【转载】全球195个国家饮酒量及酒类消费的调查：1990---2016年饮酒与疾病的关系全...1

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全球195个国家饮酒量及酒类消费的调查：1990---2016年饮酒与疾病的关系全面分析（节译）1

文/李寻的酒吧

编者按：2018年8月28日，中国媒体《今日头条》发布了一篇文章：《一滴酒也别喝！世界权威医学期刊已证实：没有任何健康好处》，据称，该文结论与其中所采用的数据，均来自于世界著名权威医学期刊《柳叶刀》上的文章：《Alcohol use andburden for 195 countries and territories,1990–2016: a systematic analysis for the Global Burden of DiseaseStudy 2016》，笔者以前没有看过《柳叶刀》这本期刊，也不知它是不是真发表了这么一篇文章，不过在网上找到了该文章的英文原文，想必应该是真的，就想看看它的结论到底是不是真如《今日头条》所言那样，如果真是那样，那么文章用了何种研究方法，采用的数据样本来自何处？本着这个目的，我们请英文翻译节译了该文，虽是节译，但文章最关键部分都已经有了。不过由于时间仓促，在字句斟酌上难免不到位，甚至会有一些错误，敬请方家指正。

Alcohol use and burden for 195 countries and territories,

1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

全球195个国家饮酒量及酒类消费的调查：1990---2016年饮酒与疾病的关系全面分析（节译）

1

Summary

Background Alcohol use is a leading risk factor for death anddisability, but its overall association with health remains

complex given the possible protective effects of moderatealcohol consumption on some conditions. With our

comprehensive approach to health accounting within the GlobalBurden of Diseases, Injuries, and Risk Factors Study

2016, we generated improved estimates of alcohol use andalcohol-attributable deaths and disability-adjusted life-

years (DALYs) for 195 locations from 1990 to 2016, for bothsexes and for 5-year age groups between the ages of

15 years and 95 years and older.

概要

背景：酒精使用是导致死亡和残疾的主要因素，鉴于适度饮酒对某些情况可能产生的保护作用，酒精与健康仍是息息相关的。

通过我们对全球疾病，伤害和风险因素研究中的综合法，2016年，我们对1990年至2016年195个地点酒精使用和酒精引起的死亡和残疾调整行了统计 - 男女性别和5岁以下年龄组15岁和95岁以上。

     Methods Using 694data sources of individual and population-level alcohol consumption, along with592 prospective

and retrospective studies on the risk of alcohol use, weproduced estimates of the prevalence of current drinking,

abstention, the distribution of alcohol consumption amongcurrent drinkers in standard drinks daily (defined as 10 g

of pure ethyl alcohol), and alcohol-attributable deaths andDALYs. We made several methodological improvements

compared with previous estimates: first, we adjusted alcoholsales estimates to take into account tourist and

unrecorded consumption; second, we did a new meta-analysis ofrelative risks for 23 health outcomes associated with

alcohol use; and third, we developed a new method to quantifythe level of alcohol consumption that minimises the

overall risk to individual health.

方法

通过对个人和人群饮酒量的694个数据来源，以及592个预期关于酒精使用风险的回顾性研究，我们预估了当前饮酒的患病率。每日标准饮料中当前饮酒者的饮酒量分布（定义为10克纯乙醇）和酒精引起的死亡。我们做了几个方法上的改进与之前的数据相比：首先，我们调整了酒精销售预测，以考虑到游客和未记录的消费; 第二，我们对与23个相关健康结果的相对风险进行了新的分析，第三，我们开发了一种新的方法来量化酒精消费水平，最大限度地减少酒精摄入量对个人健康的整体风险。

Findings Globally,alcohol use was the seventh leading risk factor for both deaths and DALYs in2016, accounting for

2•2% (95% uncertainty interval [UI] 1•5–3•0) ofage-standardised female deaths and 6•8% (5•8–8•0) of age-

standardised male deaths. Among the population aged 15–49years, alcohol use was the leading risk factor globally in

2016, with 3•8% (95% UI 3•2–4•3) of female deaths and 12•2%(10•8–13•6) of male deaths attributable to alcohol

use. For the population aged 15–49 years, female attributableDALYs were 2•3% (95% UI 2•0–2•6) and male

attributable DALYs were 8•9% (7•8–9•9). The three leadingcauses of attributable deaths in this age group were

tuberculosis (1•4% [95% UI 1•0–1•7] of total deaths), roadinjuries (1•2% [0•7–1•9]), and self-harm (1•1% [0•6–1•5]).

For populations aged 50 years and older, cancers accountedfor a large proportion of total alcohol-attributable deaths

in 2016, constituting 27•1% (95% UI 21•2–33•3) of totalalcohol-attributable female deaths and 18•9% (15•3–22•6) of

male deaths. The level of alcohol consumption that minimisedharm across health outcomes was zero (95% UI 0•0–0•8)

standard drinks per week

.结果

在全球范围内，酒精使用是2016年死亡和DALYs(疾病负担的综合性指标伤残调整生命年)的第七大风险因素，占龄标准化女性死亡的2.2％，男性死亡的6.8％。在15-49岁的人口中，酗酒是全球的主要风险因素。在15~49岁的人群中，3.8%的女性死亡要归因于酒精，男性占12.2％。结核病（1.4%）、交通事故（1.2%）和自我伤害（1.1%）是与酒精有关的主要死亡原因。

而对于年龄在50岁及以上的人来说，癌症是导致酒精相关死亡的主要原因，女性占27. 1%，男性占18.9%。

总的来说，与不饮酒的人相比，每天一杯会使相关健康风险增加0.5%，每天饮酒5杯风险则增加37％。

Interpretation Alcohol use is a leading risk factor forglobal disease burden and causes substantial health loss. We

found that the risk of all-cause mortality, and of cancersspecifically, rises with increasing levels of consumption, and

the level of consumption that minimises health loss is zero.These results suggest that alcohol control policies might

need to be revised worldwide, refocusing on efforts to loweroverall population-level consumption.

Funding Bill & Melinda Gates Foundation.

Copyright © 2018 The Author(s). Published by Elsevier Ltd.This is an Open Access article under the CC BY 4.0 license.

解释

酒精使用是全球疾病负担的主要风险因素，并导致严重的健康损失。我们

研究发现，全因死亡率和癌症的风险随着消费水平的提高而上升

最小化健康损失的消费水平为零。这些结果表明，酒精控制政策可能会

需要在全球范围内进行修订，重新关注降低总体人口消费水平。

比尔和梅琳达盖茨基金会资助。

版权所有©2018作者。由Elsevier Ltd.出版。这是CC BY 4.0许可下的Open Access文章

Introduction

Alcohol use has a complex association with health.

Researchers have recognised alcohol use as a leading risk

factor for disease burden, and studies link its consumption

to 60 acute and chronic diseases. 1–3 Additionally, some

research suggests that low levels of alcohol consumption

can have a protective effect on ischaemic heart disease,

diabetes, and several other outcomes. 4–6 This finding

remains an open question, and recent studies have

challenged this view by use of mendelian randomisation

and meta-analy

介绍

酒精使用与健康有着复杂的联系。

研究人员已将酒精使用视为主要风险

疾病负担因素，研究发现其与60种急慢性疾病。 1-3节，一些

研究表明，饮酒量低可以对缺血性心脏病有保护作用，

4-6节说明这一发现仍然是一个悬而未决的问题。最近的研

通过使用孟德尔随机化和元分析来证明这种观点。

Determination of harm due to alcohol use is com-

plicated further by the multiple mechanisms through

which alcohol use affects health: through cumulative

consumption leading to adverse effects on organs and

tissues; by acute intoxication leading to injuries or

poisoning; and by dependent drinking leading to

impairments and potentially self-harm or violence. These

effects are also influenced by an individual’s consumption

volume and pattern of drinking. 2 Measuring the health

effects of alcohol use requires careful consideration of all

these factor

确定酒精使用造成的危害是通过多种机制进一步复杂化的。

哪些酒精使用影响健康：通过累积消费导致器官和器官的不良影响器官组织; 急性中毒导致伤害或中毒; 依赖饮酒导致损伤和潜在的自我伤害或暴力。这些效果也受个人消费的影响饮酒的量和模式影响。衡量酒精使用健康状况的影响需要仔细考虑所有这些因素。

《柳叶刀》创刊号

《柳叶刀》于1823年由英国外科医生，同时也是一名国会议员的汤姆·魏克莱（Thomas Wakley）所创刊，他以外科手术刀“柳叶刀”（Lancet）的名称来为这份刊物命名，主要涉及糖尿病、肿瘤、传染病等医学领域的研究。

2

Research in context

Evidence before this study

Although researchers recognise alcohol use as a leading riskfactor

for premature death and disability, some evidence suggeststhat

low intake might have a protective effect on specificconditions

such as ischaemic heart disease and diabetes. Monitoring of

consumption behaviour is required to analyse the healtheffects of

alcohol use. Historically, researchers have relied onself-reported

survey data to estimate consumption levels and trends.However,

these data have systematic biases that make cross-country

comparisons unreliable. The Global Status Report on Alcoholand

Health, as well as previous iterations of the Global Burdenof

Diseases, Injuries, and Risk Factors Study, have sought toproduce

harmonised, cross-country comparisons of alcohol consumption

and its harms, by leveraging data on alcohol sales, theprevalence

of current drinking and abstention, and self-reports of

consumption amounts.

Added value of this study

In this analysis we improved available estimates of alcoholuse and

its associated health burden in five ways. First, weconsolidated

694 individual and population-level data sources to estimate

alcohol consumption levels among current drinkers. Second,

we developed a method to adjust population-level consumption

for alcohol consumed by tourists. Third, we improvedpre-existing

methods that account for unrecorded population-level

consumption. Fourth, we did a new systematic review and

meta-analysis of alcohol use and 23 associated healthoutcomes,

which we used to estimate new dose–response curves ofrelative

risk. Fifth, using the new relative risk curves and a newanalytical

method, we estimated the exposure of alcohol consumption that

minimises an individual’s total attributable risk.

Implications of all the available evidence

The total attributable burden of alcohol use was larger than

previous evidence has indicated and increases monotonically

with consumption. Based on weighted relative risk curves for

each health outcome associated with alcohol use, the level of

consumption that minimises health loss due to alcohol use is

zero. These findings strongly suggest that alcohol control

policies should aim to reduce total population-level

consumption. To potentially reduce the effects of alcohol use

on future health loss, there is a need for countries torevisit

their alcohol control policies and assess how they can be

modified to further lower population-level consumption.

研究背景

虽然研究人员认为对于过早死亡和残疾酒精使用是一个主要的风险因素。一些证据表明

低摄入量可能对特定条件有保护作用，如缺血性心脏病和糖尿病。监测饮酒行为来分析健康的影响。从历史上看，研究人员一直依赖于自我报道调查数据以估算消费水平和趋势。然而，这些数据具有跨国的系统性偏见比较不可靠。关于酒精和饮酒的健康全球状况报告，以及之前的全球负担迭代疾病，伤害和风险因素研究，利用酒精销售数据跨国比较它的危害，以及自我报告

消费金额，增加了本研究的价值。在此分析中，我们改进了可用的酒精使用估计值，廉价评估它对五种相关的健康的作用。首先，我们对694个人和人口年龄通过生活水平的数据来源进行估算其当前饮酒者的酒精消费水平。第二，我们开发了一种调整人口消费水平的方法引入用于游客消费的酒精。第三，我们改进了预先存在的解释未记录的人口消费水平的方法。第四，我们做了一个新的系统评价和酒精使用的荟萃分析和23种相关的健康有关的结果，我们用它来估计相对的新剂量生成反应曲线。第五，使用新的相对风险曲线和新的分析方法，我们估计酒精消费的程度，最小化个人用量。所有证据说明酒精的坏处大于保护。以前的证据只能说明单调增加与消费。基于加权相对风险曲线与酒精使用相关的每种健康结果，最大限度地减少酒精使用造成的健康损失就是消费量为零。这些发现强烈暗示酒精控制政策应旨在降低总人口消费水平。减少酒精使用的影响，关于未来的健康，各国需要重新审视他们的酒精控制政策并评估他们的可能性，进一步降低人口消费水平。

未完待续