ORIGINAL MANUSCRIPT Alcohol-Attributable Mortality in Ireland Jennifer Martin 1, *, Joe Barry 2 , Deirdre Goggin 1 , Karen Morgan 3 , Mark Ward 3 and Tadhg O’Suilleabhain 4 1 Department of Public Health, Merlin Park, Galway, Ireland, 2 Department of Public Health & Primary Care, Trinity College Centre for Health Sciences, Dublin, Ireland, 3 Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland 4 Statistics Department, AIB, Dublin, Ireland *Corresponding author: Department of Public Health, Dr Steeven’s Hospital, Dublin 8, Ireland. Tel.: +353-866-098910; E-mail: Jennifer.martin@hse.ie (Received 5 January 2010; accepted 25 May 2010) Abstract — Aims: The study aim was to calculate Irish alcohol-attributable fractions (AAFs) and to apply these measurements to existing data in order to quantify the impact of alcohol on mortality. Methods: Exposure of the Irish population to alcohol was derived from a national survey and combined with estimates of the alcohol–disease/injury risk association from meta-analyses in the interna- tional literature to calculate Irish AAFs. In diseases for which relative risk estimates were not available, such as injury, AAFs were taken directly from Ridolfo and Stevenson [(2001) The quantification of drug-caused mortality and morbidity in Australia, 1998. In Drug Statistics Series no. 7. AIHW cat. no. PHE 29. Australian Institute of Health and Welfare, Canberra]. AAFs were applied to national datasets to calculate alcohol-attributed mortality caused or prevented and potential years of life lost (PYLL) or saved. Results: In Ireland, over the 5-year period from January 1, 2000 to December 31, 2004, alcohol was estimated to have caused 4.4% (6584) of deaths and 10.8% (131,245) of all-cause PYLL. Alcohol was estimated to have prevented 2.7% (3967) of deaths and 1.5% (18,285) of all-cause PYLL. This resulted in an estimated net effect of 1.8% (2616) of deaths and 9.3% (112,959) of all-cause PYLL. Chronic conditions were responsible for 69% of alcohol-attributable deaths and acute conditions for 31%. Conditions not wholly attributable to alcohol accounted for 83% of deaths as opposed to 17% for conditions wholly caused by alcohol. Conclusions: This study showed for the first time the full magnitude of deaths from alcohol in Ireland and revealed that while young people and those dependent on alcohol are at high risk of negative outcomes due to alcohol, particularly acute injuries, at an individual level, at a population level it is in fact moderate drinkers and chronic diseases, not wholly attributable to alcohol, that are associated with most alcohol-attributed deaths. The findings of this study suggest that policies focusing on the whole population attitude to alcohol, and chronic conditions and conditions partially attributable to alcohol, would yield considerable public health benefits. INTRODUCTION Alcohol has long been known as a risk factor for disease ( Rehm et al. , 2004 ). The World Health Organisation (WHO) estimates that alcohol consumption is the third larg- est lifestyle risk factor for disease burden in developed countries and that, globally, alcohol accounts for 3.2% (1.8 million) of deaths and 4% (58.3 million) of disability- adjusted life years. However, while being a major risk factor for disease, alcohol can also have positive effects on health; for example, it is associated with reduced risk of heart dis- ease at certain low consumption levels ( World Health Organisation, 2004). Ireland now has one of the highest levels of alcohol con- sumption in the world. In 2003, the Irish adult per capita consumption (calculated from the Revenue Commissioner’s alcohol sales data and the Central Statistics Office’s [CSO] population data) of pure alcohol was 13.35 l compared with a European average of 9.1 l and a global average of 4.9 l (World Health Organisation, 2004). Both the overall quantity of alcohol consumed and the pattern of consumption have dra- matically changed in recent years in ways that are known to be dangerous to health. Overall consumption increased steadi- ly from 7.72 l per capita in 1972 to a peak of 14.3 l in 2001 (Strategic Task Force on Alcohol, 2004). Between 2001 and 2003, consumption decreased to 13.35 l and it remained around this level until 2007. Increasing alcohol consumption among women and young people as well as an increase in adult binge drinking is associated with this development (Mongan et al., 2007). In 2002, 28.6% of men and 13.3% of women reported that they drank more than the recommended weekly limits for alcohol. There were also a high proportion of abstainers (23%) in Ireland compared with other EU countries and hence the per capita consumption for alcohol consumers would be even higher than the estimates given (Morgan et al., 2009; Ramstedt and Hope, 2005). Despite this, the research literature on the outcomes associ- ated with alcohol use in Ireland is limited. To date, Irish research on outcomes due to alcohol has fo- cussed on either high risk alcohol consumers or on outcomes either wholly or mostly attributable to alcohol (Ramstedt and Hope, 2005; Mongan et al., 2007). Heavy drinkers and people with alcohol dependence in the general population who ex- ceed the guidelines advocated by various experts are undoubtedly at high risk of alcohol-related harm, yet they contribute only a minority to the total numbers of alcohol ca- sualties (Krietman, 1986). Studies that focus only on people with alcohol dependence in the population or only on diseases wholly or mostly attributable to alcohol greatly underestimate the total harm done by alcohol, and strategies that target only these people or diseases will inevitably have limited success in reducing alcohol-related harm in our community. The alcohol-attributable fraction (AAF) is the proportion of the cases recorded in a population with a particular condition that is estimated to be caused by alcohol. The AAF method has been developed to quantify, at the population level, the contribution of alcohol to all diseases and injuries for which it is known to be causally related. It is considered one of the best methods currently available at quantifying the harms and benefits due to alcohol (World Health Organisation, 2000). This method has a number of significant advantages over previous methods of measuring alcohol-related harm. It measures the impact of alcohol at all levels of consumption and on development of all diseases associated with alcohol. It dissociates the recording of alcohol consumption from that of disease or injury and hence overcomes both recall bias, affecting the association with alcohol disease when us- ing self-reported recall, and reporting bias, affecting the © The Author 2010. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved Alcohol & Alcoholism, pp. 1–8, 2010 doi: 10.1093/alcalc/agq032 Alcohol and Alcoholism Advance Access published June 7, 2010 at OUP on June 8, 2010 http://alcalc.oxfordjournals.org Downloaded from