The higher the alcohol consumption, the higher the risk

This EUphact explores alcohol consumption. Alcohol (ethanol) is consumed in the form of alcoholic beverages. When alcohol is consumed, it passes from the stomach and intestines into the bloodstream (absorption). It is metabolized in the liver, which is only capable of metabolizing a certain amount of alcohol per hour. If more alcohol is consumed than can be metabolized, the alcohol will accumulate in the body and cause intoxication (NIAAA, 1997). The more alcohol is consumed on one occasion, the higher the blood alcohol level and the higher the risk of adverse effects.

A large number of indicators exist that are related to alcohol consumption. The ECHI short-list includes total alcohol consumption, hazardous alcohol consumption and alcohol-related deaths.

Total alcohol consumption expressed in liters per person per year

Total alcohol consumption is expressed by the ‘per capita consumption’ figure for persons over the age of 15. It is the average amount of pure alcohol (in litres) consumed in one year. It is calculated from the total amount of pure alcohol consumed in one year by the whole population (including children and abstainers), divided by the number of adults (in this case persons over the age of 15). Total alcohol consumption is related to the amount of harm done by alcohol in a country. The WHO-HFA database uses estimates of the amount of pure ethanol consumed, calculated from official statistics on local production, sales, import and export, taking into account stocks and home production whenever possible.

Hazardous level of alcohol consumption differs between men and women

Hazardous alcohol consumption is defined within the WHO-CHOICE project as an average rate of consumption of more than 20g pure alcohol daily for women and more than 40g daily for men. It is calculated from total alcohol consumption data combined with data on abstinence, sex and age groups and information on drinking patterns (Rehm et al., 2004). The proportion of hazardous alcohol users is also related to mortality and the disease burden from alcohol (Chisholm et al., 2004).

Different definitions of alcohol-related deaths are used

Alcohol-related deaths is the sum of mortality from selected causes of death which are related to alcohol consumption. It is a rough indicator and it is not the estimate of alcohol attributable mortality. It is a simple pooling of alcohol related deaths, irrespective of the actual proportion of deaths due to alcohol for each cause. It can help to rank countries or to track trends in deaths. A number of different definitions are used. For example, the selection of causes used in the WHO-HFA database to calculate alcohol-related deaths does not match those used by the Mental Health Working Party (MINDFUL, 2007). The WHO-HFA database uses all causes in which alcohol consumption is a risk factor (such as cancer of oesophagus or chronic liver disease), in MINDFUL only causes directly related to alcohol are used (such as alcohol poisoning or alcoholic cardiomyopathy).