September 2015 Global study confirms harmful alcohol use is linked to increased risk of alcohol-related cancers and injury

• 51% increase in risk of alcohol-related cancers
• 29% increase in risk of injury in current drinkers
• No reduction in risk for a combination of outcomes (death, cardiovascular disease, alcohol-related cancer, injury or admission to hospital)
• Harmful alcohol use most common in lower income countries, where increases in risk were more pronounced

A new study shows that harmful alcohol use is linked with increased alcohol-related cancers and injury, with no reduction in the risk of death. The threat appears worst in lower-income countries, where harmful alcohol use is more common, as published today in The Lancet.

Alcohol consumption is proposed to be the third most important modifiable risk factor for death and disability. However, alcohol consumption has been associated with both benefits and harms, and previous studies were mostly carried out in high-income countries. This new study investigated associations between alcohol consumption and clinical outcomes in a prospective cohort of countries at different economic levels.

The lead author is Dr Andrew Smyth of the HRB Clinical Research Facility at NUI Galway and the Population Health Research Institute (PHRI), McMaster University Hamilton, Canada.

The data came from 12 countries participating in the Prospective Urban Rural Epidemiological (PURE) study of individuals aged 35–70 years, divided into four income groups: high, upper-middle, lower-middle and low. The countries studied were Sweden and Canada (high-income); Argentina, Brazil, Chile, Poland, South Africa and Turkey (upper-middle-income); China and Colombia (lower-middle-income; and India and Zimbabwe (low-income).

Dr Andrew Smyth, of the HRB Clinical Research Facility, NUI Galway says: “Our data supports the call to increase global awareness of the importance of harmful use of alcohol and the need to further identify and target the modifiable determinants of harmful alcohol use.”

Almost 115,000 adults were followed for an average of four years, and it was found that 36,000 people (31%), reported drinking alcohol. Although current alcohol consumption was associated with a 24% reduction in risk of heart attack, there was no reduction in the risk of death or stroke. There was also a 51% increase in the risk of alcohol-related cancers - meaning those of the mouth, oesophagus, stomach, colorectal, liver, breast, ovary, and head and neck - and a 29% increase in the risk of injury in current drinkers. High alcohol intake and heavy episodic drinking were both associated with significant increases in the risk of death.

The authors also identified differences between countries of different levels of prosperity. Although in higher-income-countries, current drinking was linked with a 16% reduction in the risk of a combination of all outcomes (death, cardiovascular disease, heart attack, stroke, alcohol-related cancer, injury and admission to hospital), the opposite was seen in lower-income-countries where there was a 38% increase in risk. Harmful alcohol use was most common in lower-income-countries, where one in eight current drinkers had high levels of intake and one in three had a heavy episodic drinking pattern.

Co-author Dr Salim Yusuf, senior author and Director of the Population Health Research Institute (PHRI) and President of World Heart Federation adds: “Because alcohol consumption is increasing in many countries, especially low-income and low-middle-income countries, the importance of alcohol as a risk factor for disease might be underestimated. Therefore, global strategies to reduce harmful use of alcohol are essential.”

In a related comment published in the same issue of The Lancet , Dr Jason Connor, Centre for Youth Substance Abuse Research, University of Queensland, and Professor Wayne Hall, Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia and National Addiction Centre, Kings College London, London, UK (WH), say: “More than sufficient evidence is available for governments to give increased public health priority to reducing alcohol-related disease burden in low-income and middle-income countries. This should be done by implementing the most effective population policies to discourage harmful drinking - namely, increasing the price of alcohol and reducing its availability, especially to younger drinkers, and preventing the alcohol industry from promotion of frequent drinking to intoxication.”

Graham Love, CEO of the Health Research Board added, “'The HRB national alcohol diary survey last year showed that 54% of Irish people who drink, do so in a harmful manner. When you consider our national level of harmful drinking with these global findings it points to the potential for serious health consequences for Irish drinkers into the future. We must use quality research evidence like this to inform individual choices and public health policy in relation to alcohol.”

Mr Love continued, “It is very encouraging to see both people that the HRB has funded and the research facilities that we have financed, come together to facilitate Irish participation in such a significant piece of international research. I would like to congratulate Dr Smyth and Professor Martin O’Donnell, at the HRB Clinical Research Facility in Galway, on getting their work published in such a prestigious journal.”

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