【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...2

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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）2

文/李寻的酒吧

Several studies have attempted to address these factors

to provide global estimates of alcohol consumption and its

associated health effects. The most comprehensive among

these studies have been WHO’s Global Status Report on

Alcohol and Health, as well as previous iterations of the

Global Burden of Diseases, Injuries, and Risk Factors

Study (GBD). 11–13 The present study aims to build upon pre-

existing work and to address several limitations found in

earlier research.

First, the available studies have assessed the risk of

alcohol use by relying on external meta-analyses, which do

not control for confounding in the selection of the

reference category within constituent studies. This

approach is problematic because of the so-called sick

quitter hypothesis, which emphasises the importance of

reference category selection in correctly assessing risk

among drinkers, along with other confounding study

characteristics such as survival bias. 8,14–17 Untilrecently,

most meta-analyses of alcohol consumption have not

controlled for the composition of the reference category.

Subsequently, assessments of harm relying on these

studies have been biased. We sought to resolve this issue

within our meta-analyses by including controls for

different reference categories and the average age of

participants.

Second, previous studies have used sales data to estimate

population-level alcohol stock. Researchers have noted the

benefit of using sales data instead of survey data for

quantifying alcohol stock available within a location. 18,19

However, sales data still have bias because of consumption

by tourists and unrecorded consumption from illicit sales,

一些研究试图证明这些因素提供全球饮酒量及其消费量对健康影响。其中最全面的

这些研究是世界卫生组织的酒精和健康全球状况报告，以及之前的迭代全球疾病负担，伤害和风险因素研究（GBD）。 11-13页本研究旨在建立预先现有的工作并解决了发现的一些局限性

早期研究。首先，现有研究评估了风险依赖外部荟萃分析来酗酒中的类别。假设，强调了重要性

正确评估风险的参考类别，选择在饮酒者中类加别，以及其他混淆特征。 8,14-17页直到最近，

大多数酒精消费的荟萃分析都没有控制参考类别的组成。随后，依靠这些评估做研究有偏见。我们试图解决这个问题，通过包含控件来进行元分析不同的参考类别和平均年龄参与者。其次，以前的研究使用销售数据进行估算人口级酒精库存。研究人员已经注意到了使用销售数据而不是调查数据的好处，量化一个地点内可用的酒精库存。但是，消费，销售数据仍然存在偏差因为包含

游客和非法销售的未记录消费，家庭酿造和当地饮料。

home brewing, and local beverages. Without correction for

these factors, estimates relying on sales data can be biased

and lead to inaccurate cross-national comparisons. In the

current study, we adjusted the estimates of population-

level alcohol stock to account for the effects of tourism and

unrecorded consumption.

Third, previous studies have assumed zero as the

counterfactual exposure level that minimises harm. Within

a comparative risk assessment approach, a counterfactual

level of consumption that minimises harm is required

to estimate population attributable fractions (PAFs). 1

However, this counterfactual level needs to be estimated,

rather than assumed, given the complexities involved in

estimating the risk of alcohol use across outcomes. Relying

on this assumption can fail to capture any potential non-

linear effects between alcohol use and health. Our study

proposes a new method for the use of available evidence to

establish a counterfactual level of exposure across varied

relative risks, which provides tangible evidence for low-risk

drinking recommendations.

In the present study, we aimed to address these limita-

tions and provide the best available estimates of alcohol

use and the associated health burden. We estimated the

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.

Figure 1: Age-standardised prevalence of current drinking forfemales (A)

and males (B) in 2016, in 195 locations

Current drinkers are defined as individuals who reportedhaving consumed

alcohol within the past 12 months. ATG=Antigua and Barbuda.VCT=Saint

Vincent and the Grenadines. Isl=Islands. FSM=Federated Statesof Micronesia.

LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste.

这些因素，依赖于销售数据的估计可能存在偏差并导致不准确的跨国比较。

目前的研究，我们调整了人口估计数，酒精储备水平，以及旅游业的影响，未记录的消费。

第三，先前的研究假设为零反事实暴露水平，最大限度地减少伤害。比较风险评估方法，反事实

需要最小化伤害的消费水平，估计人口归因分数（PAFs）。但是，需要估计这种反事实水平，

考虑到所涉及的复杂性，而不是假设估计结果中酒精使用的风险。依托在这个假设下可能无法捕获任何潜在的非酒精使用与健康之间的线性影响。我们的研究提出了一种利用现有证据的新方法

建立一个跨越不同的反事实暴露水平相对风险，为喝酒的低风险提供切实证据。

在本研究中，我们旨在解决这些限制并提供最佳的酒精估算值使用和相关的健康负担。我们估计了研究背景，本研究之前的证据。虽然研究人员认为酒精使用是过早死亡和残疾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

需要消费行为来分析健康的影响酒精使用。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。关于酒精和饮酒的全球健康状况报告，以及之前的全球负担迭代疾病，伤害和风险因素研究，都试图生产酒精消费的统一，跨国比较通过利用酒精销售数据，流行率，它的危害当前的饮酒，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

它有五种相关的健康负担。首先，我们巩固了694个人和人口水平的数据来源进行估算。

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

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水平的方法消费。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种相关的健康结果，我们用它来估计相对的新剂量 - 反应曲线风险。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暴露程度最小化个人的总归属风险。所有可用证据的含说明酒精使用的坏处大于以前的证据并且消费增加。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是使消费量零。这些发现强烈暗示酒精控制政策应旨在降低总人口消费。减少有可能减少酒精使用的影响对未来的健康损失，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，健康以进一步降低人口消费水平。

图1：当前女性饮酒的年龄标准化患病率（A）

和男性（B）在2016年，在195个地点

目前的饮酒者被定义为报告已经消费的个体

过去12个月内饮酒。 ATG =安提瓜和巴布达。 VCT =圣

文森特和格林纳丁斯。 ISL =群岛。 FSM =密克罗尼西亚联邦。

LCA =圣卢西亚。 TTO =特立尼达和多巴哥。 TLS =东帝汶。

事实上，此前有些研究表明中低量饮酒可以降低全因死亡率。然而，这些研究有样本量太小、混杂因素控制不足和计算相对风险的参考类别非最佳选择等限制。最近一些采用孟德尔随机化、汇集队列研究和多变量荟萃分析的高质量研究，越来越多的证据发现饮酒对全因死亡率并无保护作用。

在这次的GBD研究数据中，我们通过图片，可以得出更直接的结论。

3

prevalence of current drinking (having one or more

drinks in the past year); abstention from alcohol (having

no alcohol in the past year); the distribution of alcohol

consumption among current drinkers in standard drinks

daily; and the disease burden attributable to alcohol use,

in terms of deaths and disability-adjusted life-years

(DALYs). We produced these estimates for 195 locations

from 1990 to 2016, for both sexes and for 5-year age

groups between the ages of 15 years and 95 years and

older. We also did a new meta-analysis to assess the dose–

response risk of alcohol consumption for 23 outcomes.

Lastly, we estimated the level of alcohol consumption that

minimises an individual’s total attributable risk of anyhealth loss

prevalence of current drinking (having one or more

drinks in the past year); abstention from alcohol (having

no alcohol in the past year); the distribution of alcohol

consumption among current drinkers in standard drinks

daily; and the disease burden attributable to alcohol use,

in terms of deaths and disability-adjusted life-years

(DALYs). We produced these estimates for 195 locations

from 1990 to 2016, for both sexes and for 5-year age

groups between the ages of 15 years and 95 years and

older. We also did a new meta-analysis to assess the dose–

response risk of alcohol consumption for 23 outcomes.

Lastly, we estimated the level of alcohol consumption that

minimises an individual’s total attributable risk ofanyprevalence of current drinking (having one or more

drinks in the past year); abstention from alcohol (having

no alcohol in the past year); the distribution of alcohol

consumption among current drinkers in standard drinks

daily; and the disease burden attributable to alcohol use,

in terms of deaths and disability-adjusted life-years

(DALYs). We produced these estimates for 195 locations

from 1990 to 2016, for both sexes and for 5-year age

groups between the ages of 15 years and 95 years and

older. We also did a new meta-analysis to assess the dose–

response risk of alcohol consumption for 23 outcomes.

Lastly, we estimated the level of alcohol consumption that

minimises an individual’s total attributable risk of anyhealth loss.

家庭酿造和当地饮料一定要做为参考数据，依赖于销售数据的估计可能存在偏差并导致不准确的跨国比较。目前的研究，我们调整了人口估计数 - 酒精储备水平，包含旅游业的影响未记录的消费。第三，先前的研究假设为零，事实暴露，最大限度地减少伤害。比较风险评估方法，反事实需要最小化伤害的消费水平估计人口归因分数（PAFs）。但是，需要估计这种反事实水平，考虑到所涉及的复杂性，而不是假设估计结果中酒精使用的风险。依托在这个假设下可能无法捕获任何潜在的非酒精使用与健康之间的线性影响。我们的研究提出了一种利用现有证据的新方法建立一个跨越不同的反事实暴露水平，为低风险提供切实证据。在本研究中，我们旨在解决这些限制并提供最佳的酒精估算值使用和相关的健康负担。

研究背景

本研究前的证据虽然研究人员认为酒精使用是对于过早死亡和残疾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。监测需要消费行为来分析健康的影响酒精使用。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。关于酒精和饮酒的全球状况报告健康，以及之前的全球负担迭代疾病，伤害和风险因素研究，都试图生产酒精消费的统一，跨国比较通过利用酒精销售数据，流行率，它的危害当前的饮酒，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它有五种相关的健康负担。首先，我们巩固了694个人和人口水平的数据来源进行估当前饮酒者的酒精消费水平。第二，我们开发了一种用于统计游客消费酒精水平的方法。第三，我们改进了预先存在的解释未记录的人口水平的方法消费。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种相关的健康结果，风险。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暴露程度最小化个人的总归属风险。所有可用证据的含义酒精使用的总归责负担大于以前的证据表明并且单调增加与消费。基于加权相对风险曲线与酒精使用相关的每种健康结果，水平最大限度地减少酒精使用造成的健康损失的消费量零。这些发现强烈暗示酒精控制政策应旨在降低总人口水平消费。有可能减少酒精使用的影响关于未来的健康损失，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修改以进一步降低人口消费水平。

Methods

Study design

This study follows the comparative risk assessment

framework developed in previous iterations of GBD. 20 In

the following sections, we summarise our methods and

briefly present innovations. A full explanation is available

in appendix 1. This study fully adheres to the Guidelines

for Accurate and Transparent Health Estimates Reporting

(GATHER) statement. 21

We estimated alcohol use exposure as grams of pure

ethanol consumed daily by current drinkers (which we

present here in terms of standard drinks daily, defined as

10 g of pure ethyl alcohol). We estimated relative risks by

dose in grams of pure ethyl alcohol, for each included

risk–outcome pair. We ascertained which cause and

injury outcomes to include by reviewing prospective and

observational studies of alcohol use, and then assessing

the causal association using Bradford-Hill’s criteria for

causation. 22 We included 23 outcomes, and the full list of

risk–outcome pairs, as well as the corresponding data

sources, are provided in appendix 1 (pp 52–140).

方法

本研究遵循比较风险评估在以前的GBD迭代中开发的框架。我们总结了我们的方法和简要介绍创新。有完整的解释

附录1.本研究完全符合指南用于准确和透明的健康估计报告（GATHER）声明。 2。1我们估计酒精使用暴露量为纯净克数当前饮酒者每天消耗的乙醇（我们在这里以每日标准饮料的形式出现，定义为10克纯乙醇）。我们通过估算相对风险剂量以克为单位的纯乙醇，每种都包括在内风险 -结果对。我们确定了哪个原因和通过审查前瞻性和预后包括损伤结果酒精使用的观察研究，然后评估使用Bradford-Hill标准的因果关联因果关系。 22我们收录了23项成果，以及完整的清单。风险 - 结果对，以及相应的数据

来源，见附录1（第52-140页）。

未完待续