Association of alcohol consumption to mortality and person-years of life lost in Switzerland--measuring the impact of some methodological options.
OBJECTIVE
The present study is designed to estimate the health impact of alcohol consumption in terms of the number of deaths and person-years of life lost (PYLL) in Switzerland. To that end, three hypothetical situations have been compared to the current situation used as a reference. The underlying question was: how many deaths and person-years of life lost would be avoided if all individuals were: (1) non-drinkers, (2) low drinkers only or (3) both (either abstainers or low level drinkers)?


METHODS
Etiological fractions of alcohol-related health consequences by age and gender were applied to the officially reported numbers of deaths to estimate the total number of deaths and PYLL.


RESULTS
Depending upon the hypothetical situation, the estimated number of alcohol-related deaths varied between an overall net protective and an overall net causal effect: in situation (1), there would occur 730 additional deaths in reference to the current situation (+1.2% of the total alcohol-related mortality in Switzerland), whereas in situation (2) there would be 3460 deaths less (-5.5%). Thus, the current situation in Switzerland would be preferable compared to a society, in which no one drinks alcohol. A society, however, in which every individual drinks at low levels, would be preferable to the current situation. The corresponding figures for PYLL are 23,596 vs. 29,229 (6.4% vs. 7.9% of total PYLL).


CONCLUSIONS
The hypothetical situation decisively impacts on the number of deaths attributable to alcohol. In contrast, it has much less influence on the number of alcohol-related PYLL. Thus, mortality is at least a questionable indicator of alcohol-related health outcomes. The study also indicated that more lives and PYLL were saved in the low-risk situation than in the abstinence situation. Public health policies should not concentrate on the promotion of abstinence.
Gutjahr
Elisabeth
E
Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA), Lausanne, Switzerland.
Gmel
Gerhard
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011634:Public Health; D019057:Quality-Adjusted Life Years; D013557:Switzerland / Q000453:epidemiology