title: Alcohol-attributed disease burden in four Nordic countries: a comparison using the Global Burden of Disease, Injuries and Risk Factors 2013 study.
abstract: (1) To compare alcohol-attributed disease burden in four Nordic countries 1990-2013, by overall disability-adjusted life years (DALYs) and separated by premature mortality [years of life lost (YLL)] and health loss to non-fatal conditions [years lived with disability (YLD)]; (2) to examine whether changes in alcohol consumption informs alcohol-attributed disease burden; and (3) to compare the distribution of disease burden separated by causes.
  
  
  
  A comparative risk assessment approach.
  
  
  
  Sweden, Norway, Denmark and Finland.
  
  
  
  Male and female populations of each country.
  
  
  
  Age-standardized DALYs, YLLs and YLDs per 100 000 with 95% uncertainty intervals (UIs).
  
  
  
  In Finland, with the highest burden over the study period, overall alcohol-attributed DALYs were 1616 per 100 000 in 2013, while in Norway, with the lowest burden, corresponding estimates were 634. DALYs in Denmark were 1246 and in Sweden 788. In Denmark and Finland, changes in consumption generally corresponded to changes in disease burden, but not to the same extent in Sweden and Norway. All countries had a similar disease pattern and the majority of DALYs were due to YLLs (62-76%), mainly from alcohol use disorder, cirrhosis, transport injuries, self-harm and violence. YLDs from alcohol use disorder accounted for 41% and 49% of DALYs in Denmark and Finland compared to 63 and 64% in Norway and Sweden 2013, respectively.
  
  
  
  Finland and Denmark has a higher alcohol-attributed disease burden than Sweden and Norway in the period 1990-2013. Changes in consumption levels in general corresponded to changes in harm in Finland and Denmark, but not in Sweden and Norway for some years. All countries followed a similar pattern. The majority of disability-adjusted life years were due to premature mortality. Alcohol use disorder by non-fatal conditions accounted for a higher proportion of disability-adjusted life years in Norway and Sweden, compared with Finland and Denmark.
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. emilie.agardh@ki.se.
authors.forename: Emilie E
authors.initials: EE
authors.lastname: Agardh
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Danielsson
authors.affiliation: Swedish Council for Information on Alcohol and Drugs (CAN), Stockholm, Sweden.|Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Ramstedt
authors.affiliation: Department of Public Health Sciences, University of Copenhagen, Section of Social Medicine, Copenhagen, Denmark.
authors.forename: Astrid
authors.initials: A
authors.lastname: Ledgaard Holm
authors.affiliation: Department of Public Health Sciences, University of Copenhagen, Section of Social Medicine, Copenhagen, Denmark.
authors.forename: Finn
authors.initials: F
authors.lastname: Diderichsen
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Knud
authors.initials: K
authors.lastname: Juel
authors.affiliation: The Norwegian Institute of Public Health, Centre for Disease Burden, Oslo/Bergen, Norway.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Stein Emil
authors.initials: SE
authors.lastname: Vollset
authors.affiliation: The Norwegian Institute of Public Health, Centre for Disease Burden, Oslo/Bergen, Norway.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Ann Kristin
authors.initials: AK
authors.lastname: Knudsen
authors.affiliation: Department of Health Statistics, The Norwegian Institute of Public Health, Oslo, Norway.|Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
authors.forename: Jonas
authors.initials: J
authors.lastname: Minet Kinge
authors.affiliation: Department of Health Statistics, The Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Richard
authors.initials: R
authors.lastname: White
authors.affiliation: The Norwegian Institute of Public Health, Centre for Disease Burden, Oslo/Bergen, Norway.|Columbia University, New York, NY, USA.
authors.forename: Vegard
authors.initials: V
authors.lastname: Skirbekk
authors.affiliation: Alcohol and Drugs Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Mäkelä
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Forouzanfar
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Coates
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Casey
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Mohesen
authors.initials: M
authors.lastname: Naghavi
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Allebeck
mesh_terms: D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000401:mortality*; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D000071219:Global Burden of Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*
keywords: Alcohol; Nordic countries; comparative; comparative risk assessment; consumption; disease burden