Life-time risk of mortality due to different levels of alcohol consumption in seven European countries: implications for low-risk drinking guidelines.
OBJECTIVE
Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts.


METHODS
The maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization.


RESULTS
The variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men.


CONCLUSIONS
If low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men, and some of the current European guidelines would require downward revision.
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Kevin D
KD
Shield
School of Electrical Engineering and Telecommunications, University of New South Wales, Kensington, Australia.
Gerrit
G
Gmel
Epidemiology and Statistics Section, Addiction Suisse, Lausanne, Switzerland.
Gerhard
G
Gmel
Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare THL, Helsinki, Finland.
Pia
P
Mäkelä
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Charlotte
C
Probst
Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.|Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden.
Robin
R
Room
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.|Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.|Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada.|Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Jürgen
J
Rehm
D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000401:mortality*; D004957:Estonia / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D017408:Guidelines as Topic; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007494:Ireland / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult
Alcohol; chronic disease; guideline; infection; injuries; mortality; wounds