title: The relationship between different dimensions of alcohol use and the burden of disease-an update.
abstract: OBJECTIVE
  Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs).
  
  
  METHODS
  Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others.
  
  
  RESULTS
  In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently.
  
  
  CONCLUSIONS
  Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
authors.affiliation: Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.|Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.|Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.|Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.
authors.forename: Jürgen
authors.identifier: http://orcid.org/0000-0001-5665-0385
authors.initials: J
authors.lastname: Rehm
authors.affiliation: Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.|Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland.|Addiction Switzerland, Lausanne, Switzerland.|University of the West of England, Bristol, UK.
authors.forename: Gerhard E
authors.initials: GE
authors.lastname: Gmel
authors.affiliation: Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Gmel
authors.affiliation: Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.
authors.forename: Omer S M
authors.initials: OSM
authors.lastname: Hasan
authors.affiliation: Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.|Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sameer
authors.initials: S
authors.lastname: Imtiaz
authors.affiliation: Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.|Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Popova
authors.affiliation: Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.|Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Probst
authors.affiliation: Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Roerecke
authors.affiliation: Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia.|Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.
authors.forename: Robin
authors.initials: R
authors.lastname: Room
authors.affiliation: Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.|Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.|Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andriy V
authors.initials: AV
authors.lastname: Samokhvalov
authors.affiliation: Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Shield
authors.affiliation: Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Shuper
mesh_terms: D000437:Alcoholism / Q000453:epidemiology*; D015984:Causality; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D017281:Cost of Illness; D006304:Health Status; D006801:Humans; D018570:Risk Assessment; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: Alcohol use; average volume; chronic disease; injury; patterns of drinking; risk-relations; systematic review; unrecorded consumption