The relationship between different dimensions of alcohol use and the burden of disease-an update.
The relationship between different dimensions of alcohol use and the burden of disease-an update.
复制标题
DOI：
10.1111/add.13757
复制
发表时间：
2017-06
期刊：
影响因子：
--
通讯作者：
Shuper PA
中科院分区：
文献类型：
--
作者：
Rehm J;Gmel GE Sr;Gmel G;Hasan OSM;Imtiaz S;Popova S;Probst C;Roerecke M;Room R;Samokhvalov AV;Shield KD;Shuper PA
饮酒是造成伤害、死亡和疾病负担的主要因素。这篇综述更新了关于酒精使用各方面与健康结果之间风险关系的知识，将用于全球和国家比较风险评估(CRA)。对关于饮酒和饮酒的健康后果的综述和荟萃分析进行系统的审查。对于暴露的维度：饮酒量、血液酒精浓度和饮酒模式，特别是重度饮酒场合进行了研究。对于肝硬变，酒精的质量也是额外考虑的。对于所有结果(死亡率和/或发病率)：根据全球CRA使用的国际疾病分类(ICD)代码确定的死亡原因和疾病/伤害类别；对他人的伤害。总共确定了255篇综述和荟萃分析。酒精使用被发现与许多疾病和伤害类别有因果关系，40多个ICD-10三位数类别完全可归因于酒精。大多数部分归因性疾病类别与饮酒量呈单调关系：饮酒越多，患病或死亡的风险就越高。有曲线关系的缺血性疾病和糖尿病是例外，在没有大量不规律饮酒的人中，少量到适度饮酒的有益效果是例外。生物学途径表明，大量饮酒对其他疾病有影响；然而，由于缺乏衡量酒精使用这一方面的医学流行病学研究，因此无法进行深入分析。对于伤害，除自杀外，血液酒精浓度是酒精使用的最重要方面。饮酒对他人造成了显著的伤害，这一点还没有得到充分的研究。自2010年以来的研究证实了饮酒作为疾病和伤害风险因素的重要性；对于某些健康结果，需要考虑使用的不止一个方面。流行病学研究应包括根据生物学知识对大量饮酒的场合进行测量。
Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). Systematic review of reviews and meta‐analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. In total, 255 reviews and meta‐analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD‐10 three‐digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in‐depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.