Alcohol was the leading risk factor for disease and premature death in men and women between the ages of 15 and 49 worldwide in 2016, accounting for nearly one in 10 deaths, according to the study, published Thursday in the journal The Lancet.
For all ages, alcohol was associated with 2.8 million deaths that year.
Those deaths include alcohol-related cancer and cardiovascular diseases, infectious diseases such as tuberculosis, intentional injury such as violence and self-harm, and traffic accidents and other unintentional injuries such as drowning and fires.
“The most surprising finding was that even small amounts of alcohol use contribute to health loss globally,” said senior study author Emmanuela Gakidou, a professor at the University of Washington’s Institute for Health Metrics and Evaluation. “We’re used to hearing that a drink or two a day is fine. But the evidence is the evidence.”
Not surprisingly due to their large populations, China, India and Russia led the world in the total number of alcohol-related deaths in men and women. The US ranked fifth among men and seventh among women on that list; the UK ranked 21st for men and ninth for women.
“This study is a stark reminder of the real, and potentially lethal, dangers that too much alcohol can have on our health and that even the lowest levels of alcohol intake increase our risks,” Helen Stokes-Lampard, chair of the Royal College of General Practitioners in the UK, said in a statement. She was not involved in the study.
However, countered David Spiegelhalter, the Winton Professor for the Public Understanding of Risk at the University of Cambridge, “Given the pleasure presumably associated with moderate drinking, claiming there is no ‘safe’ level does not seem an argument for abstention.
“There is no safe level of driving, but governments do not recommend that people avoid driving,” Spiegelhalter, who also was not involved in the research, said in a statement. “Come to think of it, there is no safe level of living, but nobody would recommend abstention.”
The Lancet study, funded by the Bill and Melinda Gates Foundation, used data from the 2016 Global Burden of Disease report, which captured information on premature death and disability from over 300 diseases by sex and age in 195 countries or territories between 1990 and 2016.
Researchers analyzed the impact of alcohol on 23 health conditions and alcohol-related risks on people between the ages of 15 and approximately 95 for the year 2016.
Drinking under the age of 15, a growing problem in the US and other countries, was not included.
For purposes of the study, a standard alcoholic drink was defined as 10 grams or approximately 12 milliliters of alcohol. That measurement varies around the world; for example, a standard drink is 8 grams in the UK and 14 grams in US. It’s even higher in Italy, Portugal and Spain.
Over 1,300 studies on alcohol use by country and the accompanying disease burden, measured by both deaths and disability-adjusted life years, were analyzed by the Global Burden of Disease collaborators.
For the first time, Gakidou said, in an attempt to improve on previous research, the new analysis adjusted for the impact of tourism on local statistics in liquor sales and attempted to control for unrecorded drinking, such as home brewing or illicit trade. Another improvement over past studies, she said, was a new meta-analysis of the effects of alcohol on the 23 health outcomes, which was then used to access risk.
In independent comments published alongside the study, King’s College London alcohol researcher Robyn Burton called the study “state-of-the-art.”
“The conclusions of the study are clear and unambiguous: alcohol is a colossal global health issue,” Burton wrote, suggesting that policy makers put a priority on programs that focus on decreasing alcohol consumption.
However, the Alcohol Information Partnership, a group comprising eight of the world’s biggest liquor companies, said in a statement that “Nothing in this study challenges the array of studies suggesting that choosing to drink moderately is associated with a decreased risk of some health issues and a lower risk of death. We advocate sensible drinking by those who choose to drink and support consistent, evidence-based advice, which enables people to make their own informed choices about alcohol.”
Globally, the study found that about 2.4 billion people drink alcohol. Twenty-five percent are women, who consumed 0.73 drinks each day. Thirty-nine percent are men, who drink an average of 1.7 drinks a day.
The countries with the highest percentage of men and women who reported drinking in the previous year were Denmark, Norway and Germany. Although they didn’t make the top 10, 85.3% of men and 81.3% of women in the UK said they had tippled in the previous 12 months. In the US, 68.8% of men and 56.8% of women said they had done so.
Countries with the lowest percentage of drinking citizens were typically Arab and Middle Eastern nations.
For ages 50 and up, cancers were the leading cause of alcohol-related deaths; road injuries, self-harm and tuberculosis were the top causes of death around the world in the 15-to-49 age group.
However, in terms of total numbers, Gakidou said, “most deaths from alcohol come from cardiovascular disease and cancers when you look at average consumption by age and sex within countries.”
The results appear to fly in the face of research that indicates moderate drinking — in the United States, that’s one drink a day for women and two a day for men — might reduce the risk of heart disease and Type 2 diabetes. That might be true in isolation, Gakidou said, but the picture changes when all risks are considered.
“We too found some protective effects for Type 2 diabetes and ischemic heart disease at low levels of alcohol consumption,” she said. “But those benefits are outweighed by the overall adverse health impact of alcohol, even at moderate levels.”
Jeremy Pearson, associate medical director at the British Heart Foundation, agreed, saying in a statement, “While there may be a slight benefit to heart and circulatory health from modest drinking, many studies have shown that the overall health risks of drinking alcohol outweigh any benefits.”
University of Cambridge epidemiologist Steven Bell co-authored a separate study published in April in The Lancet that found drinking is beneficial in lowering the risk for heart attack. However, that study’s big takeaway was that even one drink a day could shorten life expectancy; long-term reduction in alcohol use added one to two years to life expectancy at age 40.
He points out that his study looked only at drinkers, but the new research compared drinkers to non-drinkers in accessing risk and is one of the first to look at data from low- and middle-income countries.
“The take-home message being that people shouldn’t drink under the belief that it will lower their risk of disease,” he said, “and those of us who opt to drink should minimize our intake if we wish to prolong our life and well-being.”