Background

Alcohol consumption in Ireland is high. It is approximately 35% higher than the Health Service Executive (HSE) low-risk drinking guidelines1 and is associated with a considerable burden of health and social harm, with the the Health Research Board's National Drug-Related Deaths Index (NDRDI) reporting three alcohol-related deaths daily in 2017.2 Effective policy decision-making relies on robust evidence of the health impact of alcohol, and one source of such evidence is the Global Burden of Disease (GBD) study.

Global Burden of Disease

The GBD captures premature death and disability from more than 350 diseases and injuries in over 200 countries worldwide and can be used to understand the alcohol-related burden on mortality and morbidity. In 2018, the Lancet published a report using GBD data to estimate the years of life lost (YLLs) and the years lived with a disability (YLDs), which when combined contributes to disability-adjusted life-years (DALYs).3

Alcohol-attributable deaths in Ireland

Using the GBD data to examine alcohol-related mortality in Ireland, a study commissioned by Alcohol Action Ireland found that in 2019 there were 1,543 deaths attributable to alcohol, representing 5% of all deaths.4 This equates to 62,237 DALYs attributable to alcohol and four deaths per day, more than that previously reported. There were approximately 750 alcohol-attributable deaths among older people (70 years and over) and approximately 260 deaths among those in the 15–49-years age group.

Causes of alcohol-related deaths

The study examined the main causes of alcohol-related deaths and found that 274 deaths in 2019 resulted from liver cancer, cirrhosis, and other chronic liver disease combined. Alcohol was attributed to 27% of suicide and self-harm deaths that year.

Trends in alcohol-related deaths

Using GBD data, the authors investigated the trend in alcohol-related deaths in Ireland between 1990 and 2019 and found that deaths correlated with per capita consumption rates that followed policy changes, economic fluctuations, and lifestyle and behaviour changes, such as the move to home drinking as opposed to on-trade consumption during that period.

Alcohol-related cancer

As a Group 1 carcinogen, alcohol has been linked to seven different types of cancer: oesophagus, larynx, upper throat, mouth, bowel, liver, and female breast.1 During the period 2012–2017, there were 55,097 discharges from Irish hospitals due to partially alcohol-attributable cancers, according to Hospital In-Patient Enquiry (HIPE) scheme data reported by the HRB.2 A Lancet Oncology study published in 2021 found that approximately 1,000 cancer diagnoses in Ireland in 2020 were alcohol attributable5 and a further study indicated that 1 in 8 breast cancer diagnoses are alcohol related.6

The authors note that cancer care has improved, greatly impacting cancer mortality rates, although knowledge of the link between alcohol use and breast cancer remains low, as indicated by the 2016 Healthy Ireland survey findings.7

Policy implications

The Public Health (Alcohol) Act 2018 in Ireland is grounded in the World Health Organization (WHO) ‘Best Buys’ that identify alcohol price, marketing, and availability as the principal factors driving alcohol consumption and subsequent harms.8,9 Several components of the Act are already in place, including structural separation; minimum unit pricing (MUP); measures around advertising in the vicinity of children; the prohibition of advertising in sports grounds for events where most competitors or participants are children, or directly on a sports area for all events; and measures around sale and supply of alcohol. However, despite the Act being signed into law in 2018, a number of sections have yet to be commenced: section 13 restricting the content of alcohol advertisements; section 18 limiting advertising in print media; section 19 providing a watershed on alcohol advertising; and section 12, labelling on alcohol products providing neutral public health information.

Recommendations

The authors of the report recommend that the remaining sections of the Act be immediately commenced and make a further recommendation that the public health response to alcohol-related harm be considered similar to that of the Road Safety Authority. Its successful multifaceted approach to reducing road traffic fatalities is a best-practice example that could also be applied to alcohol-related harm.
 

1    For further HSE information about alcohol consumption, visit: https://www2.hse.ie/alcohol/

2    O’Dwyer C, Mongan D, Doyle A and Galvin B (2021) Alcohol consumption, alcohol-related harm and alcohol policy in Ireland. HRB Overview Series 11. Dublin: Health Research Board. https://www.drugsandalcohol.ie/33909/

3    Griswold MG, Fullman N, Hawley C, et al. (2018) Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet, 392(10152): 1015–1035. https://www.drugsandalcohol.ie/29555/

4    Kabir Z, Gilheany S, McKinney E and Kit K (2022) Global Burden of Disease: estimates of alcohol use and attributable burden in Ireland. What the data tell us and what we need to do to address the burden of alcohol. Dublin: Alcohol Action Ireland and UCC School of Public Health. https://www.drugsandalcohol.ie/35733/

5    Rumgay H, Shield K, Charvat H, et al. (2021) Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. Lancet Oncology, 22(8): 1071–1080. https://www.drugsandalcohol.ie/34569/

6    Stewart BW and Wild CP (2014) World cancer report 2014. Lyon: International Agency for Research on Cancer. https://www.drugsandalcohol.ie/28525/

7    Ipsos MRBI (2016) Healthy Ireland Survey 2016: summary of findings. Dublin: Stationery Office. https://www.drugsandalcohol.ie/26278/

8    Office of the Attorney General (2018) Public Health (Alcohol) Act 2018. https://www.drugsandalcohol.ie/33698/

9    World Health Organization (2017) Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases (No. WHO/NMH/NVI/17.9). Geneva: World Health Organization. Available online at: https://www.drugsandalcohol.ie/37100/