Lecture #35 - Alcohol Flashcards
From the flow chart - what are the four types of outcomes we’re interested in?
What’s the central thing?
Why must you consider both pattern and average volume drunk?
- Chronic disease, injuries (acute diseases), acute social and chronic social.
- Intoxication
- Both pattern and average volume drunk are important because even average consumption is not enough on its own to tell us about affects on health.
“It is important to consider pattern of drinking, and not just volume of consumption, as the pattern of drinking is important in determining many of the health effects of alcohol. For example, someone who drank two bottles of wine on one drinking occasion would be at increased risk of acute health effects, such as injury. Someone who drank two bottles of wine over ten drinking occasions would be much less likely to experience acute health effects, but this pattern of drinking would contribute equally to cumulative alcohol-related health effects, such as many types of cancer.”
Pattern
- What is a pattern?
- two patterns and their numbers - What two things have consequence on health?
- How much pure alcohol in one standard drink?
- Episodes of drinking more than a little bit
- Heavy drinking episodes 6+ standard drinks or
- Binge drinking 6+/4+ standard drinks for men/ women (bc they have different body size/body water) - Frequency with which you drink more than a little and how much more than a little e.g. harms of drinking 2 bottles of wine every Friday worse than drinking one a night
- 10g
What does the current drinking prevalence look like in NZ?
“• New Zealand has a high prevalence of having ever consumed alcohol and a high prevalence of having consumed alcohol in the last 12 months.
- New Zealand has a dominant pattern of heavy intermittent drinking to intoxication.
- Men drink much more heavily than women overall. The difference is smallest among young people.
- The high prevalence of past year consumption and heavy episodic drinking behaviour haven’t changed much over time.
- The prevalence of heavy episodic drinking is highest in people aged 18-24 years and is higher in men than women.”
Just to add to that:
- 18-24 have highest hazard drinkers (higher in men than women) - hazard drinking more common in men than women
- But more people are delaying the pattern of heavy drinking
- Students drink more than non-students and amongst students, little difference between girls and boys
NZ’s “burden of alcohol studies” Summary of health impacts of alcohol at a population level for a single year
- What’re they trynna find out?
- Under “Summary of health impacts of alcohol at a population level” - what were the things?
- What conditions did they include?
- What did they do with these conditions
- How does the consumption relate to health harms. They wanted to summarise effects of alcohol across range of conditions but things like alcohol having acute and chronic effects made it difficult.
- Alcohol has chronic and acute effects (makes it difficult)
- Benefits and harms (they wanted to measure these)
- Pattern and volume of drinking (to make sense of what’s going on)
- Effects on many conditions
- Missing info (don’t have data on many conditions - not as comprehensive)
- Mental and social health (how to include that in a summary of health impacts - can be tough e.g. depression; uncertain of the association between alcohol and depression so don’t include. Social health not captured in study
- Measure of burden - deaths aren’t only burden - Cancers, neuropsychiatirc disorders, CV disorders, digestive disorders, conditions arising during pregnancy etc. But also looked at some physical benefit e.g. ischaemic heart disease + gall bladder disease by drinking
- They estimated alcohol-attributable fractions (= Population Attributable Fractions for alcohol). So they looked at alcohol as PAF for each of those conditions on that list in Q3.
- “How much % of the mortality from each condition is due to alcohol” and did this for each age, sex and ethnicity group
- Then they got numbers - Alcohol-attributable deaths in NZ
Findings of the studies done:
- What can be said about men and women suffering alcohol-related problems?
- What about Maori?
- What can be said about a estimated alcohol-attributable cancer deaths?
- What about alcohol and sex life?
- Men and women don’t suffer alcohol-related harm equally because amount they drink and what they do when they drink are different (also, injury deaths lose more life than if death by chronic disease death)
- As expected, gaps between Maori men and women esp Maori men - they have more years of life lost due to alcohol.
- You don’t need to be heavy drinkers to be affected so targeting heavy drinkers not the solution to cancer curing etc - need bigger change -The more you drink, the higher your risk but because more of the population is exposed to low level of hazardous thing - there will be more cases (I presume from that low-level drinking group) -With cancer - not a disease of drinking heavily - no threshold of drinking.
- Alcohol also affects sex life - increase in audit score =increase unsafe or unhappy sex. (audit score is frequency of drinking, impacts of alcohol on health, someone said stop drinking to you etc - put them all in one score. If score 8+ then predictive of harm from drinking
Harms from other people’s drinking
- Seven of them - list them
- So alcohol is not just about….
- What’s another advantage in terms of hospitals for taking away all people who are there because of alcohol-related problems?
- What about alcohol and assault?
- Physical violence, Sexual violence Traffic injuries, fires Child abuse and neglect, Wellbeing of drinkers families Effects on co-workers, Property damage, neighbourhood amenity
- Alcohol isn’t just about harm to drinker but everyone they come into contact with and neighbourhood in general
- Also, if take away all the people in hospital there due to alcohol - you’d have spare beds for people who need them.
- Chances you being assaulted is related to the prevalence of hazardous drinking in your sector of society (basically, in the graph,
Social benefits of alcohol:
- What do they come from?
- What are the three?
- Comes from intoxication
-
Brings us together
- get relaxation with like10-80mg/100mL BAC (but at this level - judgement etc imparied - people don’t mind bc that’s what they want but this does have consquences
- When BAC goes up - they’re inhibited or have directly affected themselves emotionally?
What are the (apparent) physical benefits of alcohol? And what are the questions raised against this?
- Cardio-protection
- small to moderate amounts of alcohl are good for your heart but like, how much? What about pattern of drinking? They say it needs to be regular but from Epi evidence - it’s like aspirin makes your platelets stick and that prevents heart attacks and alcohol does that too so alcohol prevents heart attacks but that means drink everyday
- they say red-wine is better
- they say it’s a real phenomenon but then why aren’t more people drinking or this purpose? So not heaps of evidence
Meta-analysis
If do it on all RCT, then shouldn’t have what?
Analyse this graph
It’s the whole ‘rubbish in = rubbish out’ so if the studies going in are biased then the meta analysis will be biased too
- In this graph they said if drink 20g/day - get a reduction. But this is average so it says nothing about pattern. After 72g/day it’s bad effect
- This curve seems off - why would something in smalle amount decrease risk and a larger amount not? Why is the larger one harmful?
Go read the rest, too much to type
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Whataresomeoftheepidemiologicalissueswiththeclaimthatmoderate alcohol consumption has a cardio-protective effect?
- No evidence from randomised trials.
- Implausible dose effects
- Some biases could affect all of the major studies that have found evidence of cardio-protection, including:
- Misclassification
(Self-reported alcohol consumption and changing consumption over time)
(Using an inappropriate comparison group)
-Residual confounding by characteristics related to both alcohol consumption and cardiovascular disease
