PAHO/WHO researchers say finding represents the "tip of the iceberg" of all alcohol-related deaths

Washington, D.C., 14 January 2014 (PAHO/WHO) — Some 80,000 deaths each year in the Americas would not occur in the absence of alcohol consumption, according to a new study by the Pan American Health Organization/World Health Organization (PAHO/WHO) that appears in the current issue of the scientific journal Addiction.

The study, by Vilma Gawryszewski, PAHO/WHO advisor on health information and analysis, and Maristela Monteiro, senior advisor on alcohol and substance abuse, looked at patterns of alcohol-related deaths between 2007 and 2009 in 16 countries in North and Latin America. The authors examined data only on causes of death in which alcohol is specifically named (such as "alcoholic liver disease" and "mental and behavioral disorders due to use of alcohol"). They found that alcohol was a "necessary" cause of death (i.e., death would not have occurred in the absence of alcohol consumption) in an average of 79,456 cases annually during the study period. In most countries, liver disease was the leading direct cause of the alcohol-related deaths, followed by neuropsychiatric disorders.

These deaths, however, likely represent only "the tip of the iceberg of a broader problem," according to the authors, since alcohol use is related to a wide range of diseases and conditions, including heart disease and stroke, traffic and firearms injuries, suicides, and even some cancers.

"Our study simply shows how many deaths are wholly attributable to alcohol consumption," the authors write. "The number of deaths for which alcohol consumption is a significant contributing factor is likely to be much higher."

The study finds wide variation in death rates from alcohol consumption across countries, with the highest rates in El Salvador (averaging 27.4 out of 100,000 deaths annually), Guatemala (22.3), and Nicaragua (21.3), followed by Mexico (17.8) and Brazil (12.2). These compare with much lower rates in Colombia (1.8), Argentina (4.0), Venezuela (5.5), Ecuador (5.9), Costa Rica (5.8), and Canada (5.7). The top five countries above all rate high on measures of hazardous drinking patterns, according to separate data from WHO. However, total alcohol consumption is higher in those countries with lower mortality rates.

In all countries studied, the majority of alcohol-related deaths (84%) were in men, although male/female ratios varied across countries. The risk of dying from an alcohol fully-related cause was 27.8 times higher for a man than for a woman in El Salvador, 18.9 times higher in Nicaragua, and 14.8 times higher in Cuba. On the low end of the scale, the mortality risk was 3.2 times higher for men than women in both Canada and the United States.

The risk also differed by age group. In Argentina, Canada, Costa Rica, Cuba, Paraguay, and the United States, the highest mortality rates were among people ages 50-69 years. In Brazil, Ecuador, and Venezuela, rates of alcohol mortality increased beginning at 40-49 years of age, remained stable, and then dropped after age 70. Mexico showed a different pattern, with the risk of death escalating throughout life and reaching a peak after age 70. 

The authors note that alcohol-related deaths are preventable through policies and interventions that reduce alcohol consumption, including restrictions on availability, increased prices through taxation, and controls on marketing and advertising. However, "most countries in the Americas have weak policies to respond to the problem," they write. "As these high rates have shown a major public health problem, countries should increase their efforts to improve the quality of information, monitor the problem and implement more effective policies to reduce alcohol availability and consumption at national levels."

The Pan American Health Organization is an international public health agency with more than 110 years of experience in working to improve health and living standards of the countries of the Americas. It serves as the specialized organization for health of the Inter—American System. It also serves as the Regional Office for the Americas of WHO and enjoys international recognition as part of the United Nations (UN) system.

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