Young people ‘most likely to experience injuries,’ no benefit from alcohol consumption
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Although moderate alcohol consumption may benefit older adults, including reduced risk for ischemic heart disease, stroke and diabetes, young adults saw no benefit and instead accrued “significant health risks” from consuming alcohol.
A systematic analysis published in The Lancet also recommended that global alcohol consumption recommendations should be based on age and location, with the strongest recommendations geared toward males aged 15 to 39 years.
“We estimate that 1.78 million people worldwide died due to alcohol use in 2020,” Dana Bryazka, BA, a post-bachelor fellow and researcher at the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine and lead author of the study, told Healio. “It is important that alcohol consumption guidelines and policies are updated to minimize this harm, particularly in the populations at greatest risk.”
The systematic analysis used data from the Global Burdens of Diseases, Injuries and Risk Factors Study 2020, which included 21 regions across 204 countries and territories. Bryazka and colleagues further looked at data for individuals aged 15 to 95 years from 1990 to 2020 broken down by 5-year age group, sex and year.
Researchers constructed burden-weighted, dose-response relative risk curves across 22 health outcomes to approximate the theoretical minimum risk exposure level (TMREL), defined as the “level of consumption that minimizes health loss from alcohol for a population,” and nondrinker equivalence (NDE), the “consumption level at which the health risk is equivalent to that of a nondrinker.”
According to the analysis, TMREL and NDE did not vary significantly by sex or year, but they did vary significantly by age, with younger groups tending to have much lower TMREL and NDE compared with older groups.
For example, TMREL in 2020 varied between 0 [95% uncertainty interval (UI), 0-0] and 0.603 (95% UI, 0.4-1) standard drinks per day for individuals aged 15 to 29 years. The NDE for this same group in 2020 varied between 0.002 (95% UI, 0-0) and 1.75 (95% UI, 0.698-4.3) standard drinks per day. A standard drink was defined as 10 g of pure ethanol.
In contrast, for individuals aged 40 years and older in 2020, TMREL fell between 0.114 (95% UI, 0-0.403) and 1.87 (95% UI, 0.5-3.3) standard drinks per day. The NDE for this group ranged between 0.193 (95% UI, 0-0.9) and 6.94 (95% UI, 3.4-8.3) standard drinks per day.
Notably, among those individuals who consumed harmful amounts of alcohol, which increased from 983 million in 1990 to 1.34 billion in 2020, 59.1% were aged 15 to 39 years and, of these, 76.9% were men.
“We found that the risk of alcohol use depends on background rates of disease. Due to differences in the rates of disease, the risk of alcohol use increases continuously with age and varies across geographies,” Bryazka said.
“When consumed in moderation, alcohol can reduce the risk of ischemic heart disease, stroke and diabetes,” she continued. “However, it also increases the risk of many cancers, intentional and unintentional injuries, and infectious diseases like tuberculosis. Of these health outcomes, young people are most likely to experience injuries, and as a result, we find that there are significant health risks associated with consuming alcohol for young people. Among older individuals, the relative proportions of these outcomes vary by geography, and so do the risks associated with consuming alcohol.”
Globally, for those aged 15 to 39 years, all injuries accounted for 66.3% (95% UI, 65.1-67.5) of alcohol-related disability-adjusted life-years (DALYs) for men and 47.9% (95% UI, 46-49.8) alcohol-related DALYs for women. Researchers defined DALYs as the sum of years of life lost, or premature mortality, and years lived with disability, or morbidity.
Bryazka recommended doctors take patients’ background rates of disease into account when discussing alcohol use.
“An important caveat is that our analysis was conducted at the population level,” she said. “When evaluating risk at the individual level, it is also important to consider other factors such as the presence of comorbidities and interactions between alcohol and medications.”
Bryazka and colleagues did not incorporate patterns of drinking into the analysis, which they called a limitation of the findings.
“Additional research is needed to incorporate pattern of alcohol consumption into these risk calculations,” Bryazka said. “This study does not distinguish between frequent low-level consumption and infrequent heavy episodic drinking.”
Perspective
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This analysis reinforces previous studies describing significantly increased risks for cancers, accidents and deaths related to alcohol consumption. In fact, the authors estimated from their study that 1.78 million people worldwide died because of alcohol use in 2020 alone.
While some research has suggested a benefit in terms of lower rates of cardiovascular disease and diabetes with moderate alcohol use, there is also a growing body of literature suggesting that no amount of alcohol is actually safe, especially in terms of brain health and cancer risk. Furthermore, we know that harmful alcohol use has been significantly on the rise since the beginning of the COVID-19 pandemic.
The new findings in this study suggest that the harmful effects of alcohol may further vary by both age and background rates of disease, especially in younger male patients aged 15 to 39 years; this may be the population at highest risk for harm and even death.
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