酒精销售数据跨国比较它的危害，以及自我报告

消费金额，增加了本研究的价值。在此分析中，我们改进了可用的酒精使用估计值，廉价评估它对五种相关的健康的作用。首先，我们对694个人和人口年龄通过生活水平的数据来源进行估算其当前饮酒者的酒精消费水平。第二，我们开发了一种调整人口消费水平的方法引入用于游客消费的酒精。第三，我们改进了预先存在的解释未记录的人口消费水平的方法。第四，我们做了一个新的系统评价和酒精使用的荟萃分析和23种相关的健康有关的结果，我们用它来估计相对的新剂量生成反应曲线。第五，使用新的相对风险曲线和新的分析方法，我们估计酒精消费的程度，最小化个人用量。所有证据说明酒精的坏处大于保护。以前的证据只能说明单调增加与消费。基于加权相对风险曲线与酒精使用相关的每种健康结果，最大限度地减少酒精使用造成的健康损失就是消费量为零。这些发现强烈暗示酒精控制政策应旨在降低总人口消费水平。减少酒精使用的影响，关于未来的健康，各国需要重新审视他们的酒精控制政策并评估他们的可能性，进一步降低人口消费水平。

Several studies have attempted to address these factors

to provide global estimates of alcohol consumption and its

associated health effects. The most comprehensive among

these studies have been WHO’s Global Status Report on

Alcohol and Health, as well as previous iterations of the

Global Burden of Diseases, Injuries, and Risk Factors

Study (GBD). 11–13 The present study aims to build upon pre-

existing work and to address several limitations found in

earlier research.

First, the available studies have assessed the risk of

alcohol use by relying on external meta-analyses, which do

not control for confounding in the selection of the

reference category within constituent studies. This

approach is problematic because of the so-called sick

quitter hypothesis, which emphasises the importance of

reference category selection in correctly assessing risk

among drinkers, along with other confounding study

characteristics such as survival bias. 8,14–17 Untilrecently,

most meta-analyses of alcohol consumption have not

controlled for the composition of the reference category.

Subsequently, assessments of harm relying on these

studies have been biased. We sought to resolve this issue

within our meta-analyses by including controls for

different reference categories and the average age of

participants.

Second, previous studies have used sales data to estimate

population-level alcohol stock. Researchers have noted the

benefit of using sales data instead of survey data for

quantifying alcohol stock available within a location. 18,19

However, sales data still have bias because of consumption

by tourists and unrecorded consumption from illicit sales,

一些研究试图证明这些因素提供全球饮酒量及其消费量对健康影响。其中最全面的

这些研究是世界卫生组织的酒精和健康全球状况报告，以及之前的迭代全球疾病负担，伤害和风险因素研究（GBD）。 11-13页本研究旨在建立预先现有的工作并解决了发现的一些局限性

早期研究。首先，现有研究评估了风险依赖外部荟萃分析来酗酒中的类别。假设，强调了重要性

正确评估风险的参考类别，选择在饮酒者中类加别，以及其他混淆特征。 8,14-17页直到最近，

大多数酒精消费的荟萃分析都没有控制参考类别的组成。随后，依靠这些评估做研究有偏见。我们试图解决这个问题，通过包含控件来进行元分析不同的参考类别和平均年龄参与者。其次，以前的研究使用销售数据进行估算人口级酒精库存。研究人员已经注意到了使用销售数据而不是调查数据的好处，量化一个地点内可用的酒精库存。但是，消费，销售数据仍然存在偏差因为包含

游客和非法销售的未记录消费，家庭酿造和当地饮料。

home brewing, and local beverages. Without correction for

these factors, estimates relying on sales data can be biased

and lead to inaccurate cross-national comparisons. In the

current study, we adjusted the estimates of population-

level alcohol stock to account for the effects of tourism and

unrecorded consumption.

Third, previous studies have assumed zero as the

counterfactual exposure level that minimises harm. Within

a comparative risk assessment approach, a counterfactual

level of consumption that minimises harm is required

to estimate population attributable fractions (PAFs). 1

However, this counterfactual level needs to be estimated,

rather than assumed, given the complexities involved in

estimating the risk of alcohol use across outcomes. Relying

on this assumption can fail to capture any potential non-

linear effects between alcohol use and health. Our study

proposes a new method for the use of available evidence to

establish a counterfactual level of exposure across varied

relative risks, which provides tangible evidence for low-risk

drinking recommendations.

In the present study, we aimed to address these limita-

tions and provide the best available estimates of alcohol

use and the associated health burden. We estimated the

Research in context

Evidence before this study

Although researchers recognise alcohol use as a leading riskfactor

for premature death and disability, some evidence suggeststhat

low intake might have a protective effect on specificconditions

such as ischaemic heart disease and diabetes. Monitoring of

consumption behaviour is required to analyse the healtheffects of

alcohol use. Historically, researchers have relied onself-reported

survey data to estimate consumption levels and trends.However,

these data have systematic biases that make cross-country

comparisons unreliable. The Global Status Report on Alcoholand

Health, as well as previous iterations of the Global Burdenof

Diseases, Injuries, and Risk Factors Study, have sought toproduce

harmonised, cross-country comparisons of alcohol consumption

and its harms, by leveraging data on alcohol sales, theprevalence

of current drinking and abstention, and self-reports of

consumption amounts.

Added value of this study

In this analysis we improved available estimates of alcoholuse and

its associated health burden in five ways. First, weconsolidated

694 individual and population-level data sources to estimate

alcohol consumption levels among current drinkers. Second,

we developed a method to adjust population-level consumption

for alcohol consumed by tourists. Third, we improvedpre-existing

methods that account for unrecorded population-level

consumption. Fourth, we did a new systematic review and

meta-analysis of alcohol use and 23 associated healthoutcomes,

which we used to estimate new dose–response curves ofrelative

risk. Fifth, using the new relative risk curves and a newanalytical

method, we estimated the exposure of alcohol consumption that

minimises an individual’s total attributable risk.

Implications of all the available evidence

The total attributable burden of alcohol use was larger than

previous evidence has indicated and increases monotonically

with consumption. Based on weighted relative risk curves for

each health outcome associated with alcohol use, the level of

consumption that minimises health loss due to alcohol use is

zero. These findings strongly suggest that alcohol control

policies should aim to reduce total population-level

consumption. To potentially reduce the effects of alcohol use

on future health loss, there is a need for countries torevisit

their alcohol control policies and assess how they can be

modified to further lower population-level consumption.

Figure 1: Age-standardised prevalence of current drinking forfemales (A)

and males (B) in 2016, in 195 locations

Current drinkers are defined as individuals who reportedhaving consumed

alcohol within the past 12 months. ATG=Antigua and Barbuda.VCT=Saint

Vincent and the Grenadines. Isl=Islands. FSM=Federated Statesof Micronesia.

LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste.

这些因素，依赖于销售数据的估计可能存在偏差并导致不准确的跨国比较。

目前的研究，我们调整了人口估计数，酒精储备水平，以及旅游业的影响，未记录的消费。

第三，先前的研究假设为零反事实暴露水平，最大限度地减少伤害。比较风险评估方法，反事实

需要最小化伤害的消费水平，估计人口归因分数（PAFs）。但是，需要估计这种反事实水平，

考虑到所涉及的复杂性，而不是假设估计结果中酒精使用的风险。依托在这个假设下可能无法捕获任何潜在的非酒精使用与健康之间的线性影响。我们的研究提出了一种利用现有证据的新方法

建立一个跨越不同的反事实暴露水平相对风险，为喝酒的低风险提供切实证据。

在本研究中，我们旨在解决这些限制并提供最佳的酒精估算值使用和相关的健康负担。我们估计了研究背景，本研究之前的证据。虽然研究人员认为酒精使用是过早死亡和残疾一个主要的风险因素，一些证据表明低摄入量可能对特定条件有保护作用如缺血性心脏病和糖尿病。监测

需要消费行为来分析健康的影响酒精使用。从历史上看，研究人员一直依赖于自我报道调查数据以估算消费水平和趋势。然而，这些数据具有跨国的系统性偏见比较不可靠。关于酒精和饮酒的全球健康状况报告，以及之前的全球负担迭代疾病，伤害和风险因素研究，都试图生产酒精消费的统一，跨国比较通过利用酒精销售数据，流行率，它的危害当前的饮酒，以及自我报告

消费金额。增加了本研究的价值在此分析中，我们改进了可用的酒精使用估计值

它有五种相关的健康负担。首先，我们巩固了694个人和人口水平的数据来源进行估算。

当前饮酒者的酒精消费水平。第二，我们开发了一种调整人口消费水平的方法

用于游客消费的酒精。第三，我们改进了预先存在的解释未记录的人口水平的方法消费。第四，我们做了一个新的系统评价和酒精使用的荟萃分析和23种相关的健康结果，我们用它来估计相对的新剂量 - 反应曲线风险。第五，使用新的相对风险曲线和新的分析方法，我们估计酒精消费的暴露程度最小化个人的总归属风险。所有可用证据的含说明酒精使用的坏处大于以前的证据并且消费增加。基于加权相对风险曲线与酒精使用相关的每种健康结果，最大限度地减少酒精使用造成的健康损失是使消费量零。这些发现强烈暗示酒精控制政策应旨在降低总人口消费。减少有可能减少酒精使用的影响对未来的健康损失，各国需要重新审视他们的酒精控制政策并评估他们的可能性，健康以进一步降低人口消费水平。

图1：当前女性饮酒的年龄标准化患病率（A）

和男性（B）在2016年，在195个地点

目前的饮酒者被定义为报告已经消费的个体

过去12个月内饮酒。 ATG =安提瓜和巴布达。 VCT =圣

文森特和格林纳丁斯。 ISL =群岛。 FSM =密克罗尼西亚联邦。

LCA =圣卢西亚。 TTO =特立尼达和多巴哥。 TLS =东帝汶。

事实上，此前有些研究表明中低量饮酒可以降低全因死亡率。然而，这些研究有样本量太小、混杂因素控制不足和计算相对风险的参考类别非最佳选择等限制。最近一些采用孟德尔随机化、汇集队列研究和多变量荟萃分析的高质量研究，越来越多的证据发现饮酒对全因死亡率并无保护作用。

在这次的GBD研究数据中，我们通过图片，可以得出更直接的结论。

3

prevalence of current drinking (having one or more

drinks in the past year); abstention from alcohol (having

no alcohol in the past year); the distribution of alcohol

consumption among current drinkers in standard drinks

daily; and the disease burden attributable to alcohol use,

in terms of deaths and disability-adjusted life-years

(DALYs). We produced these estimates for 195 locations

from 1990 to 2016, for both sexes and for 5-year age

groups between the ages of 15 years and 95 years and

older. We also did a new meta-analysis to assess the dose–

response risk of alcohol consumption for 23 outcomes.

Lastly, we estimated the level of alcohol consumption that

minimises an individual’s total attributable risk of anyhealth loss

prevalence of current drinking (having one or more

drinks in the past year); abstention from alcohol (having

no alcohol in the past year); the distribution of alcohol

consumption among current drinkers in standard drinks

daily; and the disease burden attributable to alcohol use,

in terms of deaths and disability-adjusted life-years

(DALYs). We produced these estimates for 195 locations

from 1990 to 2016, for both sexes and for 5-year age

groups between the ages of 15 years and 95 years and

older. We also did a new meta-analysis to assess the dose–

response risk of alcohol consumption for 23 outcomes.

Lastly, we estimated the level of alcohol consumption that

minimises an individual’s total attributable risk ofanyprevalence of current drinking (having one or more

drinks in the past year); abstention from alcohol (having

no alcohol in the past year); the distribution of alcohol

consumption among current drinkers in standard drinks

daily; and the disease burden attributable to alcohol use,

in terms of deaths and disability-adjusted life-years

(DALYs). We produced these estimates for 195 locations

from 1990 to 2016, for both sexes and for 5-year age

groups between the ages of 15 years and 95 years and

older. We also did a new meta-analysis to assess the dose–

response risk of alcohol consumption for 23 outcomes.

Lastly, we estimated the level of alcohol consumption that

minimises an individual’s total attributable risk of anyhealth loss.

家庭酿造和当地饮料一定要做为参考数据，依赖于销售数据的估计可能存在偏差并导致不准确的跨国比较。目前的研究，我们调整了人口估计数 - 酒精储备水平，包含旅游业的影响未记录的消费。第三，先前的研究假设为零，事实暴露，最大限度地减少伤害。比较风险评估方法，反事实需要最小化伤害的消费水平估计人口归因分数（PAFs）。但是，需要估计这种反事实水平，考虑到所涉及的复杂性，而不是假设估计结果中酒精使用的风险。依托在这个假设下可能无法捕获任何潜在的非酒精使用与健康之间的线性影响。我们的研究提出了一种利用现有证据的新方法建立一个跨越不同的反事实暴露水平，为低风险提供切实证据。在本研究中，我们旨在解决这些限制并提供最佳的酒精估算值使用和相关的健康负担。

研究背景

本研究前的证据虽然研究人员认为酒精使用是对于过早死亡和残疾一个主要的风险因素，一些证据表明低摄入量可能对特定条件有保护作用如缺血性心脏病和糖尿病。监测需要消费行为来分析健康的影响酒精使用。从历史上看，研究人员一直依赖于自我报道调查数据以估算消费水平和趋势。然而，这些数据具有跨国的系统性偏见比较不可靠。关于酒精和饮酒的全球状况报告健康，以及之前的全球负担迭代疾病，伤害和风险因素研究，都试图生产酒精消费的统一，跨国比较通过利用酒精销售数据，流行率，它的危害当前的饮酒，以及自我报告消费金额。增加了本研究的价值在此分析中，我们改进了可用的酒精使用估计值它有五种相关的健康负担。首先，我们巩固了694个人和人口水平的数据来源进行估当前饮酒者的酒精消费水平。第二，我们开发了一种用于统计游客消费酒精水平的方法。第三，我们改进了预先存在的解释未记录的人口水平的方法消费。第四，我们做了一个新的系统评价和酒精使用的荟萃分析和23种相关的健康结果，风险。第五，使用新的相对风险曲线和新的分析方法，我们估计酒精消费的暴露程度最小化个人的总归属风险。所有可用证据的含义酒精使用的总归责负担大于以前的证据表明并且单调增加与消费。基于加权相对风险曲线与酒精使用相关的每种健康结果，水平最大限度地减少酒精使用造成的健康损失的消费量零。这些发现强烈暗示酒精控制政策应旨在降低总人口水平消费。有可能减少酒精使用的影响关于未来的健康损失，各国需要重新审视他们的酒精控制政策并评估他们的可能性修改以进一步降低人口消费水平。

Methods

Study design

This study follows the comparative risk assessment

framework developed in previous iterations of GBD. 20 In

the following sections, we summarise our methods and

briefly present innovations. A full explanation is available

in appendix 1. This study fully adheres to the Guidelines

for Accurate and Transparent Health Estimates Reporting

(GATHER) statement. 21

We estimated alcohol use exposure as grams of pure

ethanol consumed daily by current drinkers (which we

present here in terms of standard drinks daily, defined as

10 g of pure ethyl alcohol). We estimated relative risks by

dose in grams of pure ethyl alcohol, for each included

risk–outcome pair. We ascertained which cause and

injury outcomes to include by reviewing prospective and

observational studies of alcohol use, and then assessing

the causal association using Bradford-Hill’s criteria for

causation. 22 We included 23 outcomes, and the full list of

risk–outcome pairs, as well as the corresponding data

sources, are provided in appendix 1 (pp 52–140).

方法

本研究遵循比较风险评估在以前的GBD迭代中开发的框架。我们总结了我们的方法和简要介绍创新。有完整的解释

附录1.本研究完全符合指南用于准确和透明的健康估计报告（GATHER）声明。 2。1我们估计酒精使用暴露量为纯净克数当前饮酒者每天消耗的乙醇（我们在这里以每日标准饮料的形式出现，定义为10克纯乙醇）。我们通过估算相对风险剂量以克为单位的纯乙醇，每种都包括在内风险 - 结果对。我们确定了哪个原因和通过审查前瞻性和预后包括损伤结果酒精使用的观察研究，然后评估使用Bradford-Hill标准的因果关联因果关系。 22我们收录了23项成果，以及完整的清单。风险 - 结果对，以及相应的数据

来源，见附录1（第52-140页）。

4

Data sources

We found sources that included indicators of current

drinking prevalence and alcohol consumed in grams per

day using the Global Health Data Exchange (GHDx) and

PubMed. 23 For the meta-analysis, we searched PubMed,

the GHDx, and references of previously published meta-

analyses. For our exposure estimates, we extracted

121 029 data points from 694 sources across all exposure

indicators. For our relative risk estimates, we extracted

3992 relative risk estimates across 592 studies. These

relative risk estimates corresponded to a combined study

population of 28 million individuals and 649 000 registered

数据源

我们发现包含当前指标的来源饮用流行率和酒精消耗量以克为单位使用全球健康数据交换（GHDx）和调查。 23对于荟萃分析，我们搜索了PubMed，GHDx，以及先前发表的meta-的参考文献分析。对于我们的曝光估计，我们提取，来自694个来源的121 029个数据点指标。对于我们的相对风险估计，我们提取了592项研究的3992项相对风险评估。这些相对风险评估与综合研究相对应人口2800万，注册人数649000各种结果的案例

5

cases of respective outcomes. We list all the included data

sources in appendix 1 (pp 52–140).

To estimate standard drinks consumed daily by current

drinkers, we followed the general approach used by Rehm

and colleagues. 18 We briefly explain this method here,

along with two methodological innovations to account

for bias in the sales model: an adjustment to account for

tourist consumption and an updated adjustment for

unrecorded consumption. A full explanation of this

approach is available in appendix 1 (pp 18–49).

To estimate exposure, we combined estimates of

population-level alcohol stock and individual-level alcohol

consumption to produce standard drinks consumed daily

among current drinkers and current drinker prevalence,

within a specific location, year, age group, and sex. We

started by estimating population-level alcohol stock inlitres

per capita from sales data, individual-level estimates of the

prevalence of current drinkers and abstainers from survey

data, and individual-level estimates of the amount of

alcohol consumed in grams per day from survey data.

Then, for a given location and year, we rescaled age-specific

and sex-specific estimates of individual-level consumption

so that they aggregated to the estimates of population-level

consumption. When surveys reported amount consumed

in terms of beverage types, we converted these data into

grams of pure ethanol using density equations and

assumptions of the average alcohol content by drink type

(appendix 1, p 50). Finally, we rescaled estimates of current

drinking and abstention so that, within a given location,

year, age group, and sex, the two estimates summed to one.

After we derived our model of population-level alcohol

stock from sales data, we controlled for sources of bias

that could arise from tourism and unrecorded con-

sumption not recorded in formal sales. To account for

tourist consumption, we computed an additive measure

for alcohol consumed abroad by domestic citizens and

subtractive measures for alcohol consumed domestically

by tourists. We extracted data on the number of tourists

by country of origin and destination from the World

Tourism Organization and used these data to obtain

estimates of total tourists, percentage of tourists by

location, and average duration of stay using a spatio-

temporal Gaussian process regression. 24 We combined

these estimates with measures of alcohol in litres per

capita by location, to calculate net amounts of total

population-level alcohol stock consumed by tourists or

domestic citizens travelling abroad.

To account for alcohol stock not captured within formal

alcohol sales data (ie, unrecorded consumption from

illicit production, home brewing, local beverages, or

alcohol sold as a non-alcohol product), we collated

estimates across published studies of the percentage of

total alcohol stock due to unrecorded consumption. We

sampled 1000 times from a uniform distribution with a

range between zero and the average of these collated

studies by location (sampling from the uncertainty

interval from each study, then averaging the draws) to

我们列出了所有包含的数据附录1中的来源（第52-140页）。估计当前每日消耗的标准饮料饮酒者，我们遵循Rehm使用的一般方法。 18我们在这里简要解释这个方法，以及两种方法论创新对于销售模式的偏见：对帐户的调整旅游消费和最新调整未记录的消费。对此的完整解释方法见附录1（第18-49页）。为了估计明确，我们综合估计人口级酒精和个人酒精消费每天生产标准饮料当前的饮酒者和目前的饮酒者流行率，在特定的位置，年份，年龄组和性别。我们首先通过估算人口级酒精含量来计算人均销售数据，个人水平估计调查中当前饮酒者和戒酒者的流行程度数据，以及个人数量的估计数量。从调查数据中每天以克为单位消耗的酒精。然后，对于给定的位置和年份，我们重新调整了特定年龄个人消费的性别特定估计，这样他们就可以汇总到人口水平的估计值消费。当调查报告消费量时在饮料类型方面，我们将这些数据转换为克纯乙醇使用密度方程和饮料类型的平均酒精含量的假设（附录1，第50页）。最后，我们重新调整了当前的估计值饮酒和弃权，以便在特定地点，年龄组和性别，这两个估计总和为一。在我们得出我们的人口级别酒精模型之后根据销售数据库存，我们控制了偏差来源可能来自旅游和未记录的没有在正式销售中记录的消费。要占旅游消费，我们计算了一个附加措施国内公民和国外消费的酒精减去国内饮酒量的措施及游客。我们提取了有关游客数量的数据，来自世界的原籍国和目的地国旅游组织并使用这些数据来获取估计游客总数，游客百分比使用空间的位置和平均逗留时间时间。 24我们合并了这些估算采用酒精每升的量度按地点划分人均，计算总净额游客或消费者消费的人口级酒精包括出国旅游的国内公民。计算未在正式范围内捕获的酒精库存，酒精销售数据（即未记录的消费量）非法生产，家庭酿造，当地饮料，或作为非酒精产品销售的酒精），我们整理对公布的百分比研究进行估计由于未记录消费而导致的酒精总量。我们从均匀分布中采样1000次范围在零和这些整理的平均值之间地点研究（从不确定性中抽样）每次研究的间隔，然后平均绘制图）对没有被记录可能的总存量进行保守估计。

6

generate a conservative estimate of the total stock likely

to be unrecorded. We used a conservative approach

because of the wide heterogeneity in both the methods

and estimates within included data sources. We provide

estimates of these percentages in appendix 1 (pp 46–49).

Systematic review and meta-analysis

We did a new systematic review for each associated

outcome to incorporate new findings on risk and to

improve upon existing approaches. This strategy allowed

us to systematically control for reference category con-

founding in constituent studies across associated out-

comes. We provide the search strategy, search diagrams,

dose–response curves for each included outcome, and

references for each outcome in appendix 1 (pp 57–146).

Drawing from our systematic review, we did a meta-

analysis of risk outcomes for alcohol use. For each

outcome, we estimated the dose–response relative risk

curve using mixed-effects logistic regression with non-

linear splines for doses between 0 and 12•5 standard

drinks daily. We selected 12•5 standard drinks daily as a

cutoff point given the absence of available data beyond

this range. We present additional details of the model in

appendix 1 (pp 51–138). We tested the significance of

including a study-level confounding variable on the

composition of the reference category (eg, whether former

drinkers were included in the abstainer category or not).

When found to be significant, this variable was included

as a predictor within the model, which was the case for

ischaemic heart disease, ischaemic stroke, and diabetes.

Using our dose–response curves, we estimated the

consumption level that minimises harm, which is

defined in the comparative risk assessment approach as

the theoretical minimum risk exposure level (TMREL).

We chose a theoretical minimum on the basis of a

weighted average relative risk curve across all attributable

outcomes. We constructed weights for each risk outcome

based on the respective global, age-standardised DALY

rate per 100 000 in 2016 for both sexes. Our TMREL was

the minimum of this weighted all-attributable outcome

dose–response curve.

Attributable burden due to alcohol use

We calculated PAFs using our estimates of exposure,

relative risks, and TMREL, following the same approach

taken within the GBD studies. 20 For alcohol-use disorders,

which are by definition fully attributable, we assumed a

PAF of 1. 24 Following this calculation, we multiplied PAFs

by outcome-specific estimates of deaths and DALYs and

summed these across outcomes to calculate the total

attributable burden in specific locations. We aggregated

both exposure and burden results at the global level and

have presented them by quintile of the Socio-demographic

Index (SDI). SDI is a summary measure of overall

development, based on educational attainment, fertility,

and income per capita within a location. Locations

categorised by SDI quintile are found in appendix 1

我们采用了保守的方法因为这两种方法都存在很大的异质性并在包含的数据源中进行估算。我们提供

附录1中对这些百分比的估计（第46-49页）。系统评价和荟萃分析我们对每个相关的人进行了新的系统评价结果将新发现纳入风险和改进现有方法。这个策略允许我们系统地控制参考类别在相关的外部成分研究中成立。我们提供搜索策略，搜索图表，每个纳入结果的剂量 - 反应曲线，和附录1中每个结果的参考文献（第57-146页）。根据我们的系统评价，我们做了一个分析酒精使用的风险结果。对于每一个结果，我们估计了剂量反应的相对风险曲线使用混合效应逻辑，每天喝剂量在0到12•5标准之间的线性样条。我们每天选择12•5标准饮料截止这个范围作为可用数据，。我们提供了该模型的其他细节附录1（第51-138页）。我们测试了它的重要性包括研究级别的混杂变量参考类别的组成（例如，是否为前者饮酒者是否包括在戒酒者类别中。当发现时，包括该变量作为模型中的预测，情况就是如此缺血性心脏病，缺血性中风和糖尿病。使用我们的剂量 - 反应曲线，我们估计了最小化伤害的消费水平，即在比较风险评估方法中定义为理论最小风险暴露水平（TMREL）。我们在a的基础上选择了理论最小值所有归属的加权平均相对风险曲线结果。我们为每个风险结果构建了权重基于各自的全球年龄标准化DALY。2016年两性均为每10万人的比率。我们的TMREL是此加权全部归因结果的最小值剂量 - 反应曲线。酒精使用造成的归因负担我们使用我们的暴露估计来计算PAF，在GBD研究中相对风险和TMREL遵循相同的方法进行。 20对于酒精使用障碍，根据定义，完全可归因于我们假设PAF为1. 24在此计算之后，我们将PAF乘以通过结果特定的死亡和DALYs估计将这些结果相加以计算总数特定地点的可归责。我们汇总了在全球范围内产生量。通过社会人口的五分之一提出了它们指数（SDI）。 SDI是总体的总结度量发展，基于教育程度，生育率，一个地方的人均收入。地点按SDI五分位数分类见附录1（第8-12页）。

7

(pp 8–12). 25 We also constructed age-standardised values

of all estimates, using the same age weights as those used

in the GBD standard population.

We made one adjustment to road injury PAFs to estimate

how much burden occurred to others because of alcohol

use by another individual. We based this adjustment on

data from the US Fatality Analysis Reporting System

(FARS), which includes the average number of deaths in

automobile accidents involving alcohol and the percentage

of those deaths distributed by age and sex. We multiplied

age-specific and sex-specific alcohol-attributable and road-

injury-attributable DALYs by the average number of

fatalities, given the driver’s age and sex. We then re-

distributed these attributable DALYs according to the

FARS-derived probabilities that a population by age and

sex would be involved in a road injury, given the exposed

driver’s age and sex. Because of data availability, we

assumed that locations outside the USA would follow a

similar pattern to what we estimated with FARS. After

redistributing the attributable DALYs, we derived PAFs

again by dividing the redistributed attributable DALYs by

total DALYs within specific demographics.

Uncertainty analysis

For all steps, we calculated uncertainty for estimation of

exposure, attributable deaths, and DALYs by taking 1000

draws from the data’s uncertainty due to sampling error

and modelling uncertainty arising from hyper-parameter

selection and parameter estimation. We then used these

draws throughout the entire modelling process. When

reporting uncertainty intervals, we present the 2•5th and

97•5th percentiles of the draws.

Role of the funding source

The funders of the study had no role in study design,

data collection, data analysis, data interpretation, or

writing of the report. The corresponding author had full

access to all the data in the study and had final

responsibility for the decision to submit for publication.

Results

Global, regional, and national trends in alcohol

consumption

In 2016, 32•5% (95% uncertainty interval [UI] 30•0–35•2)

of people globally were current drinkers. 25% (95% UI

23–27) of females were current drinkers, as were

39% (36–43) of males (appendix 2). These percentages

corresponded to 2•4 billion (95% UI 2•2–2•6) people

globally who were current drinkers, with 1•5 billion

(1•4–1•6) male current drinkers and 0•9 billion (0•8–1•0)

female current drinkers (appendix 2, pp 2–1994). Globally,

the mean amount of alcohol consumed was 0•73 (95% UI

0•68–0•78) standard drinks daily for females and

1•7 (1•5–1•9) standard drinks daily for males.

The prevalence of current drinking varied considerably

by location (figure 1). Prevalence was highest for high

SDI locations, where 72% (95% UI 69–75) of females and

我们还构建了年龄标准化的价值观所有估计数，使用相同的年龄在GBD标准人口中。我们对车祸害PAF进行了一次调整估算，因酒精而给别人带来了多少负担。我们基于此调整来自美国致命分析报告系统的数据（FARS），其中包括平均死亡人数涉及酒精的汽车事故和百分比按年龄和性别分配的死亡人数我们成倍增加，特定年龄和性别特定的酒精归因和道路 - 伤害归因DALYs的平均数死亡人数，同时考虑到司机的年龄和性别。然后我们重新分配这些可归因的DALYs，FARS导出的概率，即按年龄和年龄划分的人口数量。由于数据可用性，我们假设美国境外的地点会跟随与我们用FARS估计的模式类似。后重新分配归因DALY，我们得出了PAF再次将重新分配的归属DALY除以特定人口统计数据中的总DALYs。

不确定性分析

对于所有步骤，我们计算了估计的不确定性，归因于死亡和DALYs，取1000由于采样误差导致数据的不确定性和超参数引起的不确定性建模选择和参数估计。然后我们使用了这些在整个建模过程中绘制。什么时候报告不确定区间，我们提出2•5和97•平局的第5个百分位数。资金来源的作用该研究的资助者在研究设计中没有任何作用，数据收集，数据分析，数据解释或撰写报告。作者访问研究中的所有数据并进行最终决定决定提交出版。

结果

全球，区域和国家酒精趋势消费

2016年，32•5％（95％不确定区间[UI] 30•0-35•2）全球人都是当前的饮酒者。 25％（95％UI

23-27）女性当前是饮酒者39％（36-43）的男性（附录2）。这些百分比相当于2•40亿（95％UI 2•2-2•6）的人全球目前的饮酒者，拥有15亿美元（1•4-1•6）男性当前饮酒者和0.90亿（0•8-1•0）女性当前饮酒者（附录2，第2-1994页）。全球范围内，平均消耗的酒精量为0.73（95％UI0•68-0•78）女性和女性每日标准饮料男性每日1•7（1•5-1•9）标准饮品。目前饮酒的流行程度差异很大按位置（图1）。患病率最高SDI位置，72％（95％UI 69-75）的女性和

（第8-12页）。总结

从这份数据庞大的严谨报告中可以得出，饮酒增加全因死亡率，尽管酒精可以带来些微的保护作用，但被其他风险中和抵消了。在50岁以后，癌症是酒精相关死亡率最重要的因素。

83％（80-85）的男性是当前的饮酒者（地点附录2中提供了每个SDI五分位数，第8-12页）。饮酒流行率在低至低水平时最低中间SDI位置，其中8•9％（95％UI 6•6-9•7）女性和20％（17-22）的男性是当前的饮酒者。在SDI五分位数中，女性消耗的酒精较少与男性相比，这种差距的大小随之减小更高的SDI水平。例如，我们发现尼泊尔的女性和男性之间存在差异，目前只有1•5％（95％UI 1•2-1•9）的女性饮酒。2016年的饮酒者与男性21％（17-25）。相反，许多高SDI位置都相就小。例如，我们发现瑞典的差异很小，其中86％（UI为95％）（84-88）女性和87％（85-89）的男性当前的饮酒者消费的人口平均值差异好小。2016年当前饮酒者每天也有很大差异按地点和性别划分（图2）。高SDI位置有每日消费的标准平均值最高每天消耗1•9（95％UI 1•3-2•7）在女性中，男性中有2•9（2•0-4•1）。低SDI位置的男性平均值最低每日消耗1•4（0•6-2•4）标准饮料中低端SDI位置的平均值最低对于女性每天消耗标准为0•3（0•1-0•6）

。

酒精引起的死亡和死亡的全球模式

疾病

2016年，有2,800万人死亡（95％UI 2•4-3•3）归因于酒精的使用。这相当于2•2％（95％UI 1•5-3•0）总年龄标准化死亡人数女性和男性中的6•8％（5•8-8•0）。整体疾病，酒精使用导致1•6％（95％UI女性中2016年全球DALY总数的1•4-2•0）男性中有6•0％（5•4-6•7）。在全球范围内，酒精使用被评为第七大风险因素，2016年过早死亡和残疾GBD研究中的其他风险因素。人口年龄在15-49岁之间，酒精使用率居首位风险可归因为疾病全球风险因素，引起8.9％（95％UI 7•8-9•9）的归因DALYs男性和女性的2•3％（2•0-2•6）。人口年龄在15-49岁之间，3•8％（95％UI 3•2-4•3）的人口女性死亡和12•2％（10•8-13•6）的男性死亡可归因于酒精使用。酒精使用的总负担和与酒精使用相关的原因比例各不相同。按性别，年龄和SDI五分之一（图3;附录2，第1997-2186页）。从绝对意义上讲，酒精可归因女性的年龄小于男性（图3）。对于女性来说，酒精可归因于负担随着年龄的增长而增加，而男性则增加了负担直到55-65岁之间，之后归属减少。女性，尤其是高SDI地点，有一些保护作用，缺血性心脏病和60岁以上的糖尿病年龄段最明显。对于男性，只有高SDI和低SDI位置对缺血性心脏病有明显的保护作用，但效果与总量相比较小。对于男性和女性，健康结果在整个生命中改变可归因的负担 - 跨度（图3）。归因的三大主要原因该年龄组的死亡人数为肺结核（1•4％[95％UI]1•0-1•7]总死亡人数），道路伤害（1•2％[0•7-1•9]），和自残（1•1％[0•6-1•5]）。对于年龄较大的女性15-49岁，酒精使用障碍构成最大SDI中可归因负担的比例五分之一;主要的例外是块茎结核病占应占比例最大。在这个年龄段，运输伤害和酒精使用障碍是主要的中高级男性可归因的原因SDI五分位数;适用于中低SDI和低SDI五分位数是结核病的主要原因。、超过50岁，总归因的原因SDI五分之一的负担变得更加复杂。对于50岁及以上的人群，癌症占占酒精总死亡人数的很大一部分

2016年，构成27•1％（95％UI 21•2-33•3）的总酒精引起的女性死亡人数和18•9％（15•3-22•6）酒精引起的男性死亡。在高SDI国家，癌症是其主要来源两性的归因负担。在低SDI国家，结核病是造成负担的主要原因。对于男女两性，其次是肝硬化和其他慢性病肝病。

高可归因负担的概况

男性主要由缺血性中风组成和出血性中风，其次是肝病在所有SDI五分位数，出血性中风和高血压性心脏病是最大的来源。80岁及以上女性的多发这些疾病。对于男人来说这个年龄段，构成是类似疾病。

8

minimum relative risk of 0•86 (0•80–0•96) for men and

0•82 (0•72–0•95) for women, occurring at 0•83 standard

drinks daily for men and 0•92 standard drinks daily for

women. We found no significant difference in relative

risk curves for ischaemic heart disease or diabetes

when estimating the curves by age. For all other out-

comes, including all cancers, we found that relative risk

monotonically increased with alcohol consumption

(appendix 2, pp 57–146).

In estimating the weighted relative risk curve, we

found that consuming zero (95% UI 0•0–0•8) standard

drinks daily minimised the overall risk of all health

loss (figure 5). The risk rose monotonically with

increasing amounts of daily drinking. This weighted

relative risk curve took into account the protective effects

of alcohol use associated with ischaemic heart disease

and diabetes in females. However, these protective

effects were offset by the risks associated with cancers,

which in creased monotonically with consumption. In a

sensitivity analysis, where we explored how the weighted

relative risk curve changed on the basis of the choice of

weights for various health outcomes, the curve changed

signifi cantly only in settings where diabetes and

ischaemic heart disease comprised more than 60% of

total deaths in a population.

Discussion

In 2016, alcohol use led to 2•8 million deaths and was the

leading risk factor for premature death and disability

among people aged 15–49 years, with nearly 9% of all

attributable DALYs for men and more than 2% for

women. Our findings indicate that alcohol use was

associated with far more health loss for males than for

females, with the attributable burden for men around

three times higher than that for women in 2016. By

evaluating all associated relative risks for alcohol use, we

found that consuming zero standard drinks daily

minimises the overall risk to health.

Previous research has analysed all-cause risk due to

alcohol use by either investigating all-cause risk in

particular cohorts and survey series, or through meta-

analyses of those studies. 26,27 Past findings subsequently

suggested a persistent protective effect for some low or

moderate levels of alcohol consumption on all-cause

mortality. However, these studies were limited by

small sample sizes, inadequate control for confounders,

and non-optimal choices of a reference category for

calculating relative risks. More recent research, which

has used methodologies such as mendelian randomis-

ation, pooling cohort studies, and multivariable adjusted

meta-analyses, increasingly shows either a non-signifi-

cant or no protective effect of drinking on all-cause

mortality or cardiovascular outcomes. 7,14,28 Our results on

the weighted attributable risk are consistent with this

body of work. Taken together, these findings emphasise

that alcohol use, regardless of amount, leads to health

loss across populations. Although we found some

protective effects for ischaemic heart disease and

diabetes among women, these effects were offset when

overall health risks were considered—especially because

of the strong association between alcohol consump-

tion and the risk of cancer, injuries, and communic-

able disease. These findings stress the importance of

assessing how alcohol use affects population health

across the lifespan.

Evaluating attributable burden across SDI quintiles

revealed the magnitude by which outcomes of alcohol

use differ and how total attributable burden relates to

increasing SDI. Our results indicate that alcohol use and

its harmful effects on health could become an increasing

challenge amid gains in SDI. Given that most low and

low-to-middle SDI settings currently have lower average

alcohol consumption than high-to-middle SDI settings,

it is crucial for decision makers and government agencies

to enact or maintain strong alcohol control policies today

to prevent the potential for rising alcohol use in the

future. Effective policies now could yield substantial

population health benefits for years to come.

男性和女性的最低相对风险为0•86（0•80-0•96）女性0•82（0•72-0•95），。男士每日饮酒发生率为0.83，女性每日饮用0•92。我们发现相对没有显着差异缺血性心脏病或糖尿病的风险曲线按年龄估算曲线时对于 - ，包括所有癌症，我们发现相对风险单调增加饮酒量（附录2，第57-146页）。在估计加权相对风险曲线时，我们发现消耗零（95％UI 0•0-0•8）标准每饮量可最大限度地降低所有健康的总体风损失（图5）。风险单调上涨，日常饮酒量增加。这加权了相对风险曲线考虑了保护作用与缺血性心脏病相关的酒精使用和女性的糖尿病。但是，这些保护性癌症相关风险抵消了这些影响，

随着消费单调增加。有一个敏感性分析，我们在哪里探讨加权相对风险曲线在选择的基础上发生了变化，加上了各种健康结果的权重，人口中的总死亡人数曲线发生变化，不只在糖尿病和糖尿病的环境中有影响，缺血性心脏病占60％以上。

讨论

在2016年，酒精使用导致了2,800万人死亡，并且是过早死亡和残疾的主要风险因素在15-49岁的人中，有近9％的人男性的归因DALYs为2％以上妇女。我们的研究结果表明，酒精使用是与男性相比，女性健康损失远远大于男性，对男性来说可归因于负担比2016年的女性高出三倍。我们评估了酒精使用的所有相关相关风险。发现每天消费零标准酒精最大限度地降低整体健康风险。

以前的研究已经分析了由此产生的全因风险通过调查全因风险来使用酒精特别的同期群和调查系列，或通过meta-这些研究的分析。 26,27的调查结果显示一些低或者持久的保护作用全因饮酒量适中死亡。然而，这些研究受到限制样本量小，对混杂因素控制不足，参考类别的非最佳选择，并计算了相对风险。最近的研究，其中使用了诸如孟德尔随机的方法 - 组合，队列研究和多变量调整荟萃分析，越来越多地显示出非显着性饮酒对全因无影响或对心血管无保护作用。7,14,28的结果加权归属风险与此一致。总之，这些发现强调了这一点酒精的使用，无论数量多少，都会导致健康受损，人口减少。虽然我们发现了一些缺血性心脏病的保护作用，女性糖尿病，使这些保护这些影响被抵消了。考虑了整体健康风险 - 特别是因为酒精与癌症之间的强关联和。这些发现强调了重要性评估酒精使用如何影响人口健康，人类整个生命周期。评估SDI五分位数的可归因负担揭示了酒精结果的大小使用不同以及可归因负担总额如何相关增加SDI。我们的结果表明，酒精的使用和它对健康的有害影响可能会增加在SDI的收益中挑战。鉴于最低和中低SDI设置目前的平均值较低酒精消耗量高于中高SDI设置，这对政府机构至关重要，今天制定或维持强有力的酒精控制政策。

9

Our results point to a need to revisit alcohol control

policies and health programmes, and to consider

recommendations for abstention. In terms of reducing

population-level alcohol use, WHO provides a set of best

buys—policies that provide an individual year of healthy

life at less than the cost of the average individual

income. 29 Governments should consider how these

recommendations can be implemented within their local

contexts and broader policy platforms, including excise

taxes on alcohol, controlling the physical availability of

alcohol and the hours of sale, and controlling alcohol

advertising. Any of these policy actions would contribute

to reductions in population-level consumption—an

important step toward decreasing the health loss

associated with alcohol use.

Failing to address harms from alcohol use, particularly

at high levels of consumption, can have dire effects on

population health. The mortality crisis in Russia is a

striking example, where alcohol use was the primary

culprit of increases in mortality starting in the 1980s and

led to 75% of deaths among men aged 15–55 years. 30

Current global trends—namely, population ageing—

portend a growing toll of the alcohol-attributable burden

in the absence of policies, particularly since many cancers

disproportionately affect older individuals. Consequently,

low-to-middle SDI countries could benefit from policy

action today to keep alcohol consump tion low and

prevent greater health loss in the future. High and

high-to-middle SDI locations need to consider stronger

alcohol reduction policies, such as those recommend-

ed by WHO, in an effort to reduce population-level

consumption.

Our results should be interpreted within the context of

the study’s limitations. First, our consumption estimates

might not fully capture illicit production or unrecorded

consumption given our use of sales data in estimation.

We have sought to adjust for consumption beyond sales

data, but given the heterogeneity of these estimates it is

likely that additional methodological refinements are

necessary to improve the quantification of unrecorded

consumption. Second, drinking patterns within a year

are assumed to be consistent; however, past work shows

that drinking patterns, rather than average levels of

consumption such as standard daily drinks, might be

related to different levels of risk and harm. Unfortunately,

the data requirements for assessment of such drinking

patterns by age, sex, and location far exceed what is

currently available. For instance, few prospective studies

quantify the effects of drinking patterns and average

levels of consumption in tandem, a requirement for

correctly assessing the risk of alcohol-attributable

outcomes. Third, the data used to estimate motor vehicle

harm caused to others from alcohol use were only

available for the USA (ie, FARS data). Although it is

unlikely that the patterns observed in FARS are drastically

different from those of other locations (appendix 1,

pp 141–144), this assumption needs to be tested with

more location-specific estimates. Fourth, we were unable

to find robust data about the harm caused to others

from alcohol-attributable interpersonal violence, a major

potential source of health loss. More retrospective studies

are needed to assess the harm to others caused through

an individual’s alcohol use. 30 Fifth, consumption for

populations younger than 15 years was not assessed

because of data sparseness on alcohol use for these age

groups. In the absence of such data, potential approaches

to address this limitation, such as assuming consumption

patterns of older age groups or trying to extrapolate past

levels of alcohol consumption, are likely to introduce

additional bias or error. More research on youth drinking

and the associated risk is required to estimate alcohol-

attributable burden for this age group. Last, we sought to

quantify the risk of alcohol use only for outcomes with

evidence meeting the criteria for the comparative risk

assessment approach of GBD studies. However, there are

additional outcomes, such as dementia and psoriasis,

for which accumulating evidence suggests that alcohol

use might be a risk factor. 31–33 In combination, these

limitations suggest that our results are likely to under-

estimate both the health risks and overall attributable

burden of alcohol use.

Conclusion

Alcohol use is a leading risk factor for disease burden

worldwide, accounting for nearly 10% of global deaths

among populations aged 15–49 years, and poses dire

ramifications for future population health in the absence

of policy action today. The widely held view of the health

benefits of alcohol needs revising, particularly as

improved methods and analyses continue to show how

much alcohol use contributes to global death and

disability. Our results show that the safest level of

drinking is none. This level is in conflict with most

health guidelines, which espouse health benefits

associated with consuming up to two drinks per day.

Alcohol use contributes to health loss from many causes

and exacts its toll across the lifespan, particularly among

men. Policies that focus on reducing population-level

consumption will be most effective in reducing the

health loss from alcohol use.

GBD 2016 Alcohol Collaborators

Max G Griswold, Nancy Fullman, Caitlin Hawley, NicholasArian,

Stephanie R M Zimsen, Hayley D Tymeson, Vidhya Venkateswaran,

Austin Douglas Tapp, Mohammad H Forouzanfar, Joseph S Salama,

Kalkidan Hassen Abate, Degu Abate, Solomon M Abay,

Cristiana Abbafati, Rizwan Suliankatchi Abdulkader, ZegeyeAbebe,

Victor Aboyans, Mohammed Mehdi Abrar, Pawan Acharya,

Olatunji O Adetokunboh, Tara Ballav Adhikari, Jose C Adsuar,

Mohsen Afarideh, Emilie Elisabet Agardh, Gina Agarwal,

Sargis Aghasi Aghayan, Sutapa Agrawal, Muktar Beshir Ahmed,

Mohammed Akibu, Tomi Akinyemiju, Nadia Akseer, Deena H AlAsfoor,

Ziyad Al-Aly, Fares Alahdab, Khurshid Alam, Ammar Albujeer,

Kefyalew Addis Alene, Raghib Ali, Syed Danish Ali, MehranAlijanzadeh,

Syed Mohamed Aljunid, Ala’a Alkerwi, Peter Allebeck,

Nelson Alvis-Guzman, Azmeraw T Amare, Leopold N Aminde,

Walid Ammar, Yaw Ampem Amoako, Gianna Gayle Herrera Amul,

我们的结果表明需要重新考虑酒精控制政策和健康计划，并考虑放弃酒精的建议。减少人口的酒精使用，世界卫生组织提供了一套最好的购买政策，提供健康的一年饮酒费用低于一般人的平均成本收入。各国政府应该考虑这些问题建议可以在当地实施更广泛的政策平台，包括消费税对酒精征税，控制酒精的物理可用性，酒精和销售时间，以及控制酒精广告。任何这些政策行动都会有所贡献降低人口消费水平 - 减少与酒精使用有关健康损失。未能解决酒精使用的危害，尤其是在高消费水平下，会产对人口健康生可怕的影响。俄罗斯的死亡危机是一个引人注目的例子，酒精使用是主要的从20世纪80年代开始，是死亡人数增加的罪魁祸首，导致15-55岁男性死亡人数的75％。目前的全球趋势 - 即人口老龄化 - 预示着酒精可归因负担不断增加。在没有政策的情况下，特别是许多癌症不成比例地影响老年人。所以，中低端SDI国家可以从政策中受益，今天的行动是保持酒精消耗低防止将来更大的健康损失。高和高中级SDI位置需要考虑更强减少酒精的政策，由世卫组织编写，旨在减少人口消费水平。我们的结果应该在上下文中解释该研究的局限性。首先，我们的消费估计可能无法完全捕获非法生产或未记录，这是考虑到我们使用销售数据进行估算。我们一直在努力调整消费以外的销售额数据，但鉴于这些有估计的异质性，它可能是其他方法录消费的量化。第二，一年内饮用模式被认为是一致的;然而，过去的工作表明饮酒模式，而不是平均水平，可能是标准日常消费这将与不同程度的风险和伤害有关。不幸的是，评估此类饮酒的数据要求年龄，性别和地点的模式远远超过了目前可用方法。例如，很少有前瞻性研究，量化饮酒模式和平均水平的影响消费水平串联，要求正确评估酒精归因的风险结。第三，用于估算机动车辆的数据仅限酒精使用给他人造成的伤害使用于美国（即FARS数据）。虽然是不太可能在FARS中观察到的模式是巨大的与其他地方不同（附录1，pp 141-144），这个假设需要进行测试，到更具体地点的估算。第四，我们无法做到找到来自酒精的人际暴力关于对他人造成的伤害的可靠数据，这是健康损失的潜在来源。更多的回顾性研究需要评估通过他人造成的伤害个人的酒精使用。第五，消费未评估年龄小于15岁的人群，因为这些年龄段的酒精使用数据稀少。在缺乏此类数据的情况下，可能采取的方法解决这个限制，例如假设消费老年人群体的模式或试图推断过去酒精消费水平很可能会引入额外的偏见或错误。更多青少年饮酒研究估计酒精需风险 - 该年龄组的可归因负担。最后，我们寻求量化酒精使用的风险仅用于结果符合比较风险标准的证据GBD研究的评估方法。但是，有其他结果，其中积累的证据表明酒精使用可能是一个风险因素。 31-33这些组合限制表明我们的结果很可能是 - 估计健康风险和总体归因。

结论

酒精使用是疾病负担的主要风险因素在全球范围内，占全球死亡人数的近10％在15-49岁的人口中，并且构成可怕的对未来人口健康的影响。今天的政策行动广泛健康观酒精的好处需要修改，尤其是改进的方法和分析继续显示大量的酒精使用导致全球死亡和失能。我们的结果表明，最安全的水平喝酒是没有的。这个级别与大多数人都有冲突。其中包含健康益处，每天最多消耗两杯。

来源：李寻的酒吧（微信ID：lixundejiuba）

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