Articles

National, regional, and global statistics on alcohol

consumption and associated burden of disease 2000–20:
a modelling study and comparative risk assessment
Kevin Shield, Ari Franklin, Ashley Wettlaufer, Ivneet Sohi, Meera Bhulabhai, Elizabeth K Farkouh, Ilinca-Gabriela Radu, Iman Kassam,
Mikayla Munnery, Ronaz Remtulla, Sarah Richter, Farhana Safa, Sara Tasnim, Abhinav Thakral, Mavra Qamar, Jürgen Rehm

Summary
Background Data on alcohol consumption and associated health harms are essential to evaluate progress in achieving Lancet Public Health 2025;
global health goals. This study aims to estimate global alcohol consumption from 2000 to 2020, and the global burden 10: e751–61

of alcohol-attributable harms from 2000 to 2019. See Comment page e723

Institute for Mental Health
Policy Research, Centre for
Methods In this global analysis, adult per capita consumption data estimates were modelled on the basis of sales,
Addiction and Mental Health,
survey, and traveller data. Drinking status and past 30-day heavy episodic drinking were estimated through Toronto, ON, Canada
regression analyses of 540 surveys from 174 countries. Alcohol-attributable harms were estimated using (K Shield PhD, A Franklin MPH,
a comparative risk assessment methodology by combining alcohol consumption data with corresponding relative A Wettlaufer MSc, I Sohi MPH,
M Bhulabhai BASc,
risks obtained from meta-analyses and cohort studies. Mortality and morbidity data were obtained from WHO
E K Farkouh MD, I-G Radu MSc,
Global Health Estimates. I Kassam MHI, M Munnery MSc,
R Remtulla MPH, S Richter MPH,
Findings Globally, average alcohol consumption in 2019 among adults was 5·5 L (95% uncertainty interval 4·9–6·2), F Safa MScCH, S Tasnim MSc,
A Thakral MD, M Qamar MPH,
which increased from 5·1 L (4·6–5·7) in 2000. From 2019 to 2020 alcohol consumption decreased to 4·9 L (4·3–5·6).
Prof J Rehm PhD); Dalla Lana
In 2019, alcohol consumption was associated with 2·6 (2·3–3·1) million deaths (4·7% of all deaths) and 116·0 million School of Public Health,
disability-adjusted life-years (DALYs) lost (4·6% of all DALYs lost). In contrast to alcohol consumption, the number of University of Toronto, Toronto,
alcohol-attributable deaths decreased by 31·0% and DALYs lost per 100 000 people decreased by 27·4% from ON, Canada (K Shield,
Prof J Rehm); Epidemiology and
2000 to 2019. Biostatistics, Schulich School of
Medicine and Dentistry,
Interpretation Alcohol is attributed to a large burden of disease, which disproportionately affects people in Eastern Western University, London,
Europe and in Central and Southern Sub-Saharan Africa, and young people. Accordingly, these regions should ON, Canada (K Shield,
Prof J Rehm); Mayo Clinic Alix
implement policies such as alcohol taxation increases, availability reductions, and marketing restrictions to reduce School of Medicine, Rochester,
alcohol-related harms. MN, USA (E K Farkouh);
Department of Psychiatry,
Funding WHO. University of Toronto, Toronto,
ON, Canada (Prof J Rehm);
Institute of Medical Science,
Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 University of Toronto, Toronto,
license. ON, Canada (Prof J Rehm);
Centre for Interdisciplinary
Addiction Research, University
Introduction consumption and are disproportionately affected by its Medical Center Hamburg-
Alcohol consumption has created, and continues to consequences. This study aimed to provide a regional Eppendorf, Hamburg, Germany
create, substantial health, social, and economic burdens, and global overview of alcohol consumption as a risk (Prof J Rehm); Program on
repres­enting a barrier to achieving the Sustainable factor for burden of disease from 2000 to 2020, by Substance Abuse & WHO
European Region Collaboration
Development Goals globally.1 Although the negative country, sex, and age. The consumption estimates Centre, Public Health Agency of
effects of alcohol on health, social wellbeing, and encompass all relevant dimensions necessary to model Catalonia, Barcelona, Spain
economies have been well established and documented, the alcohol-related burden of disease, including: alcohol (Prof J Rehm)
alcohol remains the most widely consumed psychoactive adult per capita consumption (APC)—measured in Correspondence to:
substance of substantial public health importance.2 High litres of pure alcohol consumed per adult (≥15 years) Dr Kevin Shield, Institute for
Mental Health Policy Research,
consumption persists despite the inclusion of alcohol annually; drinking status (ie, prevalence of past-year Centre for Addiction and Mental
reduction as a key target within the Noncom­municable drinkers, former drinkers, and lifetime abstainers); and Health, Toronto M5T 1R8, ON,
Disease Global Monitoring Framework and the the prevalence of heavy episodic drinking (HED), Canada
Sustainable Development Goals,3 as well as the defined in this study as consuming 60 g or more of [Link]@[Link]

availability of numerous effective policies to reduce ethanol on at least one occasion in the past 30 days. We
alcohol-attributable harms.4 also aimed to examine the changes in APC from 2019 to
To prioritise the implementation of evidence-based 2020 to examine the effect of the COVID-19 pandemic
alcohol control policies, including treatment strategies, and associated policies on APC. Furthermore, the study
it is important to understand which countries and estimated the alcohol-attributable burden of disease
regions experience relatively high levels of alcohol from 2000 to 2019.

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Research in context
Evidence before this study diseases and injuries, and that most countries will not meet
A literature search for publications on the burden of disease the WHO Global Alcohol Action Plan 2022–30 goal of
attributable to alcohol published in English between reducing alcohol consumption by 20% unless additional
Jan 1, 2000, and Sept 17, 2024, was conducted on the Global policies are implemented. Geographical and temporal
Health data exchange, UNICEF Multiple Indicator Cluster differences in alcohol consumption and the impact of alcohol
Surveys, Demographic and Health surveys, WHO Multi-Country were observed in this study. In particular, alcohol-attributable
Studies Data Archive, The Health Navigator, International harms were high in Eastern Europe and, despite a relatively
Household Survey Network, PubMed, Google, and Google low level of alcohol consumption, the alcohol-attributable
Scholar using the term list: (“alcohol” OR “health”) AND “study” burden of disease in Sub-Saharan Africa was also observed to
AND “country name” AND “year”. We also manually searched be high. Furthermore, despite decreases in alcohol-
the WHO Global Health Observatory and the Institute for Health attributable mortality in all other regions, the alcohol-
Metrics and Evaluation research article database. Alcohol is attributable burden of disease increased in the South Asia
a leading contributor to the global burden of disease. Previous region, due to increases in both consumption and alcohol-
estimates of the alcohol-attributable burden of disease enabled attributable harms in India.
cross-country comparisons of alcohol consumption and its
Implications of all the available evidence
harms using data on alcohol sales, the prevalence of drinking
Variations in estimates of alcohol consumption and the
and abstention, and self-reports of consumption, combined
alcohol-attributable burden of disease indicate that a large
with corresponding relative risk functions. These previous
proportion of these burdens is preventable. Although policies
studies observed large differences in the levels of alcohol
affecting consumption have been implemented in some
consumed and resulting alcohol-attributable harms between
countries (eg, China, Lithuania, and Russia), such policies, in
countries, sexes, and age groups.
particular high-impact policies, remain underdeveloped in
Added value of this study many countries. Accordingly, efforts to implement high-impact
This study confirms that alcohol is still a leading risk factor for policies must be intensified.
communicable diseases in addition to non-communicable

Methods APC estimates for 2020 were estimated based on the

Indicators of alcohol consumption calendar year. Data on drinking status and HED were
A deterministic modelling approach was employed to estimated using a modelling approach. The modelled
estimate global alcohol consumption and the resulting estimates were based on survey data collected through
health burdens. This study adheres to the Guidelines for a systematic review. The electronic databases MEDLINE
Accurate and Transparent Health Estimates Reporting and Embase were searched with publication dates
See Online for appendix 1 statement (appendix 1 pp 6–7). The analyses of alcohol restricted to between Jan 1, 2010, and Aug 6, 2019. As we
consumption estimates were preregistered with do not know the global effect of the COVID-19 pandemic
PROSPERO (CRD42020186514). The analyses of alcohol- and associated social distancing policies, or the effect of
attributable harms were not preregistered. As the study policy changes regarding alcohol sales (ie, the expansion
was a secondary analysis of publicly available data, ethics of alcohol sales using online stores, and the temporary
approval and consent were not required. closing of alcohol stores due to social distancing policies6)
To characterise alcohol consumption, we used APC, on either drinking status or the prevalence of HED, we
drinking status, and HED. The definitions of drinking did not report drinking status and HED for 2020. The
status and HED were based on those outlined by web search engines Google and Google Scholar were
WHO.2 Data on alcohol consumption were estimated for searched using the search terms “alcohol population
194 countries (appendix 1 pp 9–15). APC was calculated survey [country] [year]”, where the subsequent country
as the sum of recorded consumption (alcohol consum­ or year combination was searched when no relevant
ption captured through taxation and sales databases) results were obtained after 50 consecutive results. The
and unrecorded consumption (alcohol consumption international databases Global Health Data Exchange,
not captured though taxation or sales databases, UNICEF Multiple Indicator Cluster Surveys, Demo­
eg, homemade or informally produced alcohol, smuggled graphic and Health Surveys, International Household
alcohol, and surrogate alcohol [ie, substances that contain Survey Network, WHO Multi-Country Studies Data
ethanol but are not produced for human consumption, Archive, and International Labour Organization
such as mouthwash and perfumes]) and corrected for the Microdata Repository, and the national statistical services
consumption of both inbound and outbound travellers and ministry of health websites for all countries were
for each country (appendix 1 pp 9–15).5 Presented APC searched. In addition, reference lists of all relevant
values from 2000 to 2019 were 3-year moving averages. reports were reviewed. The results from both published

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survey reports and individual-level survey datasets were were modelled. In estimating the alcohol-attributable
combined with data from a previous systematic review burden of disease, no lag time between alcohol
done by Manthey and colleagues.7 From published consumption and outcome was assumed except for
reports, data were extracted from 560 surveys. The cancer, where a 10-year lag between consumption and
combined systematic review found sex-stratified and age- outcomes was modelled.
stratified aggregate estimates of drinking status or HED The inclusion of diseases was based on a causal
for 179 countries (appendix 1 pp 16–51). association of alcohol, which was assessed by the WHO
To model drinking status, a Dirichlet regression was Technical Advisory Group on Alcohol and Drug
used. To model HED among past-year drinkers, Epidemiology. RR estimates were obtained from meta-
a fractional response regression was used. In both analyses and cohort studies (appendix 1 pp 60–94).
models, APC, gross domestic product based on
purchasing power parity (time-varying across all years), Mortality, morbidity, and population data
Global Burden of Disease (GBD) regions, Muslim Data on mortality, years of life lost (YLL), and morbidity
population size (time-varying across all years), and (years lived with disability [YLD] and disability-adjusted
Muslim-majority countries with alcohol prohibitions life-years [DALYs] lost) were obtained from the WHO
were entered as covariates. The prevalence of past-year Global Health Estimates;10 data were available by year
abstainers (obtained from the Dirichlet regression) (2000–19), country, age, and sex, as well as by cause of
was also used to predict the prevalence of HED. mortality and morbidity.
Regression models for drinking status and HED also Population data by country, age, sex, and year were
included covariates for sex (male or female) and age obtained from the UN Population Division (2022
(15–19, 20–24, 25–34, 35–49, 50–64, and ≥65 years). revisions).11 Age-standardised rates were estimated on
Interaction terms in both models were included to the basis of the WHO standard population.12 To match
account for the hypothesised interaction between age age-standardisation data, deaths, YLL, YLD, and DALYs
and sex. To account for differences in the timeframe lost were aggregated into 5-year age groups, from 0 years
used to define current and former drinking (with the to 84 years, with a final category of 85 years and older.
past year as the reference category) and HED (with The alcohol population-attributable fractions were
the past month or 28 days as the reference category), applied to mortality and morbidity age groupings, which
covariates were used in the regression models. were encompassed within the alcohol population-
A covariate for the threshold used to define HED (≥60 g attributable fraction age groupings.
per occasion as the reference category) was also used. Data were aggregated by GBD regions and according to
To model alcohol consumption among current the 2019 Human Development Index (HDI) categories
drinkers, APC was separated by age and sex (appendix 1 (appendix 1 pp 95–97).13,14
p 52). Average daily alcohol consumption among current
drinkers was modelled using a gamma distribution in Estimates of uncertainty
accordance with the methodology outlined by Kehoe Estimates of uncertainty (ie, 95% uncertainty intervals)
and colleagues, whereby the distribution of alcohol were constructed using 1000 simulated estimates
consumption is predicted on the basis of the mean generated through a Monte Carlo-type approach. Each
consumption.8 A correction factor of 0·8 was applied simulated estimate of alcohol consumption was derived
to APC data when modelling the alcohol-attributable from its respective underlying uncertainty distribution.
burden of disease to account for alcohol that was Simulated estimates of the alcohol-attributable burden
not consumed and the under-reporting of alcohol of disease were based on simulated alcohol consumption
consumption in observation studies from which the estimates, combined with corresponding simulated
relative risks (RRs) were obtained. The exact level of RR functions. Because the WHO Global Health
alcohol not consumed and under-reporting of alcohol in Estimates and UN population estimates do not include
observation studies are currently unknown, but 0·8 is in measures of uncertainty, the uncertainty in the burden
line with the undercoverage observed in a systematic of disease estimates and population data are not
review by Stockwell and colleagues of alcohol reflected in the 95% uncertainty intervals. To construct
consumption in cohort studies compared with APC the 95% uncertainty intervals, the 2·5th and 97·5th
estimates.9 percentiles of the 1000 simulations were used.
The number of simulations was chosen based on
Alcohol-attributable burden of disease a simulation study that examined the stability of
The alcohol-attributable burden of disease for 95% uncertainty intervals constructed using
2000 to 2019 was modelled using a Levin-based 1000 simulations.15
population-attributable fraction method based on the
theoretical minimum risk exposure level of lifetime Role of the funding source
abstention from alcohol (appendix 1 p 54). Both the The funder of the study had no role in study design, data
detrimental and protective health effects of alcohol collection, data analysis, interpretation of data, writing of

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Total adult per capita

consumption of alcohol (litres)
>10·8
>9·3–10·8
>6·6–9·3
>4·2–6·6
>1·6–4·2
0·4–1·6
<0·4
No data (not estimated)
Not applicable

Figure 1: Per capita consumption of alcohol among adults in 2019, by country

Absolute change in adult

per capita consumption (litres)
2019–20
>0·6
>0·2 to 0·6
>0·0 to 0·2
>–0·2 to 0·0
–0·6 to –0·2
<–0·6
No data
Not applicable

Figure 2: Change in per capita consumption of alcohol among adults from 2019 to 2020, by country

the report, or the decision to submit the paper for APC also showed a clear gradient by HDI grouping,
publication. ranging from 2·9 L (2·5–3·5) for low-HDI countries to
See Online for appendix 2 8·7 L (8·0–9·5) for high-HDI countries (appendix 2
Results sheets 1–2).
Globally, APC was 5·5 L (95% uncertainty interval Globally, from 2000 to 2019, APC increased by 17·4%,
4·9–6·2) in 2019, with an estimated 89·9% of APC from 5·1 L (95% uncertainty interval 4·6–5·7) to 5·5 L
coming from recorded sources (4·3 L [3·8–4·8]) and (4·9–6·2). At the regional level, the largest increases
11·1% coming from unrecorded sources (1·2 L [0·8–1·6]). were observed for South Asia (149·1% increase; 1·6 L
The highest levels of alcohol consumption were observed [0·4–2·9] to 3·9 L [2·1–5·8]), East Asia (57·1% increase;
in Central Europe (11·7 L [10·3–13·2]), Eastern Europe 3·6 L [1·9–5·5] to 5·7 L [3·5–7·9]), and Southeast Asia
(10·1 L [7·7–12·5]), and Australasia (10·1 L [7·6–12·5]); (46·2% increase; 2·6 L [2·1–3·3] to 3·9 L [3·2–4·7]),
alcohol consumption was lowest in North Africa and the whereas Central Sub-Saharan Africa (51·6% decrease;
Middle East (0·6 L [0·4–1·0]), Oceania (1·8 L [0·9–3·0]), 7·1 L [5·0–9·2] to 3·4 L [2·3–4·6]), Western Sub-Saharan
and Central Sub-Saharan Africa (3·4 L [2·3–4·6]; figure 1, Africa (26·8% decrease; 5·8 L [4·4–7·2] to 4·2 L
appendix 1 p 103). At the country level, APC was highest [3·2–5·3]), and Eastern Europe (21·3% decrease; 12·9 L
in Romania (17·0 L [12·6–21·4]), followed by Georgia [10·2–15·5] to 10·1 L [7·7–12·5]) had the largest decreases
(14·3 L [9·9–18·8]) and Czechia (13·3 L [10·1–16·6]). in APC. In 2020, the COVID-19 pandemic had a marked

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Alcohol-attributable burden* Age-adjusted alcohol-attributable burden per Population-attributable fraction (%)*

100 000 people*
Deaths (1000s) DALYs lost (100 000s) Deaths DALYs lost Deaths DALYs lost
All causes 2624·4 (2288·1 to 3072·8) 1158·9 (1023·8 to 1346·3) 32·3 (28·2 to 37·8) 1474·8 (1304·1 to 1715·6) 4·7 (4·1 to 5·6) 4·6 (4·1 to 5·3)
Communicable, maternal, 284·1 (130·4 to 447·5) 118·3 (50·5 to 195·3) 3·5 (1·6 to 5·6) 152·6 (64·5 to 252·7) 2·8 (1·3 to 4·4) 1·7 (0·7 to 2·9)
perinatal, and nutritional
conditions
Tuberculosis 190·0 (50·0 to 351·9) 92·0 (25·2 to 169·0) 2·4 (0·6 to 4·5) 119·6 (32·9 to 219·8) 15·8 (4·2 to 29·2) 14·0 (3·8 to 25·7)
Sexually transmitted 0·1 (0·0 to 0·1) 0·2 (0·1 to 0·3) 0·0 (0·0 to 0·0) 0·3 (0·2 to 0·4) 0·1 (0·1 to 0·2) 0·4 (0·3 to 0·6)
diseases excluding HIV
HIV/AIDS 15·4 (10·2 to 21·0) 8·4 (5·6 to 11·4) 0·2 (0·1 to 0·3) 10·9 (7·3 to 14·9) 2·3 (1·5 to 3·2) 2·1 (1·4 to 2·9)
Lower respiratory infections 78·5 (32·2 to 125·8) 17·7 (7·9 to 27·5) 0·9 (0·4 to 1·5) 21·7 (9·7 to 33·7) 3·0 (1·2 to 4·9) 1·7 (0·8 to 2·6)
Non-communicable 1616·8 (1371·3 to 1905·2) 604·7 (549·4 to 659·9) 19·6 (16·7 to 22·9) 757·9 (690·3 to 825·4) 4·0 (3·4 to 4·7) 3·8 (3·5 to 4·2)
diseases
All malignant neoplasms 400·9 (350·2 to 449·3) 106·6 (92·8 to 119·3) 4·8 (4·2 to 5·4) 130·0 (113·1 to 145·6) 4·3 (3·8 to 4·8) 4·4 (3·8 to 4·9)
Lip and oral cavity 52·8 (42·8 to 61·9) 15·5 (12·4 to 18·2) 0·6 (0·5 to 0·7) 19·0 (15·2 to 22·4) 27·5 (22·3 to 32·3) 27·5 (22·1 to 32·4)
malignant neoplasms
Other pharynx malignant 42·4 (33·6 to 49·6) 12·4 (9·7 to 14·5) 0·5 (0·4 to 0·6) 15·2 (11·9 to 17·8) 34·8 (27·6 to 40·8) 35·3 (27·7 to 41·3)
neoplasms
Oesophageal cancer 83·0 (64·3 to 100·2) 21·3 (16·6 to 25·6) 1·0 (0·8 to 1·2) 25·8 (20·1 to 31·0) 17·9 (13·9 to 21·7) 18·6 (14·5 to 22·3)
Colon and rectum cancers 105·9 (87·7 to 126·2) 25·0 (20·6 to 30·1) 1·3 (1·0 to 1·5) 30·3 (25·0 to 36·4) 11·6 (9·6 to 13·8) 11·6 (9·5 to 13·9)
Liver cancer 64·2 (43·3 to 93·4) 16·4 (10·9 to 23·9) 0·8 (0·5 to 1·1) 20·1 (13·4 to 29·2) 11·1 (7·5 to 16·2) 10·5 (7·0 to 15·2)
Breast cancer 27·6 (20·5 to 35·5) 8·8 (6·5 to 11·3) 0·3 (0·2 to 0·4) 10·9 (8·1 to 14·0) 4·3 (3·2 to 5·6) 4·5 (3·3 to 5·7)
Cervix uteri cancer 1·4 (0·8 to 2·4) 0·5 (0·3 to 0·9) 0·0 (0·0 to 0·0) 0·7 (0·4 to 1·2) 0·5 (0·3 to 0·8) 0·5 (0·3 to 0·9)
Larynx cancer 23·7 (17·9 to 29·6) 6·6 (4·9 to 8·2) 0·3 (0·2 to 0·4) 8·0 (6·0 to 9·9) 21·0 (15·9 to 26·3) 21·5 (16·0 to 26·7)
Diabetes –5·2 (–23·2 to 16·3) –4·4 (–13·9 to 6·9) –0·1 (–0·3 to 0·2) –5·3 (–16·9 to 8·5) –0·3 (–1·6 to 1·1) –0·6 (–2·0 to 1·0)
Alcohol use disorders 156·5 (156·5 to 156·5) 193·1 (193·1 to 193·1) 2·0 (2·0 to 2·0) 248·6 (248·6 to 248·6) 100·0 (100·0 to 100·0) 100·0 (100·0 to 100·0)
Epilepsy 13·2 (10·1 to 16·2) 11·9 (9·2 to 14·5) 0·2 (0·1 to 0·2) 15·4 (11·9 to 18·8) 11·4 (8·7 to 14·0) 9·1 (7·1 to 11·1)
All cardiovascular diseases 473·6 (252·9 to 743·4) 103·0 (61·7 to 149·0) 5·6 (3·0 to 8·6) 125·1 (75·4 to 179·2) 2·7 (1·4 to 4·2) 2·7 (1·6 to 3·8)
Hypertensive heart disease 57·1 (41·0 to 71·9) 11·9 (8·7 to 14·8) 0·7 (0·5 to 0·8) 14·3 (10·4 to 17·8) 5·0 (3·6 to 6·3) 5·4 (3·9 to 6·8)
Ischaemic heart disease 208·3 (–6·4 to 422·2) 31·7 (–3·8 to 66·1) 2·4 (–0·1 to 4·8) 37·1 (–4·9 to 77·6) 2·3 (–0·1 to 4·8) 1·8 (–0·2 to 3·7)
Ischaemic stroke –65·5 (–144·6 to 40·8) –14·7 (–27·2 to 3·0) –0·7 (–1·6 to 0·5) –17·5 (–31·9 to 2·9) –2·1 (–4·7 to 1·3) –2·4 (–4·5 to 0·5)
Haemorrhagic stroke 244·7 (172·9 to 330·4) 64·6 (46·1 to 86·3) 2·9 (2·1 to 3·9) 79·1 (56·5 to 105·5) 7·8 (5·5 to 10·6) 8·2 (5·9 to 11·0)
Alcoholic cardiomyopathy 29·0 (29·0 to 29·0) 9·6 (9·6 to 9·6) 0·4 (0·4 to 0·4) 12·0 (12·0 to 12·0) 100·0 (100·0 to 100·0) 100·0 (100·0 to 100·0)
All digestive diseases 578·0 (490·8 to 660·3) 194·4 (165·1 to 219·6) 7·1 (6·0 to 8·1) 244·1 (207·2 to 275·6) 23·6 (20·0 to 26·9) 22·2 (18·9 to 25·1)
Cirrhosis of the liver† 550·3 (465·7 to 632·6) 184·6 (155·9 to 210·3) 6·8 (5·7 to 7·8) 231·7 (195·6 to 263·9) 41·9 (35·5 to 48·2) 43·2 (36·5 to 49·2)
Pancreatitis 27·7 (20·2 to 36·3) 9·8 (7·1 to 12·8) 0·3 (0·2 to 0·4) 12·4 (9·0 to 16·2) 25·5 (18·6 to 33·4) 27·9 (20·3 to 36·4)
Injuries 723·5 (563·0 to 948·6) 435·9 (342·8 to 571·6) 9·2 (7·2 to 12·1) 564·3 (444·2 to 739·5) 16·4 (12·8 to 21·6) 16·8 (13·2 to 22·0)
Unintentional injuries 520·7 (401·6 to 709·7) 330·8 (257·1 to 443·6) 6·6 (5·1 to 9·0) 426·6 (331·2 to 572·0) 16·5 (12·7 to 22·5) 17·3 (13·4 to 23·2)
Road injury 297·5 (198·1 to 454·0) 187·5 (125·1 to 284·6) 3·8 (2·5 to 5·8) 244·0 (162·6 to 370·4) 23·3 (15·5 to 35·5) 23·8 (15·9 to 36·1)
Poisonings 10·8 (7·9 to 14·6) 5·1 (3·7 to 6·9) 0·1 (0·1 to 0·2) 6·6 (4·8 to 8·9) 12·8 (9·4 to 17·3) 10·8 (7·8 to 14·4)
Falls 75·1 (49·1 to 110·0) 55·3 (38·2 to 76·1) 0·9 (0·6 to 1·3) 69·4 (47·9 to 95·4) 11·0 (7·2 to 16·1) 14·5 (10·0 to 19·9)
Fire, heat, and hot 12·4 (9·4 to 16·2) 8·9 (6·4 to 11·9) 0·2 (0·1 to 0·2) 11·4 (8·3 to 15·3) 10·9 (8·2 to 14·3) 10·9 (7·9 to 14·6)
substances
Drowning 27·2 (18·0 to 38·1) 12·3 (8·1 to 17·3) 0·3 (0·2 to 0·5) 16·1 (10·6 to 22·6) 11·6 (7·6 to 16·2) 9·2 (6·1 to 12·9)
Exposure to mechanical 15·8 (9·9 to 22·8) 19·2 (12·8 to 26·5) 0·2 (0·1 to 0·3) 24·6 (16·4 to 33·9) 13·0 (8·2 to 18·8) 16·0 (10·7 to 22·1)
forces
Other unintentional injuries 82·0 (55·1 to 113·2) 42·5 (28·6 to 58·1) 1·0 (0·7 to 1·4) 54·5 (36·7 to 74·6) 13·0 (8·7 to 18·0) 12·1 (8·2 to 16·6)
Intentional injuries 202·8 (93·9 to 310·9) 105·1 (47·7 to 161·2) 2·6 (1·2 to 4·0) 137·8 (62·3 to 211·5) 16·3 (7·5 to 24·9) 15·3 (6·9 to 23·4)
Self-harm 123·2 (62·7 to 184·1) 56·8 (28·8 to 84·2) 1·6 (0·8 to 2·4) 74·0 (37·5 to 109·6) 17·5 (8·9 to 26·2) 17·8 (9·1 to 26·5)
Interpersonal violence 79·6 (32·4 to 126·9) 48·3 (19·8 to 76·9) 1·0 (0·4 to 1·7) 63·8 (26·0 to 101·7) 16·8 (6·8 to 26·8) 16·0 (6·5 to 25·5)

Data are median (95% uncertainty interval). DALY=disability-adjusted life-year. *Negative values represent deaths and DALYs avoided due to alcohol consumption (ie, negative numbers indicate there would be an
increase in the number of deaths or DALYs lost under the counterfactual scenario of everyone being a lifetime abstainer). †Includes ICD-10 codes K70 (alcoholic liver disease) and K74 (fibrosis and cirrhosis of the liver).

Table: Alcohol-attributable burden of disease in 2019, by cause

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Age-standardised
alcohol-attributable deaths
per 100 000 people
>74·2
>53·1–74·2
>37·8–53·1
>26·4–37·8
>15·7–26·4
8·8–15·7
<8·8
No data (not estimated)
Not applicable

Age-standardised
alcohol-attributable DALYs
lost per 100 000 people
>3151
>2283–3151
>1732–2283
>1386–1732
>800–1386
364–800
<364
No data (not estimated)
Not applicable

Figure 3: Age-standardised alcohol-attributable deaths per 100 000 people (A) and population attributable fraction for the proportion of deaths attributable
to alcohol consumption (B) in 2019, by country
DALY=disability-adjusted life-year.

effect on APC, with alcohol consumption decreasing by population varied widely across the globe. The highest
11·1% since 2019 to 4·9 L (4·3–5·6). However, from 2019 prevalence of current drinking was in Western Europe
to 2020, 23 (12%) of 189 countries had increases in APC (77·4% [77·0–77·8]), high-income North America (70·9%
of 0·1 L or greater, 116 (61%) countries had a decrease in [69·7–72·2]), and Central Europe (70·7% [70·1–71·3]),
APC of 0·1 L or greater, and 50 (26%) countries had whereas the lowest prevalence of current drinkers was
a change in APC of less than 0·1 L (figure 2; appendix 1 in North Africa and the Middle East (6·2% [5·9–6·4]),
pp 99, 103; appendix 2 sheets 1–2). Central Asia (21·4% [20·3–22·5]), and South Asia
Globally, in 2019, most people did not consume alcohol (25·5% [23·4–27·6]). The highest prevalence of HED
in the past year (current drinking 43·8% [95% uncertainty was in high-income Asia–Pacific (43·2% [42·1–44·4]),
interval 42·8–44·8]) or engage in HED (16·7% [14·5–18·9]; Australasia (39·5% [37·0–42·1]), and Central Sub-Saharan
appendix 1 pp 103–04, appendix 2 sheets 4–5). The Africa (36·7% [35·4–38·1]), whereas the lowest prevalence
prevalence of current drinking was higher among male of HED was in North Africa and the Middle East (1·3%
(52·2% [51·3–53·2]) compared with female (35·4% [1·2–1·4]), Central Asia (7·9% [7·6–8·1]), and South Asia
[34·3–36·5]) individuals. Similarly, the prevalence of (9·9% [9·0–10·8]). The prevalence of current drinking
HED was higher among male (23·5% [20·4–26·6]) and HED also showed a clear association with
compared with female (9·7% [8·4–10·9]) individuals. The HDI groupings, ranging from a prevalence of 19·8%
prevalence of current drinkers and HED in the adult (19·3–20·3) for current drinkers and 9·9% (9·7–10·1) for

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HED in low-HDI countries to a prevalence of 64·0%

A
(63·6–64·4) for current drinkers and 29·4% (28·9–29·9)
Central Asia
for HED in very high-HDI countries (appendix 1 Central Europe
pp 100, 102, 104). Eastern Europe
Australasia
Alcohol consumption resulted in an estimated High-income Asia Pacific
2·6 (95% uncertainty interval 2·3–3·1) million deaths High-income North America
(4·7% [4·1–5·6] of all deaths) and 116·0 million DALYs Southern Latin America
Western Europe
lost (4·6% [4·1–5·3] of all DALYs lost) in 2019 Andean Latin America
(table, figure 3). Deconstructed, 89·6 (78·0–105·3) Caribbean Infectious diseases
Central Latin America Malignant neoplasms
million DALYs lost were attributed to premature mortality Tropical Latin America Diabetes
(ie, YLL), representing 5·3% (4·6–6·2) of all YLL, and North Africa and Middle East Alcohol use disorders
South Asia Epilepsy
26·4 (24·1–29·8) million DALYs lost were attributed to East Asia Cardiovascular diseases
morbidity (ie, YLD), representing 3·2% (2·9–3·6) of all Oceania Digestive diseases
YLD (appendix 1 pp 110–12). Male individuals had Southeast Asia Road injuries
Central Sub-Saharan Africa Unintentional injuries
a larger number of deaths attributable to alcohol Eastern Sub-Saharan Africa (excluding road injuries)
(2·0 [1·7–2·4] million, representing 6·7% [5·6–7·9] of Southern Sub-Saharan Africa Intentional injuries
Western Sub-Saharan Africa
all deaths) compared with female individuals (0·6
–20 0 20 40 60 80 100 120 140 160
[0·5–0·8] million, representing 2·4% [1·8–3·2] of all
Alcohol-attributable deaths per 100 000 people
deaths). Similarly, male individuals had a larger number
of DALYs lost attributable to alcohol (92·7 [79·6–108·0] B
million DALYs lost, representing 6·9% [5·9–8·0] of all Central Asia
DALYs lost) compared with female individuals (23·2 Central Europe
Eastern Europe
[20·6–28·4] million DALYs lost, representing 2·0% Australasia
[1·8–2·4] of all DALYs lost; appendix 1 pp 105–06). High-income Asia Pacific
High-income North America
Globally, alcohol consumption was a large contributor Southern Latin America
to the burden of communicable, maternal, perinatal, and Western Europe
Andean Latin America
nutritional conditions, with 0·3 (95% uncertainty interval Caribbean
0·1–0·4) million alcohol-attributable deaths (2·8% Central Latin America
[1·3–4·4] of total) and 11·8 (5·1–19·5) million alcohol- Tropical Latin America
North Africa and Middle East
attributable DALYs lost (1·7% [0·7–2·9] of total); to South Asia
the burden of non-communicable diseases, alcohol East Asia
Oceania
contributed 1·6 (1·4–1·9) million deaths (4·0% [3·4–4·7] Southeast Asia
of total) and 60·5 (54·9–66·0) million DALYs lost Central Sub-Saharan Africa
Eastern Sub-Saharan Africa
(3·8% [3·5–4·2] of total); and to the burden of injuries, Southern Sub-Saharan Africa
alcohol contributed 0·7 (0·6–0·9) million deaths Western Sub-Saharan Africa
(16·4% [12·8–21·6] of total) and 43·6 million (34·3–57·2) –1000 0 1000 2000 3000 4000 5000 6000 7000 8000 9000
DALYs lost (16·8% [13·2–22·0] of total; table). Alcohol-attributable DALYs lost per 100 000 people
At the regional level, the alcohol-attributable age-
Figure 4: Age-standardised rates of alcohol-attributable deaths and DALYs lost, by cause and region
standardised death and DALYs lost rates were highest in DALY=disability-adjusted life-year.
the Eastern Europe and Central and Southern Sub-
Saharan Africa regions, and lowest in the North Africa for deaths (from 46·8 [41·9–55·1] to 32·3 [28·2–37·8]
and Middle East region (figure 4). At the country level, deaths per 100 000 people) and by 27·4% for DALYs lost
the alcohol-attributable age-standardised death rates (from 2030·8 [1832·0–2330·3] to 1474·8 [1304·1–1715·6]
were highest in Belarus (164·3 [147·5–179·4] per 100 000), DALYs lost per 100 000 people); these decreases were
Moldova (162·3 [142·2–181·3] per 100 000), and Ukraine similar in magnitude to the relative decreases in
(156·9 [135·4–173·8] per 100 000). The numbers of the age-standardised rates of all deaths of 29·8%
alcohol-attributable age-standardised DALYs lost were (944·5 to 663·3 deaths per 100 000 people) and all
highest in Russia (5772·4 [5153·6–6196·3] per 100 000), DALYs lost of 29·2% (45 083·5 to 31 910·6 DALYs per
Ukraine (5667·9 [4961·9–6170·6] per 100 000), and 100 000 people).10 From 2000 to 2019, alcohol-attributable
Belarus (5596·2 [5146·3–5972·4] per 100 000; appendix 2 cardiovascular deaths (48·9% decrease, from 10·9
sheets 5–6). [7·7–15·6] to 5·6 [3·0–8·6] deaths per 100 000 people)
In 2000, 2·5 (95% uncertainty interval 2·2–2·9) million and DALYs lost (49·0% decrease, from 245·1
deaths and 113·2 (101·8–130·5) million DALYs lost [190·9–322·9] to 125·1 [75·4–179·2] DALYs lost per
globally were attributable to alcohol, representing 100 000 people) proportionally changed more than any
4·9% (4·3–5·7) of all deaths and 4·2% (3·8–4·9) of all other alcohol-related disease or injury. At the regional
DALYs lost globally. From 2000 to 2019, the alcohol- level, the largest decreases in alcohol-attributable deaths
attributable age-standardised rates decreased by 31·0% per 100 000 people were observed for the Eastern

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European (46·3% decrease, from 268·6 [251·3–284·8] intake and negative effects on infectious diseases,
to 147·3 [133·5–158·3] deaths per 100 000 people), cardiovascular diseases, and injuries.18 In Central and
Central Sub-Saharan Africa (45·2% decrease, from Southern Sub-Saharan Africa, although alcohol
120·5 [93·5–144·8] to 68·5 [54·0–89·9] deaths per consumption is relatively low, the high prevalence of
100 000 people), and high-income Asia–Pacific (43·2% infectious diseases and liver cirrhosis amplifies the
decrease, from 35·6 [30·3–41·5] to 19·1 [15·9–22·4] burden of alcohol.10
deaths per 100 000 people) regions. Unlike other regions, At the country level, stronger alcohol-related policies
which all saw a decrease, the South Asia region had have been associated with lower rates of chronic liver
a 23·2% increase in alcohol-attributable deaths per disease, hepatocellular carcinoma, other neoplasms, and
100 000 people (from 26·3 [18·4–42·0] to 32·4 [23·4–41·6] cardiovascular disease.19 These policies include the WHO
deaths per 100 000 people), which was primarily due “best buys” of increases in taxation, restrictions in
to an increase in the deaths attributable to alcohol availability, and restrictions in marketing, and WHO
consumption per 100 000 people in India (26·3% SAFER, which includes the “best buys” of screening and
increase, from 30·5 [20·5–49·4] to 38·5 [27·2–49·5] brief interventions for harmful use of alcohol and the
deaths per 100 000 people). This contrasts with enforcement of drink-driving laws.4 However, unlike
a 33·2% decrease in all-cause mortality in the South Asia other psychoactive substances that exert substantial
region (from 1251·1 to 835·3 deaths per 100 000 people) effects on global health, alcohol is not regulated at the
and a 35·1% decrease in all-cause mortality in India international level by legally binding regulatory
(from 1268·7 to 823·4 deaths per 100 000 people) during instruments.
the same time period (appendix 2 sheets 5–6). In the present study, we observed a strong gradient in
As a sensitivity analysis, we examined the effect of alcohol consumption, where consumption was lowest in
using a 1-year estimate of APC for 2019 when compared low-HDI regions and highest in high-HDI regions. Using
with 2020. A similar estimate was observed for the these data, we hypothesise that as countries develop there
change in APC from 2019 to 2020 when APC in 2019 was will be an increase in alcohol consumption in most
based on a 1-year estimate, with alcohol consumption countries, and the harms caused by the increase in alcohol
decreasing by 7·6% from 5·3 L (4·7–6·0) in 2019 to 4·9 L consumption will, in part, offset some of the health gains
(4·3–5·6) in 2020. from development (how development will affect alcohol
consumption in Muslim-majority countries is unknown).
Discussion Of note is the large increase in alcohol consumption and
This study provides a comprehensive overview of the alcohol-related harms in countries such as India and Viet
changing landscape in both alcohol consumption and Nam, with alcohol-attributable mortality rates increasing
the associated health harms. Globally, most adults do not despite a decrease in overall mortality rates.
consume alcohol, and most people who do consume Although not discussed in this paper, alcohol
alcohol do not engage in HED; however, current levels of disproportionately affects certain populations, including
alcohol consumption and HED still cause substantial adolescents (who are often targeted by alcohol advert­
health harms globally. The results of this study also isements20 and face higher risks of injury and brain
highlight substantial sex, geographical, and temporal development issues21), young women (who have rising
differences in alcohol consumption and the attributable alcohol-related liver disease and alcohol use disorders22),
burden of disease. and people of lower socioeconomic status.23 Accordingly,
Notable decreases in alcohol consumption were alcohol policies—such as restricting advertisements,20
observed in Eastern Europe and Central Sub-Saharan zoning laws for retail establishments,24 and taxation25—
Africa. The factors driving changes in alcohol should be prioritised to achieve health equity for these
consumption in Central Sub-Saharan Africa are not well groups.
documented and warrant further investigation. In The alcohol consumption and alcohol-attributable
Eastern Europe, the decline has largely been attributed to burden of disease estimates presented in this study are
alcohol policies, such as restrictions on marketing and limited by multiple factors. Drinking status and HED
availability, increased excise taxes, minimum pricing for estimates are based on surveys. Accordingly, we expect
vodka, and efforts to reduce unrecorded consumption in the prevalence of HED to be underestimated owing to
Russia since 2004.16 Policies in Lithuania and Estonia, populations excluded due to the design of the survey,
including regulations on availability, advertising, participation bias, and social desirability bias.26 The
taxation, and drink-driving, have also contributed to measure of HED is limited by the binary categorisation
reduced consumption and alcohol-related harms.17 of yes and no, which does not consider variations in
Despite decreases in consumption, the alcohol- intensity or frequency. This is especially relevant for
attributable burden in 2019 was highest in Eastern Eastern European countries, where people engage in
Europe, Central Sub-Saharan Africa, and Southern Sub- dynamic drinking patterns of continuous alcohol intake
Saharan Africa. In Eastern Europe, the burden is largely (markedly exceeding 60 g of alcohol per day) over several
driven by HED, with prolonged periods of heavy alcohol days or weeks.27

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The APC data from 2000 to 2019 are 3-year averages. The uncertainty intervals are likely to underestimate
Thus, the data might hide yearly fluctuations in alcohol the true error, as error estimates for global health
consumption. The choice of a correction factor of 0·8 estimates of mortality, morbidity, and population data
applied to APC data, although in line with a systematic were unavailable and not considered. Additionally, the
review by Stockwell and colleagues,9 could have consumption and burden estimates do not account for
an effect on our findings, although whether this effect systematic errors (eg, those introduced by human
would cause an underestimation or overestimation is judgement in selecting regression models, covariates,
unknown. More research is needed here to determine and RRs35) that could affect the overall uncertainty.
what the appropriate correction factor should be. Finally, when comparing our estimates with those of the
Moreover, the burden of disease estimates presented Global Burden of Diseases, Injuries, and Risk Factors
in this study are limited by current knowledge of Study (GBD) 2021,36 the following points deserve attention.
the causal relationship between alcohol consumption The estimate of 2·6 million deaths attributable to alcohol
and the development of disease. Future causality presented in this study is different from that presented in
assessments could lead to additions or exclusions the Institute for Health Metrics and Evaluation (IHME)
of diseases and injuries attributable to alcohol GBD Study, which estimates that 1·8 million deaths in
consumption. 2019 were attributable to high alcohol consumption
The RR estimates used in this study were selected by the (appendix 1 pp 105–06).36 Estimates of alcohol-attributable
WHO Technical Advisory Group on the basis of majority infectious diseases were appreciably different between
consensus. This approach might bias the selection of the studies (284 100 in this study compared with the IHME
RRs. To reduce the random error introduced by expert estimate of 136 800). This is in large part due to GBD
decisions, ideally, a Delphi study or other systematic estimates not including alcohol-attributable deaths from
methods to deal with decision making under uncertainty lower respiratory infections (78 500 deaths in this study),
can assist in making important judgements.28 The RR sexually transmitted diseases excluding HIV (100 deaths in
estimates used were obtained from studies that used this study), and HIV/AIDS (15 400 deaths in this study).
lifetime abstention or abstainers as the reference category. Additionally, our study estimated 723 500 alcohol-
People choose to be lifetime abstainers from alcohol attributable injury deaths and the IHME GBD study
consumption for various potentially confounding reasons, estimated 187 900 alcohol-attributable injury deaths. In
including religion and health.29 The use of abstainers as both cases, the largest category of alcohol-attributable
the reference category is also problematic as abstainers injuries was from road injuries, with 297 500 alcohol-
often include people who are so-called sick quitters, ie, attributable deaths in the present study and
people who have stopped drinking for health reasons. 45 400 alcohol-attributable deaths estimated by IHME.
Therefore, this use of reference category might lead to Injury registry data from Brazil (10 900 alcohol-attributable
an underestimation of the risk of disease among drinkers.30 deaths in 2021), China (48 800 alcohol-attributable
The WHO’s Global Health Estimates combine data deaths; yearly average from 2001 to 2016), and the USA
for both type 1 and type 2 diabetes. Type 2 diabetes (10 100 alcohol-attributable deaths in 2019) suggest that the
accounts for the majority of diabetes cases globally.31 burden estimated by IHME is underestimated.37–39 In
The present study modelled the effect of alcohol use on addition, IHME GBD basing injury outcomes on the
diabetes by applying an RR function for type 2 diabetes average level of drinking is potentially problematic, as
to an aggregated category, which includes both type 1 injuries are strongly linked to HED.32
and type 2 diabetes.32 Although alcohol consumption is Our RR approach to model the burden of injuries
a known causal risk factor for the development of type 2 attributable to alcohol consumption also has limitations.
diabetes,32 less is known about its effects on type 1 Policy and contextual factors, such as drink-driving laws
diabetes. Alcohol can affect glucose metabolism and and enforcement, affect the burden of alcohol-related
could have adverse effects in individuals with type 1 road injuries, but these factors are not accounted for in
diabetes, however, it remains unclear whether its effect the RR model.40 Accordingly, imple­ menting a global
on type 1 diabetes mirrors that observed for type 2 injury registration (eg, road injuries or falls) system is
diabetes.33 As such, the estimated health effect of essential to better assess the effect of alcohol on injury
alcohol on diabetes in this study might represent outcomes.
an overestimate. In conclusion, although at the global level there has
The presented estimates are not separated by race or been a reduction in health harms, alcohol consumption
ethnicity. This limits the results of our study as people has not decreased, indicating that the reduction in harms
with the aldehyde dehydrogenase 2*2 allele (prevalent is likely to be driven by a decrease in the underlying risk
in East Asian populations) have a higher risk of of diseases, conditions, and injuries causally related to
upper aerodigestive tract cancers.32 Furthermore, alcohol. Accordingly, there remains a need for policies to
racialised minorities in some countries are dispropor­ reduce the disease burden attributable to alcohol,
tionately affected by alcohol use compared with people including but not limited to regulating alcohol at
from other ethnicities.34 the international level by legally binding regulatory

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instruments, taxation, reductions in availability, and 12 Ahmad O, Boschi-Pinto C, Lopez A, Murray CJ, Lozano R,
restrictions in marketing. Inoue M. Age standardization of rates: a new WHO standard.
World Health Organization, 2001.
Contributors 13 UN Development Programme (UNDP). Human development
All authors had full access to all the data in the study and had reports—table 1—Human Development Index and its
responsibility for the integrity of the data and accuracy of the data components. 2017. [Link]
analysis. KS and JR were responsible for the study concept and design. (accessed Oct 21, 2019).
AF and AW oversaw the collection of the data. IS, MB, EKF, I-GR, IK, 14 Institute for Health Metrics and Evaluation. GBD 2015
MM, RR, SR, FS, ST, AT, and MQ assisted with data collection. geographies. Seattle, WA: Institute for Health Metrics and
KS, AW, AF, and JR directly accessed and verified the underlying data, Evaluation, 2015.
interpreted the data, and drafted the manuscript. KS, AW, and AF did the 15 Gmel G, Shield KD, Frick H, Kehoe T, Gmel G, Rehm J.
statistical analysis and were responsible for data visualisation. Estimating uncertainty of alcohol-attributable fractions for
KS and JR supervised the study. All authors critically revised the infectious and chronic diseases. BMC Med Res Methodol 2011;
manuscript for important intellectual content and had final 11: 1–12.
responsibility for the decision to submit for publication. 16 WHO Regional Office for Europe. Alcohol policy impact case
study: the effects of alcohol control measures on mortality and life
Declaration of interests expectancy in the Russian Federation. World Health Organization,
We declare no competing interests. 2019.
17 WHO Regional Office for Europe. Evaluation of the Estonian
Data sharing
green paper on alcohol policy. World Health Organization, 2024.
Data that underlie the results reported in this article (text, tables, figures,
18 Zaridze D, Brennan P, Boreham J, et al. Alcohol and cause-specific
and appendices), as well as the study protocol, statistical analysis plan,
mortality in Russia: a retrospective case–control study of
and analytic code, will be made available upon request following 48 557 adult deaths. Lancet 2009; 373: 2201–14.
publication, with no end date, to anyone who wishes to access the data
19 Díaz LA, Fuentes-López E, Idalsoaga F, et al. Association between
for any purpose. Proposals should be directed to the corresponding public health policies on alcohol and worldwide cancer, liver
author to gain access. disease and cardiovascular disease outcomes. J Hepatol 2024;
Acknowledgments 80: 409–18.
This study is based on validated data for alcohol consumption up to 20 Ross CS, De Bruijn A, Jernigan D. Do time restrictions on alcohol
and including 2020, carried out by the WHO Headquarters and the advertising reduce youth exposure? J Public Aff 2013; 13: 123–29.
WHO regional offices, and was financially supported by the Centre for 21 Squeglia LM, Gray KM. Alcohol and drug use and the developing
Addiction and Mental Health (Toronto, ON, Canada) as part of their brain. Curr Psychiatry Rep 2016; 18: 1–10.
continuous support of the WHO Collaborating Centre for Addiction 22 Danpanichkul P, Ng CH, Muthiah M, et al. From shadows to
and Mental Health. We would like to acknowledge WHO for providing spotlight: exploring the escalating burden of alcohol-associated
liver disease and alcohol use disorder in young women.
the Global Information System on Alcohol and Health and Global
American J Gastroenterol 2024; 119: 893–909.
Health Estimates data. Global Information System on Alcohol and
23 Probst C, Lange S, Kilian C, Saul C, Rehm J. The dose–response
Health data curation is done by staff at WHO, as well as by staff at
relationship between socioeconomic deprivation and alcohol-
regional-level and country-level WHO offices. We would also like to
attributable mortality risk—a systematic review and meta-analysis.
thank the WHO statistical department for providing data on mortality BMC Med 2021; 19: 1–13.
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24 Roche A, Kostadinov V, Fischer J, et al. Addressing inequities in
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