health outcomes due to alcohol 14 july 2005 kanitta bundhamcharoen moph
DESCRIPTION
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?TRANSCRIPT
Health Outcomes due to Health Outcomes due to AlcoholAlcohol
14 July 2005Kanitta
BundhamcharoenMOPH
Acknowledgement
• Ratchata Tangsiripat IHPP• Thaksapon Thamarangsi IHPP• and the Thai Working Group on burden
attributable to risk factor• Theo Vos• Majid Ezzati
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?
Consumption, Mediators & Effects
Pattern volume
Chronic disease
Accidents/ injuries
(Acute disease)
Acute social problems
Chronic social
problems
Intoxication
Toxic effect Dependence
Ref: Babor et al. (2003)
Basic CRA framework and goals
Risk factor levels• current distribution• counterfactual • distribution(s)
Disease burden
Risk factor-disease relationships
• risk accumulation• risk reversal
Attributable burdenAvoidable burden
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
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
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
Basic CRA framework and goals
Risk factor levels• current distribution• counterfactual • distribution(s)
Disease burden
Risk factor-disease relationships
• risk accumulation• risk reversal
Attributable burdenAvoidable burden
Burden of Disease and injuriesThailand, 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 DALYsloss
Disease category
FEMALE DALYsloss
% %
Source: Thai Working Group on BOD, 2002
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 injuriesThailand, 1999
Source: Thai Working Group on BOD, 2002
Rank
Disease category MALE
DALYsloss
Disease category
FEMALE DALYsloss
% %
Risk Burden4.5
0.40.50.40.7
2.32.4
1.10.50.70.6
0.30.10.3
0.1
8.65.1
4.43.33.3
2.61.3
1.10.9
0.60.50.40.30.30.2
0 1 2 3 4 5 6 7 8 9 10
Unsafe sexAlcoholTobacco
Illicit drugsNot wearing helmet
Blood pressureObesity
CholesterolFruit & veggies
Air pollutionPhysical inactivity
Malnutrition – Int’l standardNot wearing seatbeltWater & sanitation
Malnutrition - Thai standard
FemaleMale
Source: Thai Working Group, MOPH, 2003
13.8%5.8%
5.1%5.0%
4.2%3.9%
3.6%2.3%
1.4%1.4%
1.2%0.7%0.7%
0.4%0.3%
0 0.02 0.04 0.06 0.08 0.1 0.12 0.14 0.16
Unsafe sexAlcohol
TobaccoBlood pressure
Not wearing helmetObesity
Illicit drugsCholesterol
Fruit & vegiesAir pollution
Physical inactivityMalnutrition - int standard
Water & sanitationNot wearing seatbelt
Malnutrition - Thai standard
Risk Burden
0 . 00 % 5 . 00 %
10 . 00 % 15 . 00 %
0 - 4 0 - 4 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 + 0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 + age group ( yrs )
%
Total DALYs
unsafe sex water and sanitation Tobacco Physical inactivity
malnutrition_international standard malnutrition_thai standard illicit drug use Non - Helmet No safety belts inadequate intake of fruit and vegetable cholesterol BMI Blood pressure alcohol
air pollution
Risk burden by age group
Alcohol
5%6%
14%
Stroke6%
Cirrhosis12%
Burden attributable to alcohol: M
Dependence 25%
Traffic accidents22%
SuicidesHomicide and violence
ca liver
Traffic accidents12%
ca liver13%
Alcohol dependence
44%
Burden attributable to alcohol: F
Alcohol dependence 44%
CA Liver
Cirrhosis 7%
Data Sources
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
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
30-44 45-59 60-69 70-79 80+
abstainerresponsiblehazardousharmful
Alcohol consumption: Male
Alcohol consumption: Female
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
30-44 45-59 60-69 70-79 80+
abstainerresponsiblehazardousharmful
Relative RiskM FHazard Harm Hazard Harm
CA mouth/ pharynx
1.85 5.39 1.85 5.39
CA oesophagus
2.38 4.36 2.38 4.36
CA liver 3.03 3.6 3.03 3.60CA larynx 3.9 4.93 3.90 4.93CA breast <45
1 1 1.41 1.46
CA breast 45+
1 1 1.38 1.62
Diabetes (NIDDM)
0.57 0.73 0.87 1.13
Ref: Ezzati et al (2004)
Relative RiskM FHazard Harm Hazard Harm
Epilepsy 7.52 6.83 7.22 7.52hypertension 2 4.1 2 2IHD 0.83 1 0.83 1.12Ischaemic stroke
1.33 1.65 0.64 1.06
Haemorrhagic stroke
2.19 2.38 0.65 7.98
Cirrhosis 9.5 13 9.5 13Cholelithiasis 0.68 0.5 0.68 0.5LBW 1.4 1.4 1.4 1.4
Ref: Ezzati et al (2004)
Injuries
• Fraction of alcohol related injuries from Injury surveillance data