Distributions of alcohol use and alcohol-caused death and disability in Canada: Defining alcohol harm density functions and new perspectives on the prevention paradox

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2024-01-18 DOI:10.1111/add.16414

Adam Sherk, Samuel Churchill, Samantha Cukier, Sierra C. Grant, Kevin Shield, Tim Stockwell

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Abstract

Aims

The aims of this study were to examine the distribution of alcohol use and to define ‘harm density functions’ representing distributions of alcohol-caused health harm in Canada, by sex, towards better understanding which groups of drinkers experience the highest aggregate harms.

Design

This was an epidemiological modeling study using survey and administrative data on alcohol exposure, death and disability and risk relationships from epidemiological meta-analyses.

Setting

This work took place in Canada, 2019.

Participants

Canadians aged 15 years or older participated.

Measurements

Measures included modeled life-time mean daily alcohol use in grams of pure alcohol (ethanol) per day, alcohol-caused deaths and alcohol-caused disability-adjusted life-years.

Findings

As a life-time average, more than half of Canadians aged 15+ (62.8% females, 46.9% males) use fewer than 10 g of pure alcohol per day (g/day). By volume, the top 10% of the population consume 45.9% of the total ethanol among males and 47.1% of the total ethanol among females. The remaining 90% of the population experience a slim majority of alcohol-caused deaths (males 55.3%, females 46.9%). Alcohol harm density functions compose the size of the using population and the risk experienced at each volume level to show that the population-level harm experienced is highest for males at 25 g/day and females at 13 g/day.

Conclusions

Almost 50% of alcohol use in Canada is concentrated among the highest 10% of drinkers, but more than half of the alcohol-caused deaths in Canada in 2019 were experienced by the bottom 90% of the population by average volume, providing evidence for the prevention paradox. New alcohol harm density functions provide insight into the aggregate health harm experienced across the mean alcohol use spectrum and may therefore be used to help determine where alcohol policies should be targeted for highest efficacy.

Abstract Image

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加拿大酒精使用及酒精导致死亡和残疾的分布情况：定义酒精危害密度函数和预防悖论的新视角。

目的：本研究的目的是研究酒精使用的分布情况，并按性别定义代表加拿大酒精造成的健康危害分布情况的 "危害密度函数"，以便更好地了解哪些饮酒群体受到的总体危害最大：这是一项流行病学建模研究，使用了有关酒精暴露、死亡和残疾的调查和管理数据，以及流行病学荟萃分析中的风险关系：这项工作于 2019 年在加拿大进行：年龄在 15 岁或以上的加拿大人参加：测量指标包括以每日纯酒精（乙醇）克数为单位的模型化终生平均每日饮酒量、酒精导致的死亡人数和酒精导致的残疾调整寿命年数：在 15 岁以上的加拿大人中，超过半数（62.8% 的女性和 46.9% 的男性）一生平均每天纯酒精摄入量少于 10 克。按消费量计算，前 10%的人口所消费的乙醇占男性乙醇总量的 45.9%，占女性乙醇总量的 47.1%。其余 90% 的人口因酒精导致的死亡占绝大多数（男性 55.3%，女性 46.9%）。酒精危害密度函数由饮酒人口的规模和每个量级的风险组成，表明男性每天饮酒 25 克，女性每天饮酒 13 克，对人口造成的危害最大：加拿大近50%的酒精使用集中在饮酒量最高的10%人群中，但2019年加拿大因酒精导致的死亡中，超过一半是由平均饮酒量最低的90%人群造成的，这为预防悖论提供了证据。新的酒精危害密度函数提供了对平均酒精使用范围内总体健康危害的深入了解，因此可用于帮助确定酒精政策应针对哪些方面以取得最大成效。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.