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Benny C, Hobin E, Andreacchi AT, Schwartz N, Smith BT. Socio-economic inequities in emergency department visits for wholly alcohol-attributable acute and chronic harms in Canada, 2003-2017. Drug Alcohol Rev 2024; 43:927-936. [PMID: 38388158 DOI: 10.1111/dar.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Individuals with low socio-economic position (SEP) experience disproportionate alcohol-attributable harm. Limited research has investigated whether these inequities are driven by alcohol-attributable conditions that are acute or chronic. The study aimed to estimate the sex-specific associations between SEP and incident wholly alcohol-attributable emergency department (ED) visits for acute and chronic harms, respectively. METHODS A cohort study was conducted using the Canadian Community Health Survey (2003-2008) linked to the National Ambulatory Care Reporting System (2002-2017) in Alberta and Ontario. SEP was measured using educational attainment. Acute and chronic ED visits were captured in the National Ambulatory Care Reporting System follow-up data. Hazard models were fit to estimate the association between SEP and acute and chronic wholly alcohol-attributable ED visits. RESULTS The analytical sample included 88,865 respondents. In men and women, individuals with lower SEP had increased hazard of acute ED visits (women hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.07-2.87; men HR 3.47, 95% CI 2.29-5.25) and chronic ED visits (women HR 2.24, 95% CI 1.04-4.80; men HR 5.02, 95% CI 2.88-8.75). Acute and chronic wholly alcohol-attributable ED visit rates were higher in men than women. DISCUSSION AND CONCLUSIONS The findings indicated lower SEP was associated with greater harms for both acute and chronic wholly alcohol-attributable ED visits when compared to their higher SEP counterparts. We conclude that gradients in SEP are associated with acute and chronic harms. These results highlight a need for equitable interventions that reduce the absolute burden of inequities in both acute and chronic wholly alcohol-attributable ED visits.
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Affiliation(s)
| | - Erin Hobin
- Public Heath Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alessandra T Andreacchi
- Public Heath Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Brendan T Smith
- Public Heath Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Bernstein EY, Moreno JO, Edelman EJ. Expanding the Use of Medications for Alcohol Use Disorder: Lessons from the Proliferation of Anti-obesity Medications. J Gen Intern Med 2024; 39:1233-1235. [PMID: 38087177 PMCID: PMC11116289 DOI: 10.1007/s11606-023-08565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/01/2023] [Indexed: 05/25/2024]
Affiliation(s)
- Eden Y Bernstein
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Jorge O Moreno
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
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Esser MB, Sherk A, Liu Y, Henley SJ, Naimi TS. Reducing Alcohol Use to Prevent Cancer Deaths: Estimated Effects Among U.S. Adults. Am J Prev Med 2024; 66:725-729. [PMID: 38514233 PMCID: PMC10963036 DOI: 10.1016/j.amepre.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/03/2023] [Accepted: 12/03/2023] [Indexed: 03/23/2024]
Abstract
INTRODUCTION The Dietary Guidelines for Americans, 2020-2025 recommends non-drinking or no more than 2 drinks for men or 1 drink for women in a day. However, even at lower levels, alcohol use increases the risk for certain cancers. This study estimated mean annual alcohol-attributable cancer deaths and the number of cancer deaths that could potentially be prevented if all U.S. adults who drank in excess of the Dietary Guidelines had instead consumed alcohol to correspond with typical consumption of those who drink within the recommended limits. METHODS Among U.S. residents aged ≥20 years, mean annual alcohol-attributable cancer deaths during 2020-2021 that could have been prevented with hypothetical reductions in alcohol use were estimated. Mean daily alcohol consumption prevalence estimates from the 2020-2021 Behavioral Risk Factor Surveillance System, adjusted to per capita alcohol sales to address underreporting of drinking, were applied to relative risks to calculate population-attributable fractions for cancers that can occur from drinking alcohol. Analyses were conducted during February-April 2023. RESULTS In the U.S., an estimated 20,216 cancer deaths were alcohol-attributable/year during 2020-2021 (men: 14,562 [72.0%]; women: 5,654 [28.0%]). Approximately 16,800 deaths (83% of alcohol-attributable cancer deaths, 2.8% of all cancer deaths) could have been prevented/year if adults who drank alcohol in excess of the Dietary Guidelines had instead reduced their consumption to ≤2 drinks/day for men or ≤1 drink/day for women. Approximately 650 additional deaths could have been prevented annually if men consumed 1 drink/day, instead of 2. CONCLUSIONS Implementing evidence-based alcohol policies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to decrease drinking could reduce alcohol-attributable cancers, complementing clinical interventions.
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Affiliation(s)
- Marissa B Esser
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Timothy S Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
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Subbaraman MS, Schulte A, Berglas NF, Kerr WC, Thomas S, Treffers R, Liu G, Roberts SCM. Associations between alcohol taxes and varied health outcomes among women of reproductive age and infants. Alcohol Alcohol 2024; 59:agae015. [PMID: 38497162 PMCID: PMC10945295 DOI: 10.1093/alcalc/agae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE No studies have examined whether alcohol taxes may be relevant for reducing harms related to pregnant people's drinking. METHOD We examined how beverage-specific ad valorem, volume-based, and sales taxes are associated with outcomes across three data sets. Drinking outcomes came from women of reproductive age in the 1990-2020 US National Alcohol Surveys (N = 11 659 women $\le$ 44 years); treatment admissions data came from the 1992-2019 Treatment Episode Data Set: Admissions (N = 1331 state-years; 582 436 pregnant women admitted to treatment); and infant and maternal outcomes came from the 2005-19 Merative Marketscan® database (1 432 979 birthing person-infant dyads). Adjusted analyses for all data sets included year fixed effects, state-year unemployment and poverty, and accounted for clustering by state. RESULTS Models yield no robust significant associations between taxes and drinking. Increased spirits ad valorem taxes were robustly associated with lower rates of treatment admissions [adjusted IRR = 0.95, 95% CI: 0.91, 0.99]. Increased wine and spirits volume-based taxes were both robustly associated with lower odds of infant morbidities [wine aOR = 0.98, 95% CI: 0.96, 0.99; spirits aOR = 0.99, 95% CI: 0.98, 1.00] and lower odds of severe maternal morbidities [wine aOR = 0.91, 95% CI: 0.86, 0.97; spirits aOR = 0.95, 95% CI: 0.92, 0.97]. Having an off-premise spirits sales tax was also robustly related to lower odds of severe maternal morbidities [aOR = 0.78, 95% CI: 0.64, 0.96]. CONCLUSIONS Results show protective associations between increased wine and spirits volume-based and sales taxes with infant and maternal morbidities. Policies that index tax rates to inflation might yield more public health benefits, including for pregnant people and infants.
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Affiliation(s)
- Meenakshi S Subbaraman
- Behavioral Health and Recovery Studies, Public Health Institute, 555 12th St, Oakland, CA 94607, United States
| | - Alex Schulte
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, S1330 Broadway, Suite 1100, Oakland, CA 94612, United States
| | - Nancy F Berglas
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, S1330 Broadway, Suite 1100, Oakland, CA 94612, United States
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - Sue Thomas
- National Capital Region Center, Pacific Institute of Research and Evaluation, 4061 Powder Mill Road Suite 350, Beltsville, MD 20705-3113, United States
| | - Ryan Treffers
- National Capital Region Center, Pacific Institute of Research and Evaluation, 4061 Powder Mill Road Suite 350, Beltsville, MD 20705-3113, United States
| | - Guodong Liu
- Center for Applied Studies in Health Economics, Pennsylvania State College of Medicine, 90 Hope Drive, Suite 2200, Hershey, PA 17033, United States
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, S1330 Broadway, Suite 1100, Oakland, CA 94612, United States
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Esser MB, Sherk A, Liu Y, Naimi TS. Deaths from Excessive Alcohol Use - United States, 2016-2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:154-161. [PMID: 38421934 PMCID: PMC10907037 DOI: 10.15585/mmwr.mm7308a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Deaths from causes fully attributable to alcohol use have increased during the past 2 decades in the United States, particularly from 2019 to 2020, concurrent with the onset of the COVID-19 pandemic. However, previous studies of trends have not assessed underlying causes of deaths that are partially attributable to alcohol use, such as injuries or certain types of cancer. CDC's Alcohol-Related Disease Impact application was used to estimate the average annual number and age-standardized rate of deaths from excessive alcohol use in the United States based on 58 alcohol-related causes of death during three periods (2016-2017, 2018-2019, and 2020-2021). Average annual number of deaths from excessive alcohol use increased 29.3%, from 137,927 during 2016-2017 to 178,307 during 2020-2021; age-standardized alcohol-related death rates increased from 38.1 to 47.6 per 100,000 population. During this time, deaths from excessive alcohol use among males increased 26.8%, from 94,362 per year to 119,606, and among females increased 34.7%, from 43,565 per year to 58,701. Implementation of evidence-based policies that reduce the availability and accessibility of alcohol and increase its price (e.g., policies that reduce the number and concentration of places selling alcohol and increase alcohol taxes) could reduce excessive alcohol use and alcohol-related deaths.
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Romero-Gómez M, Arab JP, Oliveira CP, Hernández M, Arrese M, Cortez-Pinto H, Bataller R. Is There a Safe Alcohol Consumption Limit for the General Population and in Patients with Liver Disease? Semin Liver Dis 2024; 44:69-78. [PMID: 38574752 DOI: 10.1055/s-0044-1785228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Excessive alcohol consumption represents an important burden for health systems worldwide and is a major cause of liver- and cancer-related deaths. Alcohol consumption is mostly assessed by self-report that often underestimates the amount of drinking. While alcohol use disorders identification test - version C is the most widely used test for alcohol use screening, in patients with liver disease the use of alcohol biomarker could help an objective assessment. The amount of alcohol that leads to significant liver disease depends on gender, genetic background, and coexistence of comorbidities (i.e., metabolic syndrome factors). All patients with alcohol-associated liver disease are recommended to follow complete abstinence and they should be treated within multidisciplinary teams. Abstinence slows down and even reverses the progression of liver fibrosis and can help recompensate patients with complicated cirrhosis. Whether there is a safe amount of alcohol in the general population is a matter of intense debate. Large epidemiological studies showed that the safe amount of alcohol to avoid overall health-related risks is lower than expected even in the general population. Even one drink per day can increase cancer-related death. In patients with any kind of chronic liver disease, especially in those with metabolic-associated steatotic liver disease, no alcohol intake is recommended. This review article discusses the current evidence supporting the deleterious effects of small-to-moderate amounts of alcohol in the general population and in patients with underlying chronic liver disease.
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Affiliation(s)
- Manuel Romero-Gómez
- UCM Digestive Diseases and CIBERehd, Institute of Biomedicine of Seville (HUVR/CSIC/US), Virgen del Rocío University Hospital, University of Seville, Seville, Spain
| | - Juan Pablo Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Claudia P Oliveira
- Division of Clinical Gastroenterology and Hepatology, Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, Hospital das Clínicas HCFMUSP, Sao Paulo, Brazil
| | - María Hernández
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Marco Arrese
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Envejecimiento y Regeneración, Santiago, Chile
| | - Helena Cortez-Pinto
- Clínica Universitaria de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ramón Bataller
- Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
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Bertin L, Leung G, Bohm MK, LeClercq J, Skillen EL, Esser MB. Estimating the Effects of Hypothetical Alcohol Minimum Unit Pricing Policies on Alcohol Use and Deaths: A State Example. J Stud Alcohol Drugs 2024; 85:120-132. [PMID: 38252451 PMCID: PMC10846602 DOI: 10.15288/jsad.22-00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/28/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Alcohol minimum unit pricing (MUP) policies establish a floor price beneath which alcohol cannot be sold. The potential effectiveness of MUP policies for reducing alcohol-attributable deaths in the United States has not been quantitatively assessed. Therefore, this study estimated the effects of two hypothetical distilled spirits MUP policies on alcohol sales, consumption, and alcohol-attributable deaths in one state. METHOD The International Model of Alcohol Harms and Policies tool was used to estimate the effects of two hypothetical MUP per standard drink policies (40-cent and 45-cent) pertaining to distilled spirits products at off-premises alcohol outlets in Michigan during 2020. Prevalence estimates on drinking patterns among Michigan adults were calculated by sex and age group. Prices per standard drink and sales of 9,747 spirits products were analyzed using National Alcohol Beverage Control Association data. Analyses accounted for other alcoholic beverage type sales using cross-price elasticities. RESULTS Increasing the MUP of the 3.5% of spirits with the lowest prices per standard drink to 40 cents could reduce total alcohol per capita consumption in Michigan by 2.6% and prevent 232 (5.3%) alcohol-attributable deaths annually. A 45-cent MUP would affect 8.0% of the spirits and reduce total alcohol per capita consumption by 3.9%, preventing 354 (8.1%) deaths. CONCLUSIONS Modestly increasing the prices of the lowest-priced spirits with an MUP policy in a single state could save hundreds of lives annually. This suggests that alcohol MUP policies could be an effective strategy for improving public health in the United States, consistent with the World Health Organization's recommendation.
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Affiliation(s)
- Lauren Bertin
- Department of Psychology, Emory University, Atlanta, Georgia
| | - Gregory Leung
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michele K. Bohm
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Policy Analysis and Engagement Office, Office of Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer LeClercq
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth L. Skillen
- Policy Analysis and Engagement Office, Office of Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marissa B. Esser
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Smith BT, Warren CM, Andreacchi AT, Schwartz N, Hobin E. The Joint Effect of Education and Alcohol Use on 100% Alcohol-attributable Hospitalization or Death in Canada. Epidemiology 2024; 35:64-73. [PMID: 37756281 DOI: 10.1097/ede.0000000000001674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Individuals with low socioeconomic position (SEP) experience disproportionately greater alcohol-attributable harm than individuals with high SEP despite similar or less alcohol use (i.e., the alcohol harm paradox). We examined the sex/gender- specific independent and joint effects of education and heavy drinking or volume of alcohol use on 100% alcohol-attributable hospitalization or death. METHODS We conducted a cohort study among 199,125 current and former alcohol users aged 15-64 years from population-representative Canadian Community Health Surveys (2000-2008) linked to hospitalization and mortality records through 2017. We estimated the sex/gender-specific associations between education and heavy drinking or volume of alcohol use and incident 100% alcohol-attributable hospitalization or death using multivariable Fine and Gray subdistribution hazard models with competing risk (non-100% alcohol-attributable deaths), assessing additive interactions using the Synergy Index (S). RESULTS Overall, heavy drinking prevalence and volume of alcohol use were similar or lower in individuals with lower education compared with higher education. Lower education levels compared with a bachelor's degree or above were associated with increased 100% alcohol-attributable hospitalization or death [e.g., less than high school, men: hazard ratio (HR) = 2.78; 95% CI = 2.17, 3.56; women: HR = 2.98; 95% CI = 2.00, 4.44]. We found superadditive joint effects between low education and heavy drinking (men: S = 1.22; 95% CI = 1.14, 1.30; women: S = 1.34; 95% CI = 0.88, 2.04) and low education and higher volume of alcohol use (e.g., excess volume, men: S = 1.30; 95% CI = 1.05, 1.62; women: S = 1.41; 95% CI = 0.77, 2.58), with larger inequities in women than men with similar alcohol use. CONCLUSIONS Our study is consistent with the hypothesis that increased vulnerability to alcohol use among individuals with lower education partially explains the alcohol harm paradox in Canada.
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Affiliation(s)
- Brendan T Smith
- Public Health Ontario, Toronto, Ontario, Canada and
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Alessandra T Andreacchi
- Public Health Ontario, Toronto, Ontario, Canada and
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Erin Hobin
- Public Health Ontario, Toronto, Ontario, Canada and
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Naimi TS, Sherk A, Esser MB, Zhao J. Estimating alcohol-attributable injury deaths: A comparison of epidemiological methods. Addiction 2023; 118:2466-2476. [PMID: 37466014 PMCID: PMC10926872 DOI: 10.1111/add.16299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/18/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND AND AIMS Injuries often involve alcohol, but determining the proportion caused by alcohol is difficult. Several approaches have been used to determine the causal role of alcohol, but these methods have not been compared directly with one another. Such a comparison would be useful for understanding the strengths and comparability of different approaches. This study compared estimates of average annual alcohol-attributable deaths in the United States from injuries during 2015-19 using a blood alcohol concentration (BAC) method compared with a population attributable fraction (PAF) approach. METHODS For the BAC method, we used a direct method involving the proportion of decedents with a high blood alcohol concentration (BAC; e.g. ≥ 0.10%). For the PAF approach, we compared the use of unadjusted survey data with average consumption data adjusted using alcohol sales data to account for underreporting and also accounting for the underreporting of binge drinking. Survey data were from the Behavioral Risk Factor Surveillance System and mortality data were from the National Vital Statistics System. RESULTS The number of alcohol-attributable injury deaths using the direct method (48 516 deaths annually) was similar to that using PAF methods (47 879 deaths annually), but only when alcohol use measures were adjusted using alcohol sales data. Furthermore, estimates were similar for cause-specific categories of deaths, including non-motor vehicle unintentional injuries and motor vehicle crashes. Among PAF methods, excessive drinking accounted for 38.3% of injury deaths using unadjusted survey data, but 64.8% of injury deaths using adjusted data. CONCLUSIONS Estimates of alcohol-attributable injury deaths from a direct method and from a population attributable fraction method that adjusts for alcohol use based on alcohol sales data appear to be comparable.
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Affiliation(s)
- Timothy S Naimi
- Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | - Marissa B Esser
- Alcohol Program, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jinhui Zhao
- Canadian Institute for Substance Use Research, Victoria, BC, Canada
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Morgan E, Mallory A, Albright N, Dyar C. Alcohol and inflammation: Examining differences at the intersection of sexual identity and race/ethnicity. Alcohol 2023; 118:1-7. [PMID: 37952785 PMCID: PMC11090082 DOI: 10.1016/j.alcohol.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
Sexual minorities (SMs; e.g., lesbian, gay, bisexual, and other non-heterosexual individuals) are more likely to be current alcohol drinkers than their heterosexual peers while separately experiencing elevated inflammation. Yet, little research has assessed the association between alcohol use and inflammation among subgroups of SMs, let alone potential differences among people with multiple marginal identities (e.g., race/ethnicity and sexual identity). Data came from the National Health and Nutrition Survey 2015-2016. Survey-weighted multivariable linear regression analysis was used to assess the relationship between alcohol use categories, heavy episodic drinking, and log-CRP (C-reactive protein). Models were stratified by sexual identity to determine whether associations between alcohol use and inflammation or between race/ethnicity and inflammation differed by sexual identity. Among 3220 participants, 1000 (36.8%) reported light alcohol use, 870 (32.0%) reported moderate use, and 483 (17.8%) reported heavy use. Mean raw CRP was 4.1 mg/L (SD = 8.1). The association between race/ethnicity and CRP differed in stratified relative to non-stratified models with key differences in CRP among individuals with multiple marginalized identities. We also observed that while the "classic" J-shaped relationship between alcohol use and systemic inflammation persists among heterosexuals in this sample, it does not hold among subgroups of sexual minorities. In particular, bisexuals who report heavy alcohol use, compared to non-users, experience significantly elevated CRP. Finally, we did not observe any association between heavy episodic drinking and CRP among subgroups of sexual minorities. Future studies assessing alcohol and biomarker data need to strive to include subgroups of sexual minorities and people with multiple marginal identities to better target behavioral and biomedical interventions aimed at reducing health disparities.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, United States; College of Public Health, The Ohio State University, Columbus, OH, United States.
| | - Allen Mallory
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States
| | - Nathaniel Albright
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Christina Dyar
- College of Nursing, The Ohio State University, Columbus, OH, United States
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Pekarska K, Parker R. Alcohol-Related Liver Disease: Is There a Safe Alcohol Consumption Limit for Liver Disease? Semin Liver Dis 2023; 43:305-310. [PMID: 37640063 DOI: 10.1055/s-0043-1772836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
This review is to evaluate how much alcohol is safe in the context of alcohol-related liver disease (ALD). In patients without an established diagnosis of ALD consuming alcohol at quantities below 12 to 20 g daily with alcohol-free days is associated with a very low risk of developing disease. This risk is mediated by the presence of cofactors such as sex, medical comorbidity, obesity, and genetic factors. A threshold effect below which liver disease will not occur is not seen, instead a dose-response relationship where risk ranges from low to high. Once ALD is present, natural history studies confirm that continued alcohol consumption is clearly associated with an increased risk of ill health and premature death. In conclusion, low-level alcohol consumption in the absence of liver disease is associated with a very small risk of developing ALD, but once ALD is present patients should be supported to achieve complete abstinence from alcohol.
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Affiliation(s)
- Katrina Pekarska
- Leeds Liver Unit, St James's University Hospital, Leeds, West Yorkshire, United Kingdom
| | - Richard Parker
- Leeds Liver Unit, St James's University Hospital, Leeds, West Yorkshire, United Kingdom
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Esser MB, Leung G, Sherk A, Bohm MK, Liu Y, Lu H, Naimi TS. Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019. JAMA Netw Open 2022; 5:e2239485. [PMID: 36318209 PMCID: PMC9627409 DOI: 10.1001/jamanetworkopen.2022.39485] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
IMPORTANCE Alcohol consumption is a leading preventable cause of death in the US, and death rates from fully alcohol-attributable causes (eg, alcoholic liver disease) have increased in the past decade, including among adults aged 20 to 64 years. However, a comprehensive assessment of alcohol-attributable deaths among this population, including from partially alcohol-attributable causes, is lacking. OBJECTIVE To estimate the mean annual number of deaths from excessive alcohol use relative to total deaths among adults aged 20 to 64 years overall; by sex, age group, and state; and as a proportion of total deaths. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study of mean annual alcohol-attributable deaths among US residents between January 1, 2015, and December 31, 2019, used population-attributable fractions. Data were analyzed from January 6, 2021, to May 2, 2022. EXPOSURES Mean daily alcohol consumption among the 2 089 287 respondents to the 2015-2019 Behavioral Risk Factor Surveillance System was adjusted using national per capita alcohol sales to correct for underreporting. Adjusted mean daily alcohol consumption prevalence estimates were applied to relative risks to generate alcohol-attributable fractions for chronic partially alcohol-attributable conditions. Alcohol-attributable fractions based on blood alcohol concentrations were used to assess acute partially alcohol-attributable deaths. MAIN OUTCOMES AND MEASURES Alcohol-attributable deaths for 58 causes of death, as defined in the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact application. Mortality data were from the National Vital Statistics System. RESULTS During the 2015-2019 study period, of 694 660 mean deaths per year among adults aged 20 to 64 years (men: 432 575 [66.3%]; women: 262 085 [37.7%]), an estimated 12.9% (89 697 per year) were attributable to excessive alcohol consumption. This percentage was higher among men (15.0%) than women (9.4%). By state, alcohol-attributable deaths ranged from 9.3% of total deaths in Mississippi to 21.7% in New Mexico. Among adults aged 20 to 49 years, alcohol-attributable deaths (44 981 mean annual deaths) accounted for an estimated 20.3% of total deaths. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that an estimated 1 in 8 total deaths among US adults aged 20 to 64 years were attributable to excessive alcohol use, including 1 in 5 deaths among adults aged 20 to 49 years. The number of premature deaths could be reduced with increased implementation of evidenced-based, population-level alcohol policies, such as increasing alcohol taxes or regulating alcohol outlet density.
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Affiliation(s)
- Marissa B. Esser
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gregory Leung
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Michele K. Bohm
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hua Lu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Timothy S. Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
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Gloppen KM, Roesler JS, Farley DM. Assessing the Costs of Excessive Alcohol Consumption in Minnesota. Am J Prev Med 2022; 63:505-512. [PMID: 36137668 DOI: 10.1016/j.amepre.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Alcohol consumption, particularly excessive drinking, incurs a high societal cost. This study aimed to apply current state-specific data from 1 state, Minnesota, to established national methods for estimating the societal cost of excessive alcohol consumption for 2 purposes: first, to update the cost estimate for the state and, second, to understand the potential benefits of using state-specific data versus a national apportionment strategy for economic burden estimates. METHODS In 2021, established methods were used to apply alcohol-attributable fractions for health care, lost productivity, crime, and other effects (e.g., motor vehicle crashes) to 2019 Minnesota data. The main outcome measure was the annual prevalence cost (incurred and paid each year) of excessive alcohol use in Minnesota from the societal perspective. Secondary outcome measures were the cost of specific outcomes (e.g., crime), different types of consumption (e.g., drinking during pregnancy), the cost to government payers, and the cost per drink. RESULTS The societal cost of alcohol use in Minnesota in 2019 was nearly $8 billion dollars (2019 USD) or $1,383 per resident. This estimate is substantially higher than a previous estimate on the basis of apportionment of a national estimate. CONCLUSIONS The cost of alcohol use in Minnesota is considerable. Geographically specific and current cost estimates can inform decision making about the public health impact of excessive alcohol use and the cost effectiveness of prevention strategies. Evidence-based prevention strategies to reduce alcohol use include increased alcohol taxes, enhanced enforcement of laws prohibiting sales to minors, and electronic screening and brief intervention.
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Affiliation(s)
- Kari M Gloppen
- Injury and Violence Prevention Section, Minnesota Department of Health, St. Paul, Minnesota.
| | - Jon S Roesler
- Injury and Violence Prevention Section, Minnesota Department of Health, St. Paul, Minnesota
| | - Dana M Farley
- Injury and Violence Prevention Section, Minnesota Department of Health, St. Paul, Minnesota
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Barbería-Latasa M, Gea A, Martínez-González MA. Alcohol, Drinking Pattern, and Chronic Disease. Nutrients 2022; 14:nu14091954. [PMID: 35565924 PMCID: PMC9100270 DOI: 10.3390/nu14091954] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 12/16/2022] Open
Abstract
This review discusses the inconsistent recommendations on alcohol consumption and its association with chronic disease, highlighting the need for an evidence-based consensus. Alcohol is an addictive substance consumed worldwide, especially in European countries. Recommendations on alcohol consumption are controversial. On one hand, many nonrandomized studies defend that moderate consumption has a beneficial cardiovascular effect or a lower risk of all-cause mortality. On the other hand, alcohol is associated with an increased risk of cancer, neurological diseases, or injuries, among others. For years, efforts have been made to answer the question regarding the safe amount of alcohol intake, but controversies remain. Observational studies advocate moderate alcohol consumption following a Mediterranean pattern (red wine with meals avoiding binge drinking) as the best option for current drinkers. However, agencies such as the IARC recommend abstention from alcohol as it is a potent carcinogen. In this context, more randomized trial with larger sample size and hard clinical endpoints should be conducted to clarify the available evidence and provide clinicians with support for their clinical practice.
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Affiliation(s)
- María Barbería-Latasa
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (M.B.-L.); (M.A.M.-G.)
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (M.B.-L.); (M.A.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Biomedical Research Network Center for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
- Correspondence:
| | - Miguel A. Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (M.B.-L.); (M.A.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Biomedical Research Network Center for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
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Sherk A, Esser MB, Stockwell T, Naimi TS. Estimating alcohol-attributable liver disease mortality: A comparison of methods. Drug Alcohol Rev 2022; 41:1245-1253. [PMID: 35363378 DOI: 10.1111/dar.13470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Alcohol is a leading contributor to liver disease, however, estimating the proportion of liver disease deaths attributable to alcohol use can be methodologically challenging. METHODS We compared three approaches for estimating alcohol-attributable liver disease deaths (AALDD), using the USA as an example. One involved summing deaths from alcoholic liver disease and a proportion from unspecified cirrhosis (direct method); two used population attributable fraction (PAF) methodology, including one that adjusted for per capita alcohol sales. For PAFs, the 2011-2015 Behavioral Risk Factor Surveillance System and per capita sales from the Alcohol Epidemiologic Data System were used to derive alcohol consumption prevalence estimates at various levels (excessive alcohol use was defined by medium and high consumption levels). Prevalence estimates were used with relative risks from two meta-analyses, and PAFs were applied to the 2011-2015 average annual number of deaths from alcoholic cirrhosis and unspecified cirrhosis (using National Vital Statistics System data) to estimate AALDD. RESULTS The number of AALDD was higher using the direct method (28 345 annually) than the PAF methods, but similar when alcohol prevalence was adjusted using per capita sales and all alcohol consumption levels were considered (e.g. 25 145 AALDD). Using the PAF method, disaggregating non-drinkers into lifetime abstainers and former drinkers to incorporate relative risks for former drinkers yielded higher AALDD estimates (e.g. 27 686) than methods with all non-drinkers combined. DISCUSSION AND CONCLUSIONS Using PAF methods that adjust for per capita sales and model risks for former drinkers yield more complete and possibly more valid AALDD estimates.
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Affiliation(s)
- Adam Sherk
- Canadian Institute for Substance Use Research, Victoria, Canada
| | - Marissa B Esser
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, Victoria, Canada
| | - Timothy S Naimi
- Canadian Institute for Substance Use Research, Victoria, Canada
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