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Implications of Cardioprotective Assumptions for National Drinking Guidelines and Alcohol Harm Monitoring Systems

Date

2019

Authors

Sherk, Adam
Gilmore, William
Churchill, Samuel
Lensvelt, Eveline
Stockwell, Tim
Chikritzhs, Tanya

Journal Title

Journal ISSN

Volume Title

Publisher

International Journal of Environmental Research and Public Health

Abstract

The existence and potential level of cardioprotection from alcohol use is contested in alcohol studies. Assumptions regarding the risk relationship between alcohol use and ischaemic heart disease (IHD) are critical when providing advice for national drinking guidelines and for designing alcohol harm monitoring systems. We use three meta-analyses regarding alcohol use and IHD risk to investigate how varying assumptions lead to di erential estimates of alcohol-attributable (AA) deaths and weighted relative risk (RR) functions, in Australia and Canada. Alcohol exposure and mortality data were acquired from administrative sources and AA fractions were calculated using the International Model of Alcohol Harms and Policies. We then customized a recent Global Burden of Disease (GBD) analysis to inform drinking guidelines internationally. Australians drink slightly more than Canadians, per person, but are also more likely to identify as lifetime abstainers. Cardioprotective scenarios resulted in substantial di erences in estimates of net AA deaths in Australia (between 2933 and 4570) and Canada (between 5179 and 8024), using GBD risk functions for all other alcohol-related conditions. Country-specific weighted RR functions were analyzed to provide advice toward drinking guidelines: Minimum risk was achieved at or below alcohol use levels of 10 g/day ethanol, depending on scenario. Consumption levels resulting in ‘no added’ risk from drinking were found to be between 10 and 15 g/day, by country, gender, and scenario. These recommendations are lower than current guidelines in Australia, Canada, and some other high-income countries: These guidelines may be in need of downward revision.

Description

Keywords

alcohol harms, national drinking guidelines, alcohol-attributable deaths, alcohol use and ischaemic heart disease, alcohol policy, International Model of Alcohol Harms and Policies, alcohol’s burden of disease, international comparison, Australia, Canada

Citation

Sherk, A., Gilmore, W., Churchill, S. Lensvelt, E., Stockwell, T. & Chikritzhs, T. (2019). Implications of Cardioprotective Assumptions for National Drinking Guidelines and Alcohol Harm Monitoring Systems. International Journal of Environmental Research and Public Health, 16(24), 4956. https://doi.org/10.3390/ijerph16244956