Economic wealth, patterns of drinking, and alcohol-attributable disease burden
Background: The concept of harm per liter has been widely used to compare alcohol-related harm across regions, taking into account the differences in the volume of alcohol consumed. The aim of this study is to apply the concept of harm per liter of pure alcohol to international statistics, shifting the study of the alcohol harm paradox from the typically adopted individual perspective to a contextual point of view. Resulting in the identification of the principal determinants of harm per liter and consequently the determinants in the harm produced by drinking alcohol.
Methods: The principal measure of harm per liter were the age-standardized alcohol-attributable mortality rates in each country divided by the correspondent alcohol per capita consumption (ASAMRL). Log-linear models were used to analyse the possible interaction between harm per liter and the gross domestic product on purchasing power parity (GDP-PPP) per capita and linear models for the association between heavy episodic drinkers (HED) and GDP-PPP per capita. The models were stratified by sex and adjusted by potential confounders. The aggregated data on alcohol exposure was obtained from the World Health Organization, while dependent variables and confounders were sourced from various outlets, including the World Bank and the Global Burden of Disease.
Results: The harm per liter in alcohol-attributable deaths per 100,000 people and liter of pure alcohol vary between 120.78 (66.13-175.48) in Egypt and 1.23 (0.82-1.64) in Cyprus. Looking at them by sex, the highest and lowest results can be seen on females. The results of the models suggest that there was an inverse significant association between harm per liter and GDP-PPP per capita but not between HED and GDP-PPP per capita. Harm per liter was also associated with healthcare coverage, percentage of lifetime abstainers in the country, Gini coefficient for females and percentage of the elderly people for males.
Conclusions: At the population level, the impact of alcohol on health is influenced not only by the total amount consumed but also by the socio-political and economic factors of each region, which play a significant role in determining the level of harm perceived by its inhabitants.
