Abstract
Introduction: Alcohol is a component cause for numerous disease and injury conditions. This report provides an updated estimate for alcohol-attributable morbidity and mortality for Māori, non-Māori, and the overall Aotearoa New Zealand population in 2018. One approach to quantifying the wide-ranging health harms of alcohol is the use of attributable fractions, which estimate the proportion of a disease or condition in a population that is associated with a particular risk factor (e.g. alcohol). The estimates reflect currently available risk quantifications on the health impacts of alcohol consumption and Aotearoa New Zealand alcohol consumption patterns. The estimates also lay the groundwork for the future monitoring of alcohol harms in the Māori and non-Māori population. Specifically, this report addresses the following research questions: 1. What is the alcohol-attributable morbidity and mortality as measured by deaths, cancer registrations, hospitalisations, Accident Compensation Corporation (ACC) injury claims and disability-adjusted life years (DALYs)? 2. What are the differences in alcohol-attributable morbidity and mortality in Māori and non-Māori?
Methods: This project used a comparative risk assessment methodology to estimate the health loss due to alcohol consumption in Aotearoa New Zealand in 2018 for ages >14 years. We used national-level data on alcohol consumption and health loss measures drawn from a variety of sources including the Manatū Hauora | Ministry of Health, Statistics New Zealand (Stats NZ), ACC and the Global Burden of Disease Study (GBD). We calculated estimates for Māori and non-Māori, by sex and by age group. We used the International Model of Alcohol Harms and Policies (InterMAHP), an open access alcohol harms and policy scenario model developed by the University of Victoria (Canada) to calculate Aotearoa New Zealand-specific alcohol-attributable fractions (AAF) for 26 disease and injury conditions. We applied the relevant disease and injury AAFs to our measures of health loss (deaths, cancer registrations, publicly funded hospitalisations, ACC injury claims, DALYs) to estimate the burden of disease associated with alcohol use. The results presented are the net outcomes (assume a reduced risk for three conditions at low levels of consumption) unless specified as the gross outcomes (assumes there is no reduced risk for those three conditions).
Results: Table 2 provides a summary of the alcohol-attributable health burden in Aotearoa New Zealand in 2018. In total, alcohol was attributable for an estimated 901 deaths (95%uncertainty interval (UI) 681 - 1,104), 1,250 cancers (95%UI 1,084 − 1,383), 29,282 hospitalisations (95%UI 25,713 − 32,318), 49,742 DALYs (95%UI 42,988 - 55,518) and 128,963 ACC claims (95%UI 114,324 – 140,681) in 2018. The alcohol-attributable burden for Māori included 173 deaths, 148 cancers, 5,210 hospitalisations and 16,078 ACC claims. The age and sex standardised rate of alcohol-attributable mortality was twice as high for Māori (309 per 100,000 people) than for non-Māori. Males accounted for the majority of health harms with 753 deaths (83% of all alcohol-attributable deaths), 589 cancers (47% of all alcohol-attributable cancers), 18,779 hospitalisations (64% of all alcohol-attributable publicly funded hospitalisations), 37,738 DALYs (76% of all alcohol-attributable DALYs) and 81,102 ACC claims (63% of all alcohol-attributable ACC claims). Alcohol-attributable cancers contributed the highest number of deaths of any condition group with 376 deaths (42% of all alcohol-attributable deaths), the third highest number of hospitalisations at 1,580 (5%) and the third highest DALYs at 10,227 (21%). Injuries accounted for the second highest number of deaths at 296 (33% of all alcohol-attributable deaths), the highest number of hospitalisations at 12,766 (44% of all alcohol-attributable hospitalisations) and second most DALYs 17,962 (36% of all alcohol-attributable DALYs). The ‘Other’ category of conditions (i.e. alcohol use disorders, alcohol gastritis, epilepsy, liver cirrhosis, pancreatitis) contributed the third highest mortality with 220 deaths (25% of all alcohol-attributable deaths), second highest number of hospitalisations at 11,764 (34% of all alcohol-attributable hospitalisations) and the most DALYs at 22,150 (45% of all alcohol-attributable DALYs).
Conclusions: Alcohol causes a substantial preventable health burden via a range of disease and injury conditions. The health burden from alcohol is disproportionately borne by Māori and males. Cancers, injuries and conditions that are wholly attributable to alcohol use (e.g. alcoholic gastritis and alcohol use disorders – contained in the ‘other’ category) contribute the majority of alcohol-attributable mortality and morbidity. Our estimates are conservative for a number of reasons, including: 1) they assume there are potential protective effects of low-level consumption, for which the evidence is heavily contested; 2) our inability to include the full range of alcohol-attributable conditions (e.g. fetal alcohol spectrum disorder); 3) our inability to include other measures of health loss such as utilisation of secondary and community mental health and addiction treatments; 4) the GBD’s relative risk functions used in this analysis produce estimates ~25% lower than studies using the World Health Organisation’s relative risks. In addition to the health burden, these alcohol-attributable heath impacts also place a substantial economic burden on individuals and the Government. Given the current policy landscape in Aotearoa New Zealand and international best practice, the most effective policy avenues for reducing the alcohol-attributable health burden are restrictions on alcohol marketing and availability, increases to excise tax, and implementation of a national screening and brief intervention programme.
The full set of resources developed by the University of Otago for Te Whatu Ora are available at https://doi.org/10.60967/healthnz.27048892.