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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.”
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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“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]
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“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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Metadata
- Authors
- Bryazka, D., Reitsma, M. B., Griswold, M. G., Abate, K. H., Abbafati, C., Abbasi-Kangevari, M., Abbasi-Kangevari, Z., Abdoli, A., Abdollahi, M., Abdullah, A. Y. M., Abhilash, E. S., Abu-Gharbieh, E., Acuna, J. M., Addolorato, G., Adebayo, O. M., Adekanmbi, V., Adhikari, K., Adhikari, S., Adnani, Q. E. S., Afzal, S., Agegnehu, W. Y., Aggarwal, M., Ahinkorah, B. O., Ahmad, A. R., Ahmad, S., Ahmad, T., Ahmadi, A., Ahmadi, S., Ahmed, H., Ahmed Rashid, T., Akunna, C. J., Al Hamad, H., Alam, M. Z., Alem, D. T., Alene, K. A., Alimohamadi, Y., Alizadeh, A., Allel, K., Alonso, J., Alvand, S., Alvis-Guzman, N., Amare, F., Ameyaw, E. K., Amiri, S., Ancuceanu, R., Anderson, J. A., Andrei, C. L., Andrei, T., Arabloo, J., Arshad, M., Artamonov, A. A., Aryan, Z., Asaad, M., Asemahagn, M. A., Astell-Burt, T., Athari, S. S., Atnafu, D. D., Atorkey, P., Atreya, A., Ausloos, F., Ausloos, M., Ayano, G., Ayanore, M. A. A., Ayinde, O. O., Ayuso-Mateos, J. L., Azadnajafabad, S., Azanaw, M. 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. E., Getachew Obsa, A., Getie, A., Ghaderi, A., Ghafourifard, M., Ghajar, A., Ghamari, S.-H., Ghandour, L. A., Ghasemi Nour, M., Ghashghaee, A., Ghozy, S., Glozah, F. N., Glushkova, E. V., Godos, J., Goel, A., Goharinezhad, S., Golechha, M., Goleij, P., Golitaleb, M., Greaves, F., Grivna, M., Grosso, G., Gudayu, T. W., Gupta, B., Gupta, R., Gupta, S., Gupta, V. B., Gupta, V. K., Hafezi-Nejad, N., Haj-Mirzaian, A., Hall, B. J., Halwani, R., Handiso, T. B., Hankey, G. J., Hariri, S., Haro, J. M., Hasaballah, A. I., Hassanian-Moghaddam, H., Hay, S. I., Hayat, K., Heidari, G., Heidari, M., Hendrie, D., Herteliu, C., Heyi, D. Z., Hezam, K., Hlongwa, M. M., Holla, R., Hossain, M. M., Hossain, S., Hosseini, S. K., hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Hu, G., Huang, J., Hussain, S., Ibitoye, S. E., Ilic, I. M., Ilic, M. D., Immurana, M., Irham, L. M., Islam, M. M., Islam, R. M., Islam, S. M. S., Iso, H., Itumalla, R., Iwagami, M., Jabbarinejad, R., Jacob, L., Jakovljevic, M., Jamalpoor, Z., Jamshidi, E., Jayapal, S. K., Jayarajah, U. U., Jayawardena, R., Jebai, R., Jeddi, S. A., Jema, A. T., Jha, R. P., Jindal, H. A., Jonas, J. B., Joo, T., Joseph, N., Joukar, F., Jozwiak, J. J., Jürisson, M., Kabir, A., Kabthymer, R. H., Kamble, B. D., Kandel, H., Kanno, G. G., Kapoor, N., Karaye, I. M., Karimi, S. E., Kassa, B. G., Kaur, R. J., Kayode, G. A., Keykhaei, M., Khajuria, H., Khalilov, R., Khan, I. A., Khan, M. A., Kim, H., Kim, J., Kim, M. S., Kimokoti, R. W., Kivimäki, M., Klymchuk, V., Knudsen, A. K. S., Kolahi, A.-A., Korshunov, V. A., Koyanagi, A., Krishan, K., Krishnamoorthy, Y., Kumar, G. A., Kumar, N., Kumar, N., Lacey, B., Lallukka, T., Lasrado, S., Lau, J., Lee, S.-W., Lee, W.-C., Lee, Y. H., Lim, L.-L., Lim, S. S., Lobo, S. W., Lopukhov, P. D., Lorkowski, S., Lozano, R., Lucchetti, G., Madadizadeh, F., Madureira-Carvalho, Á. 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
- Adnani, Qorinah Estiningtyas Sakilah
- Afzal, Saira
- Ahinkorah, Bright Opoku
- Ahmad, Araz Ramazan
- Ahmad, Tauseef
- Ahmed, Haroon
- Akunna, Chisom Joyqueenet
- Alam, Md Zakiul
- Alene, Kefyalew Addis
- Allel, Kasim
- Alonso, Jordi
- 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
- Bhattacharyya, Krittika
- Bintoro, Bagas Suryo
- Blokhina, Elena A Elena
- Bodicha, Belay Boda Abule
- Boloor, Archith
- Bosetti, Cristina
- Braithwaite, Dejana
- Brenner, Hermann
- Briko, Nikolay Ivanovich
- Butt, Zahid A
- Cao, Chao
- Cao, Yin
- Cárdenas, Rosario
- Carvalho, Andre F
- Carvalho, Márcia
- Castelpietra, Giulio
- Cattaruzza, Maria Sofia
- Chakraborty, Promit Ananyo
- Charan, Jaykaran
- Chattu, Vijay Kumar
- Chaurasia, Akhilanand
- Cherbuin, Nicolas
- Chu, Dinh-Toi
- Chung, Sheng-Chia
- Churko, Chuchu
- Ciobanu, Liliana G
- Claro, Rafael M
- Cowden, Richard G
- Criqui, Michael H
- Culbreth, Garland T
- Dachew, Berihun Assefa
- Dadras, Omid
- Dai, Xiaochen
- Damiani, Giovanni
- Dandona, Lalit
- Dandona, Rakhi
- Danielewicz, Anna
- Davletov, Kairat
- Debela, Sisay Abebe
- Dehghan, Azizallah
- Demetriades, Andreas K
- Desai, Rupak
- Digesa, Lankamo Ena
- Diress, Mengistie
- Dodangeh, Milad
- Dongarwar, Deepa
- Dsouza, Haneil Larson
- Duko, Bereket
- Duncan, Bruce B
- Edvardsson, Kristina
- Ekholuenetale, Michael
- Elgar, Frank J
- Elhadi, Muhammed
- Elmonem, Mohamed A
- Endries, Aman Yesuf
- Eskandarieh, Sharareh
- Etemadimanesh, Azin
- Fagbamigbe, Adeniyi Francis
- Fakhradiyev, Ildar Ravisovich
- Farinha, Carla Sofia e Sá
- Farzadfar, Farshad
- Fatehizadeh, Ali
- Fauk, Nelsensius Klau
- Feigin, Valery L
- Feldman, Rachel
- Feng, Xiaoqi
- Fentaw, Zinabu
- Ferrero, Simone
- Filip, Irina
- Fischer, Florian
- Francis, Joel Msafiri
- Franklin, Richard Charles
- Gad, Mohamed M
- Gallus, Silvano
- Galvano, Fabio
- Ganesan, Balasankar
- Garg, Tushar
- Gebrehiwot, Mesfin Gebrehiwot Damtew
- Gebremeskel, Teferi Gebru
- Gebremichael, Mathewos Alemu
- Getacher, Lemma
- Getie, Asmare
- Ghafourifard, Mansour
- Ghajar, Alireza
- Ghamari, Seyyed-Hadi
- Ghandour, Lilian A
- Ghashghaee, Ahmad
- Ghozy, Sherief
- Glozah, Franklin N
- Glushkova, Ekaterina Vladimirovna
- Godos, Justyna
- Goel, Amit
- Goharinezhad, Salime
- Golechha, Mahaveer
- Goleij, Pouya
- Greaves, Felix
- Grivna, Michal
- Grosso, Giuseppe
- Gudayu, Temesgen Worku
- Gupta, Bhawna
- Gupta, Sapna
- Gupta, Veer Bala
- Gupta, Vivek Kumar
- Hall, Brian J
- Halwani, Rabih
- Hankey, Graeme J
- Hariri, Sanam
- Haro, Josep Maria
- Hasaballah, Ahmed I
- Hay, Simon I
- Hayat, Khezar
- Heidari, Golnaz
- Heidari, Mohammad
- Hendrie, Delia
- Hezam, Kamal
- Hlongwa, Mbuzeleni Mbuzeleni
- Holla, Ramesh
- Hossain, Md Mahbub
- Hossain, Sahadat
- Hosseini, Seyed Kianoosh
- hosseinzadeh, Mehdi
- Hostiuc, Mihaela
- Hostiuc, Sorin
- Hu, Guoqing
- Huang, Junjie
- Hussain, Salman
- Ibitoye, Segun Emmanuel
- Immurana, Mustapha
- Irham, Lalu Muhammad
- Islam, M Mofizul
- Islam, Rakibul M
- Islam, Sheikh Mohammed Shariful
- Iso, Hiroyasu
- Itumalla, Ramaiah
- Iwagami, Masao
- Jacob, Louis
- Jakovljevic, Mihajlo
- Jamshidi, Elham
- Jayapal, Sathish Kumar
- Jayarajah, Umesh Umesh
- Jayawardena, Ranil
- Jebai, Rime
- Jeddi, Seyed Ali
- Jha, Ravi Prakash
- Joseph, Nitin
- Jozwiak, Jacek Jerzy
- Jürisson, Mikk
- Kabir, Ali
- Kabthymer, Robel Hussen
- Kamble, Bhushan Dattatray
- Kandel, Himal
- Kanno, Girum Gebremeskel
- Kapoor, Neeti
- Karaye, Ibraheem M
- Karimi, Salah Eddin
- Kassa, Bekalu Getnet
- Kaur, Rimple Jeet
- Kayode, Gbenga A
- Keykhaei, Mohammad
- Khajuria, Himanshu
- Khalilov, Rovshan
- Khan, Imteyaz A
- Khan, Moien AB
- Kim, Hanna
- Kim, Jihee
- Kim, Min Seo
- Kimokoti, Ruth W
- Klymchuk, Vitalii
- Knudsen, Ann Kristin Skrindo
- Kolahi, Ali-Asghar
- Korshunov, Vladimir Andreevich
- Koyanagi, Ai
- Krishan, Kewal
- Krishnamoorthy, Yuvaraj
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- Miller, Ted R
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- 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
- Citations by year
- 2026: 107 · 2025: 160 · 2024: 160 · 2023: 128 · 2022: 27
- FWCI
- 80.44
- Type
- journal article
- Language
- en
- Update notices
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- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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
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