1. Health Outcomes due to Alcohol 14 July 2005 Kanitta Bundhamcharoen MOPH

2. Acknowledgement Ratchata Tangsiripat IHPP Thaksapon Thamarangsi IHPP and the Thai Working Group on burden attributable to risk factor Theo Vos Majid Ezzati

3. Outline What are the effects of alcohol on health? How do we measure the health loss? How many healthy life years were lost due to alcohol?

4. Consumption, Mediators & Effects Patternvolume Chronic disease Accidents/ injuries (Acute disease) Acute social problems Chronic social problems Intoxicatio n Toxic effectDependenc e Ref: Babor et al. (2003)

5. Basic CRA framework and goals Risk factor levels current distribution counterfactual distribution(s) Disease burden Risk factor-disease relationships risk accumulation risk reversal Attributable burden Avoidable burden

6. Burden of Disease Burden of disease analysis provides a standardized framework for integrating all available information on mortality, causes of death, individual health status, and condition-specific epidemiology to provide an overview of the the levels and causes of population health

7. Disability-Adjusted Life Years (DALYs) One DALY is one lost year of ‘healthy’ life DALY = YLL + YLD –DALY (Disability-Adjusted Life Years) = YLL (Years Lost Due to Premature Death)+YLD (Years Lived With Disability) YLL = Dx * Ex (use standard life table (West level 26)) YLD = Incidence * DW * Duration

8. birth Death/Life expectancy 0 yr 80 yr ill death person Years lost due to premature death(YLLs) Years lived with disability (YLDs) DALYs = YLDs + YLLs

9. Basic CRA framework and goals Risk factor levels current distribution counterfactual distribution(s) Disease burden Risk factor-disease relationships risk accumulation risk reversal Attributable burden Avoidable burden

10. Burden of Disease and injuries Thailand, 1999 1 HIV/AIDS 960,087 17 HIV/AIDS 372,947 9 2 Traffic accidents 510,907 9 Stroke 280,673 7 3 Stroke 267,567 5 Diabetes 267,158 7 4 Liver cancer 248,083 4 Depression 145,336 4 5 Diabetes 168,372 3 Liver cancer 118,384 3 6 Ischaemic heart disease 164,094 3 Osteoarthritis 117,994 3 7 COPD (emphysema) 156,861 3 Traffic accidents 114,963 3 8 Homicide and violence 156,371 3 Anaemia 112,990 3 9 Suicides 147,988 3 Ischaemic heart dis 109,592 3 10 Drug dependence/ Harmful use 137,703 2 Cataracts 96,091 2 Rank Disease category MALE DALYs loss Disease category FEMALE DALYs loss % % Source: Thai Working Group on BOD, 2002

11. 11 Alcohol dependence/harmful use 130,654 2 COPD (emphysema) 93,387 2 12 Cirrhosis 117,527 2 Deafness 87,612 2 13 Lung cancer 106,120 2 Lower respiratory tract infections 84,819 2 14 Drownings 98,464 2 Low birth weight 83,879 2 15 Depression 95,530 2 Dementia 70,191 2 16 Osteoarthritis 93,749 2 Anxiety disorders 66,835 2 17 Tuberculosis 93,695 2 Schizophrenia 60,800 2 18 Deafness 93,497 2 Tuberculosis 60,643 2 19 Low birth weight 91,934 2 Birth trauma & asphyxia 57,488 1 20 Anaemia 87,610 2 Nephritis & nephrosis 55,258 1 Burden of Disease and injuries Thailand, 1999 Source: Thai Working Group on BOD, 2002 Rank Disease category MALE DALYs loss Disease category FEMALE DALYs loss % %

12. Risk Burden Source: Thai Working Group, MOPH, 2003

13. Risk Burden

14. Risk burden by age group

15. Alcohol 5% 6% 14% Stroke 6% Cirrhosis 12% Burden attributable to alcohol: M Dependence 25% Traffic accidents 22% Suicides Homicide and violence ca liver

16. Burden attributable to alcohol: F Alcohol dependence 44% CA Liver Cirrhosis 7%

17. Data Sources

18. Alcohol Consumption Prevalence – Inter Asia (2000) Data Average volume drinking category II: –females 20 – <40 g pure alcohol daily –males 40 – <60 g pure alcohol daily Average volume drinking category III: –females 40+ g pure alcohol daily –males 60+ g pure alcohol daily

19. Alcohol consumption: Male

20. Alcohol consumption: Female

21. Relative Risk MF HazardHarmHazardHarm CA mouth/ pharynx 1.855.391.855.39 CA oesophagus 2.384.362.384.36 CA liver3.033.63.033.60 CA larynx3.94.933.904.93 CA breast <45 111.411.46 CA breast 45+ 111.381.62 Diabetes (NIDDM) 0.570.730.871.13 Ref: Ezzati et al (2004)

22. Relative Risk MF HazardHarmHazardHarm Epilepsy7.526.837.227.52 hypertension24.122 IHD0.831 1.12 Ischaemic stroke 1.331.650.641.06 Haemorrhagi c stroke 2.192.380.657.98 Cirrhosis9.5139.513 Cholelithiasis0.680.50.680.5 LBW1.4 Ref: Ezzati et al (2004)

23. Injuries Fraction of alcohol related injuries from Injury surveillance data