Is one UK death in eight really caused by drinking?
Many newspapers and websites reported last week that one in eight deaths of UK adults under the age of 65 were caused by alcohol. Here, for example, is the Daily Mail’s take: similar stories appeared in The Daily Telegraph, The Independent, and elsewhere.
The claim is a misquotation from a press release which actually claimed that one in eight deaths in Europe between the age of 15 and 64 is caused by alcohol. It originated from a programme called ALICE RAP (Addictions and Lifestyles in Contemporary Europe – Reframing Addictions Project, which published a report called Alcohol – The Neglected Addiction. (see file attachments below for report and press release.)
The report is remarkably short on evidence to substantiate this claim, or the further claims it makes that alcohol costs every man, woman and child in Europe 300 Euros a year in lost productivity and costs to the health, welfare and criminal justice system, and that it is a cause of “250 or so” different diseases and conditions.
However, the source of the mortality data quoted by ALICE RAP appears to be a 146-page report published by a Canadian group headed by Jürgen Rehm of the Centre for Addiction and Mental Health in Toronto, and backed by a grant from Lundbeck AG, a pharma company which is currently conducting trials of a drug designed to treat alcoholics by reducing the pleasure they experience.
The report covers the 27 member states of the EU, plus Norway, Switzerland and Iceland, with data relating to 2004. It concludes that in the EU, 11.9 per cent of all deaths before the age of 65 are attributable to alcohol (95 per cent CI 6.5 to 16.9 per cent). For men, the figure is 13.9 per cent (CI 8.1 to 19.2 per cent) and for women 7.7 per cent (CI 3.1 to 12.1 per cent). This is presumably the basis for the “one in eight” claim – 11.9 per cent is one in 8.40, which can be rounded to one in eight.
The UK is actually the ninth lowest of the 30 countries for male deaths, well below the EU average, with around 8 per cent of deaths under 65 attributable to alcohol. For deaths among women, the UK is eleventh lowest, with 7 per cent. Adding both sexes together, around 7.5 per cent of deaths, or one in 13, are linked to alcohol.
So rather than one in eight UK deaths before the age of 64 being caused by alcohol, one in 13 may be attributable to alcohol. The confidence intervals are very wide: it could be as few as one in 34, or as many as one in eight. The wide range indicates the degree of uncertainty in the calculations.
The estimates differ from many of those made previously, such as one published in 2008 by the North West Public Health Observatory, which concluded that 3.1 per cent of all deaths in England in 2005 were attributable to alcohol (4.4 per cent of male deaths, 2.0 per cent of female deaths). But the NWPHO was looking at all deaths, while the Toronto group only counted deaths below the age of 65.
By choosing a cut-off of 65, the calculation excludes the majority of deaths, reducing the denominator. But because many deaths from alcoholic liver disease - the commonest cause, responsible for 37.2 per cent of the deaths - occur before the age of 65, the numerator is not reduced by so much. The same applies to deaths from unintentional injury, such as road traffic accidents, and intentional injury, which are proportionately much commoner among younger people. The effect is to increase the proportion of deaths attributable to alcohol.
While it is entirely legitimate to limit the age range in this way, people should understand that the results measure the chances that alcohol will contribute to a premature death, not to a death at any age – and that the majority of us will not suffer a premature death. In the older age groups, alcohol has a marked protective effect because it reduces deaths from heart disease, so excluding deaths over 65 removes most of this benefit from the calculations.
An unusual feature of the Toronto report is the 9 per cent of deaths of alcohol-attributable deaths claimed to be the consequence of mental and neurological disorders. The figures published for England by the NHS Information Centre, however, show mental and nervous system disorders contributing relatively few deaths. Death certification procedures may differ in other countries, perhaps.
Finally, it is permissible to question the levels of consumption quoted in the Toronto report. The team used data from the World Health Organisation, based on alcohol tax payments. Such data may well be a more accurate measure of how much people actually drink, rather than how much they say they drink. But the estimates of the damage caused by alcohol come from studies based on reported levels of consumption, not actual consumption. It is therefore more appropriate, as Professor Max Parkin has argued in the British Journal of Cancer, to use the self-reported data to calculate alcohol-attributable deaths. That has the effect of reducing the risks markedly.
The Toronto authors conclude by saying: “If an effective treatment for alcohol dependence could be delivered to a sizeable portion of the affected population, it would have a profound and positive effect on overall public health through reduction of mortality”.
Lundbeck's trial drug nalmefene (Selincro) reduced alcohol consumption by 66 per cent in heavy drinkers who were also given medical advice, according to Phase III trial results, but placebo did almost as well, European Biotechnology News reported. The European Medicines Agency has yet to rule on Lundbeck’s application for a licence. Follow-up data is expected next month at the Research Society on Alcoholism Scientific Meeting in San Francisco.