Estimating the global burden of alcohol's harm to others

Background: Alcohol's harm to others (AHTO) affects individuals, families, communities and societies in Australia and globally. We aim to describe and compare the harms experienced from others' drinking across the world. 

Methods: Using cross-national survey data (2008-2021) from the Gender and AHTO (GENAHTO) project, the Standard European Alcohol Study (SEAS) and independent participant data meta-analysis in STATA to adjust for individual and group level effects, we estimated the burden of AHTO cross-nationally. Surveyed harms from known drinkers and from strangers were analysed by respondent gender, education and the country’s per-capita income (purchasing power parity, PPP). In a second component to the study, analysis of data from social, health and police services in Australia are used to illustrate the extent and seriousness of AHTO when response agency data are considered.  

Results: Overall 45% (CI 39-50%) of the 29 country-population reported harm from others' drinking in the previous year. Women were more likely to report harm from others’ drinking than men. Harms from known drinkers (partners, family or friends) were generally higher in lower-income countries, with a few exceptions. The pattern was less clear for harms from strangers’ drinking, although it was more commonly reported in higher income countries. At the individual level, higher education (high school completion) is generally associated with fewer harms from known drinkers, and more harms from strangers. High levels of AHTO were reported in Australia, UK, Lithuania, Chile and Thailand.  Additional Australian secondary data on mortality, morbidity, treatment, child abuse, family violence and assault were used to illustrate the huge burden of harm. 

Conclusion: Cross-national survey and Australian secondary response agency data were used to augment and model the full potential burden of AHTO globally. Estimates and analysis of predictors of international and national harm make an important contribution to national and global strategy developments and policy debates.