How many deaths are caused and prevented due to alcohol use in the EU?

There are numerous papers estimating the detrimental effects of harmful alcohol use to our society. Amongst others, that includes estimates of deaths, DALYs, cost of illness, harm to others, and recently, a growing emphasis can be recognised on the association between harmful alcohol use and its contribution to the growing NCD problem globally. In an aging society, the main causes of death are NCDs, namely heart diseases followed by cancer.

The amount of evidence on the issues listed above is constantly growing. At the same time, a number of all-cause mortality risk studies over the last decades find that light-to-moderate alcohol use reduces the all-cause mortality risk in comparison to heavy drinking or abstaining. Alcohols protective effect on heart diseases is, presumably, the strongest driver to such findings. Indeed, all-cause mortality risk findings appear to persist even if so-called ‘sick quitters’ are considered. More research is needed to clarify whether and why abstainers may radically differ from drinkers: meaning, one the one hand, that abstainers cannot be taken as a reference group, and, on the other, that there must be other factors explaining the difference, such as unbalanced nutrition, less exercises, little access to health-care, and/or a more underlying causal condition, such as income inequalities.

While it is important to keep the two main points questioning the findings of all-cause mortality risk studies in mind, – that is, as mentioned above, the sick quitter issue and the drastically different feature of the alcohol abstaining population – a j-shaped all-cause mortality risk curve for different levels of alcohol intake means, that alcohol use is not only associated to a higher but also to a lower risk of death, depending on how much is consumed. This paper is an attempt to quantify both deaths caused and prevented by alcohol use in the (European) population. Moreover, I will try to provide death estimates for a counterfactual society without alcohol, or, for a society where everybody would consume alcohol quantities that quality as ‘low-risk’, according to some governmental drinking guidelines. This new analysis will enrich the contemporary evidence base and will support a nuanced debate, which is of utter importance for public health policy makers, especially in the context of the ongoing activities to reduce NCDs.