Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020
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BACKGROUND: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. METHODS: For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. FINDINGS: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male. INTERPRETATION: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. FUNDING: Bill & Melinda Gates Foundation.
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In young adults, thresholds of healthy alcohol consumption are close to zero.
“In young adults, thresholds of healthy alcohol consumption are close to zero.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [78]
The impact of alcohol consumption depends on background disease rates, which vary by region, age, sex, and year.
“The impact of alcohol consumption depends on background disease rates, which vary by region, age, sex, and year.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [78]
In older populations facing a high burden of cardiovascular disease, small amounts of alcohol consumption are associated with improved health outcomes.
“In older populations facing a high burden of cardiovascular disease, 78 small amounts of alcohol consumption are associated with improved health outcomes.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [78]
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- Authors
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M., Azangou-Khyavy, M., Azari Jafari, A., Azzam, A. Y., Badiye, A. D., Bagheri, N., Bagherieh, S., Bairwa, M., Bakkannavar, S. M., Bakshi, R. K., Balchut/Bilchut, A. H., Bärnighausen, T. W., Barra, F., Barrow, A., Baskaran, P., Belo, L., Bennett, D. A., Benseñor, I. M., Bhagavathula, A. S., Bhala, N., Bhalla, A., Bhardwaj, N., Bhardwaj, P., Bhaskar, S., Bhattacharyya, K., Bhojaraja, V. S., Bintoro, B. S., Blokhina, E. A. E., Bodicha, B. B. A., Boloor, A., Bosetti, C., Braithwaite, D., Brenner, H., Briko, N. I., Brunoni, A. R., Butt, Z. A., Cao, C., Cao, Y., Cárdenas, R., Carvalho, A. F., Carvalho, M., Castaldelli-Maia, J. M., Castelpietra, G., Castro-de-Araujo, L. F. S., Cattaruzza, M. S., Chakraborty, P. A., Charan, J., Chattu, V. K., Chaurasia, A., Cherbuin, N., Chu, D.-T., Chudal, N., Chung, S.-C., Churko, C., Ciobanu, L. G., Cirillo, M., Claro, R. M., Costanzo, S., Cowden, R. G., Criqui, M. H., Cruz-Martins, N., Culbreth, G. T., Dachew, B. A., Dadras, O., Dai, X., Damiani, G., Dandona, L., Dandona, R., Daniel, B. D., Danielewicz, A., Darega Gela, J., Davletov, K., de Araujo, J. A. P., de Sá-Junior, A. R., Debela, S. A., Dehghan, A., Demetriades, A. K., Derbew Molla, M., Desai, R., Desta, A. A., Dias da Silva, D., Diaz, D., Digesa, L. E., Diress, M., Dodangeh, M., Dongarwar, D., Dorostkar, F., Dsouza, H. L., Duko, B., Duncan, B. B., Edvardsson, K., Ekholuenetale, M., Elgar, F. J., Elhadi, M., Elmonem, M. A., Endries, A. Y., Eskandarieh, S., Etemadimanesh, A., Fagbamigbe, A. F., Fakhradiyev, I. R., Farahmand, F., Farinha, C. S. E. S., Faro, A., Farzadfar, F., Fatehizadeh, A., Fauk, N. K., Feigin, V. L., Feldman, R., Feng, X., Fentaw, Z., Ferrero, S., Ferro Desideri, L., Filip, I., Fischer, F., Francis, J. M., Franklin, R. C., Gaal, P. A., Gad, M. M., Gallus, S., Galvano, F., Ganesan, B., Garg, T., Gebrehiwot, M. G. D., Gebremeskel, T. G., Gebremichael, M. A., Gemechu, T. R., Getacher, L., Getachew, M. 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M., Mahjoub, S., Mahmoodpoor, A., Mahumud, R. A., Makki, A., Malekpour, M.-R., Manjunatha, N., Mansouri, B., Mansournia, M. A., Martinez-Raga, J., Martinez-Villa, F. A., Matzopoulos, R., Maulik, P. K., Mayeli, M., McGrath, J. J., Meena, J. K., Mehrabi Nasab, E., Menezes, R. G., Mensink, G. B. M., Mentis, A.-F. A., Meretoja, A., Merga, B. T., Mestrovic, T., Miao Jonasson, J., Miazgowski, B., Micheletti Gomide Nogueira de Sá, A. C., Miller, T. R., Mini, G., Mirica, A., Mirijello, A., Mirmoeeni, S., Mirrakhimov, E. M., Misra, S., Moazen, B., Mobarakabadi, M., Moccia, M., Mohammad, Y., Mohammadi, E., Mohammadian-Hafshejani, A., Mohammed, T. A., Moka, N., Mokdad, A. H., Momtazmanesh, S., Moradi, Y., Mostafavi, E., Mubarik, S., Mullany, E. C., Mulugeta, B. T., Murillo-Zamora, E., Murray, C. J. L., Mwita, J. C., Naghavi, M., Naimzada, M. D., Nangia, V., Nayak, B. P., Negoi, I., Negoi, R. I., Nejadghaderi, S. A., Nepal, S., Neupane, S. P. P., Neupane Kandel, S., Nigatu, Y. T., Nowroozi, A., Nuruzzaman, K. M., Nzoputam, C. I., Obamiro, K. O., Ogbo, F. A., Oguntade, A. S., Okati-Aliabad, H., Olakunde, B. O., Oliveira, G. M. M., Omar Bali, A., Omer, E., Ortega-Altamirano, D. V., Otoiu, A., Otstavnov, S. S., Oumer, B., P A, M., Padron-Monedero, A., Palladino, R., Pana, A., Panda-Jonas, S., Pandey, A., Pandey, A., Pardhan, S., Parekh, T., Park, E.-K., Parry, C. D. H., Pashazadeh Kan, F., Patel, J., Pati, S., Patton, G. C., Paudel, U., Pawar, S., Peden, A. E., Petcu, I.-R., Phillips, M. R., Pinheiro, M., Plotnikov, E., Pradhan, P. M. S., Prashant, A., Quan, J., Radfar, A., Rafiei, A., Raghav, P. R., Rahimi-Movaghar, V., Rahman, A., Rahman, M. M., Rahman, M., Rahmani, A. M., Rahmani, S., Ranabhat, C. L., Ranasinghe, P., Rao, C. R., Rasali, D. P., Rashidi, M.-M., Ratan, Z. A., Rawaf, D. L., Rawaf, S., Rawal, L., Renzaho, A. M. N., Rezaei, N., Rezaei, S., Rezaeian, M., Riahi, S. M., Romero-Rodríguez, E., Roth, G. A., Rwegerera, G. M., Saddik, B., Sadeghi, E., Sadeghian, R., Saeed, U., Saeedi, F., Sagar, R., Sahebkar, A., Sahoo, H., Sahraian, M. A., Saif-Ur-Rahman, K., Salahi, S., Salimzadeh, H., Samy, A. M., Sanmarchi, F., Santric-Milicevic, M. M., Sarikhani, Y., Sathian, B., Saya, G. K., Sayyah, M., Schmidt, M. I., Schutte, A. E., Schwarzinger, M., Schwebel, D. C., Seidu, A.-A., Senthil Kumar, N., SeyedAlinaghi, S., Seylani, A., Sha, F., Shahin, S., Shahraki-Sanavi, F., Shahrokhi, S., Shaikh, M. A., Shaker, E., Shakhmardanov, M. Z., Shams-Beyranvand, M., Sheikhbahaei, S., Sheikhi, R. A., Shetty, A., Shetty, J. K., Shiferaw, D. S., Shigematsu, M., Shiri, R., Shirkoohi, R., Shivakumar, K. M., Shivarov, V., Shobeiri, P., Shrestha, R., Sidemo, N. B., Sigfusdottir, I. D., Silva, D. A. S., Silva, N. T. D., Singh, J. A., Singh, S., Skryabin, V. Y., Skryabina, A. A., Sleet, D. A., Solmi, M., SOLOMON, Y., Song, S., Song, Y., Sorensen, R. J. D., Soshnikov, S., Soyiri, I. N., Stein, D. J., Subba, S. H., Szócska, M., Tabarés-Seisdedos, R., Tabuchi, T., Taheri, M., Tan, K.-K., Tareke, M., Tarkang, E. E., Temesgen, G., Temesgen, W. A., Temsah, M.-H., Thankappan, K. R., Thapar, R., Thomas, N. K., Tiruneh, C., Todorovic, J., Torrado, M., Touvier, M., Tovani-Palone, M. R., Tran, M. T. N., Trias-Llimós, S., Tripathy, J. P., Vakilian, A., Valizadeh, R., Varmaghani, M., Varthya, S. B., Vasankari, T. J., Vos, T., Wagaye, B., Waheed, Y., Walde, M. T., Wang, C., Wang, Y., Wang, Y.-P., Westerman, R., Wickramasinghe, N. D., Wubetu, A. D., Xu, S., Yamagishi, K., Yang, L., Yesera, G. E. E., Yigit, A., Yiğit, V., Yimaw, A. E. A. E., Yon, D. K., Yonemoto, N., Yu, C., Zadey, S., Zahir, M., Zare, I., Zastrozhin, M. S., Zastrozhina, A., Zhang, Z.-J., Zhong, C., Zmaili, M., Zuniga, Y. M. H., & Gakidou, E.
- Affiliations
- University of Washington (US)
- Corresponding author
- Gakidou, Emmanuela
- ORCID
- Bryazka, Dana
- Reitsma, Marissa B
- Griswold, Max G
- Abate, Kalkidan Hassen
- Abbafati, Cristiana
- Abbasi-Kangevari, Zeinab
- Abdoli, Amir
- Abdollahi, Mohammad
- Abdullah, Abu Yousuf Md
- Acuna, Juan Manuel
- Addolorato, Giovanni
- Adebayo, Oladimeji M
- Adekanmbi, Victor
- Adhikari, Kishor
- Adhikari, Sangeet
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- Ahmad, Tauseef
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- Alam, Md Zakiul
- Alene, Kefyalew Addis
- Allel, Kasim
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- Alvand, Saba
- Amare, Firehiwot
- Ameyaw, Edward Kwabena
- Amiri, Sohrab
- Ancuceanu, Robert
- Andrei, Tudorel
- Arabloo, Jalal
- Arshad, Muhammad
- Artamonov, Anton A
- Aryan, Zahra
- Asemahagn, Mulusew A
- Athari, Seyyed Shamsadin
- Atnafu, Desta Debalkie
- Atorkey, Prince
- Atreya, Alok
- Ausloos, Floriane
- Ausloos, Marcel
- Ayano, Getinet
- Ayanore, Martin Amogre ayanore
- Ayinde, Olatunde O
- Azadnajafabad, Sina
- Azanaw, Melkalem Mamuye
- Azzam, Ahmed Y
- Badiye, Ashish D
- Bagheri, Nasser
- Bagherieh, Sara
- Bairwa, Mohan
- Bakkannavar, Shankar M
- Bakshi, Ravleen Kaur
- Bärnighausen, Till Winfried
- Barra, Fabio
- Barrow, Amadou
- Baskaran, Pritish
- Bennett, Derrick A
- Benseñor, Isabela M
- Bhagavathula, Akshaya Srikanth
- Bhala, Neeraj
- Bhardwaj, Nikha
- Bhardwaj, Pankaj
- Bhaskar, Sonu
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- Blokhina, Elena A Elena
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- Butt, Zahid A
- Cao, Chao
- Cao, Yin
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- Carvalho, Márcia
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- Ciobanu, Liliana G
- Claro, Rafael M
- Cowden, Richard G
- Criqui, Michael H
- Culbreth, Garland T
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- SOLOMON, YONATAN
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- Sorensen, Reed J D
- Soshnikov, Sergey
- Soyiri, Ireneous N
- Stein, Dan J
- Subba, Sonu Hangma
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- Zadey, Siddhesh
- Zahir, Mazyar
- Zhang, Zhi-Jiang
- Zmaili, Mohammad
- Gakidou, Emmanuela
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2022-07
- Volume
- 400
- Issue
- 10347
- Pages
- 185-235
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC9289789
- OpenAlex
- W4285498409
- Cited by
- 582
- References
- 42
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- FWCI
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- en
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- National Heart Foundation of Australia
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- Macquarie University
- University of Tasmania
- London South Bank University
- South African Medical Research Council
- National University of Singapore
- Department of Biotechnology, Ministry of Science and Technology, India
- Indian Council of Medical Research (COVID-19)
- Public Health Foundation of India
- Amity University
- Deutsche Forschungsgemeinschaft (CZ.02.2.69/0.0/0)
- Institut National de la Santé et de la Recherche Médicale (UMR 1219)
- Danmarks Grundforskningsfond
- Charles Sturt University
- University of New South Wales
- University of Technology Sydney
- University of Wollongong
- Deakin University
- Monash University
- University of South Australia
- James Cook University
- Queensland University of Technology
- University of Queensland
- Curtin University of Technology
- University of Canberra
- Canada Research Chairs
- National Natural Science Foundation of China (KQTD20190929172835662, 81761128031)
- Universiteit Utrecht
- Public Health England
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (309589/2021-5)
- Semmelweis Egyetem
- Bundesministerium für Bildung und Forschung (01EA1808A)
- Ain Shams University
- King Saud University
- Kosin University
- Kyung Hee University
- Ajou University
- Ewha Womans University
- Gachon University
- Korea University
- Islamic Azad University
- Banaras Hindu University
- University of Calcutta
- Central South University
- Bundesministerium für Gesundheit
- Universitat de València
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (Code 001, 309589/2021-5, 57/2016, DL57/2016)
- Institució Catalana de Recerca i Estudis Avançats
- Isfahan University of Medical Sciences
- Kashan University of Medical Sciences
- Khalifa University of Science, Technology and Research
- Mazandaran University of Medical Sciences
- Universidad Autónoma Metropolitana
- Novo Nordisk
- Shahroud University of Medical Sciences
- Shiraz University of Medical Sciences
- Tabriz University of Medical Sciences
- Universiti Malaya
- Chinese Center for Disease Control and Prevention
- Universiteit Stellenbosch
- Tehran University of Medical Sciences and Health Services
- University of Waterloo
- Università di Catania
- Universidad Autónoma de Madrid
- Università degli Studi di Genova
- University of Peshawar
- Inyuvesi Yakwazulu-Natali
- Hamadan University of Medical Sciences
- Mashhad University of Medical Sciences
- Universiteit van die Vrystaat
- Ministerio de Ciencia e Innovación (FJC2019-039314-I, LA/P/0140/2020, UIDP/04378/2020, UIDB/04378/2020)
- Haramaya University
- Zahedan University of Medical Sciences
- Chinese University of Hong Kong
- Universidade Federal do Rio Grande do Sul
- Shanghai Jiao Tong University
- Süleyman Demirel Üniversitesi
- Nankai University
- Ahvaz Jundishapur University of Medical Sciences
- Universitetet i Bergen
- Jimma University
- Shiraz University
- Birjand University of Medical Sciences
- National and Kapodistrian University of Athens
- Kermanshah University of Medical Sciences
- Universitetet i Oslo
- Tehran Heart Center
- Guilan University of Medical Sciences
- University of Ghana
- Université de Liège (COVID-19)
- Universidade de São Paulo
- Babol University of Medical Sciences
- Universidad Nacional Autónoma de México
- Shahrekord University of Medical Sciences
- Göteborgs Universitet
- Universidade de Lisboa (DL 57/2016)
- Universitat de Barcelona
- Medizinische Universität Wien
- Autoritatea Natională pentru Cercetare Stiintifică (PN-III-P2-2.1-SOL-2020-2-0351, PN-III-P4-ID-PCCF-2016-0084)
- Baqiyatallah University of Medical Sciences
- Shahid Beheshti University of Medical Sciences
- Bahir Dar University
- Università di Bologna
- United Arab Emirates University
- ERAB: The European Foundation for Alcohol Research (EA1767)
- Université de Bordeaux
- Baki Dövlət Universiteti
- Institut National Du Cancer
- Centre Hospitalier Universitaire Vaudois
- Qazvin University of Medical Sciences
- University of Dhaka
- University of Tsukuba
- Unitatea Executiva pentru Finantarea Invatamantului Superior, a Cercetarii, Dezvoltarii si Inovarii (PN-III-P4-ID, PN-III-P4-ID-PCCF-2016-0084, PN-III-P4-ID-PCCF-2016, PN-III-P2-2, 57/2016)
- Cooperativa de Ensino Superior Politécnico e Universitário (LA/P/0140/2020, UIDB/04378/2020, UIDP/04378/2020)
- Centro de Investigación Biomédica en Red de Salud Mental
- Universidade do Porto
- Wuhan University
- Universidade Federal de Santa Catarina
- University of Cape Town
- Arak University of Medical Sciences
- National Research University Higher School of Economics
- Universidade Federal de Minas Gerais
- Universidade Federal de Juiz de Fora
- Universitatea de Medicină şi Farmacie "Carol Davila" Bucureşti
- University of Tabriz
- Tartu Ülikool
- University of Gondar
- Addis Ababa University
- Southeast University
- Università degli Studi di Udine (2020-2, 2020-2025)
- Zanjan University of Medical Sciences
- Dire Dawa University
- Universidade Federal do Rio de Janeiro
- Khulna University
- Pomorski Uniwersytet Medyczny W Szczecinie
- University of Hail
- NSW Ministry of Health
- International Centre for Diarrhoeal Disease Research, Bangladesh
- University of Science and Technology of China
- National Center of Neurology and Psychiatry
- Jawaharlal Institute Of Postgraduate Medical Education and Research
- Hawassa University
- University of Colombo
- Walailak University
- Masarykova Univerzita (CZ.02.2.69/0.0/0.0/18_053/0016952)
- Rajarata University of Sri Lanka
- African Union
- Swedish Orphan Biovitrum
- Alborz University of Medical Sciences
- Universitas Gadjah Mada
- Uniwersytet Warmińsko-Mazurski w Olsztynie
- Hellenic Foundation for Research and Innovation (LA/P/0140/2020, MIMS-860)
- Aja University of Medical Sciences
- Kurdistan University Of Medical Sciences
- I.M. Sechenov First Moscow State Medical University
- Frankfurt University of Applied Sciences
- Háskólinn í Reykjavík
- Imam Abdulrahman Bin Faisal University
- Applied Molecular Biosciences Unit (LA/P/0140/2020, UIDP/04378/2020, UIDB04378/2020)
- Jahrom University of Medical Sciences
- Universitas Padjadjaran
- Central University of Kerala
- Universidade Federal de Sergipe
- Rajshahi University
- Universitatea Sapientia
- Universidad Autónoma de Sinaloa
- Al-Farabi Kazakh National University
- Mahatma Gandhi University
- Ambo University
- RUDN University
- Western Sydney University
- Laboratório Associado para a Química Verde (LA/P/0140/2020, UIDP/04378/2020, UIDB/04378/2020)
- Moscow Institute of Physics and Technology
- Pirogov Russian National Research Medical University
- Ajman University
- British Columbia Centre for Disease Control
- Lilly Deutschland
- Madda Walabu University
- Université de Versailles Saint-Quentin-en-Yvelines
- George Institute for Global Health
- Debre Markos University
- Dilla University
- University of Health and Allied Sciences
- Debre Tabor University
- University of Veterinary and Animal Sciences
- Uniwersytet Opolski
- Robert Koch Institut
- National Institutes of Health (2020-2025, COVID-19, S011676)
- Directorate for Biological Sciences
- Samsung
- Duke Global Health Institute, Duke University
- University of California, San Diego
- University of Florida Health
- Novartis Pharma
- School of Public Health and Family Medicine, University of Cape Town
- Medical Research Council (S011676, 221854/Z/20/Z, MR/S011676/1, MR/S011676, MR/R024227/1, S011676/1, MR/T03355X/1, MR/M015084/1, COVID-19)
- National Health and Medical Research Council (350426)
- Japan Society for the Promotion of Science (21K10295)
- Fundação para a Ciência e a Tecnologia (DL-57/2016, 57/2016, UIDB/04378/2020, UIDP/04378/2020, LA/P/0140/2020)
- Russian Academy of Sciences (2018-2020)
- Sydney Medical School
- Instituto de Salud Carlos III
- Queensland Brain Institute
- Gastrointestinal and Liver Diseases Research Center
- European Regional Development Fund (LA/P/0140/2020, UIDB/04378/2020, CZ.02, UIDP/04378/2020, DL 57/2016, 57/ 2016)
- Faculty of Medicine and Health, University of Sydney
- Norwegian Institute of Public Health
- Student Research Committee, Tabriz University of Medical Sciences
- National Institute on Aging (R01AG056477)
- National Heart, Lung, and Blood Institute (350426, 221854/Z/20/Z)
- National Institute of Mental Health (R01MH128911)
- National Institute on Drug Abuse (K01DA051346)
- Division of Human Resource Development
- Stanford Cardiovascular Institute, School of Medicine, Stanford University
- Daiichi Sankyo Europe
- EIT Health
- Cilag
- European and Developing Countries Clinical Trials Partnership
- Health Data Research UK
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
- Keywords
- alcohol consumption, hazardous drinking, dose-response relationship, J-curve, sex differences, regional variation, global burden of disease, alcohol advertising regulation
- MeSH terms
- Global Burden of Disease, Adult, Alcohol Drinking, Child, Preschool, Female, Geography, Humans, Male, Middle Aged, Risk Factors, Global Health, Quality-Adjusted Life Years
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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