Use of alcohol and its consequences on health in Argentine Northwest. Sex differentials and impact of life expectancy at birth during 2011 Bertone Carola Leticia. CENIIT-UNLAR; CONICET Torres, Victor Eduardo. CIECS (CONICET y UNC) y Fac. de Ciencias Económicas (UNC) Andrada Marcos, CENIIT-UNLAR; CONICET Abstract In 2012, harmful alcohol consumption was responsible for 5.9% of the world's deaths. In Argentina, during 2008, 11,013 deaths were due to this risk factor, representing 3.6% of the country's total deaths. However, the use of alcohol in that country has remained at about 9.5 liters of pure alcohol per capita in recent years, 3.3 liters superior to world consumption. We make a quantitative, transversal and descriptive study in order to study the mortality attributable to alcohol consumption in the Argentine Northwest in 2011 and how it affects the life expectancy of the region in men and women. The methodology proposed by the CDC (1990) - Attributable Mortality to Alcohol Consumption (MACA) and Years of Life Expectancy (Arriaga, 1996) is applied. It is intended to simulate two scenarios of the possible impact of certain public policies on the mortality measured with the latter indicator. We use secondary sources of data as National Vital statistics, specific health surveys and also population projections of official organisms. Previously we make a brief estimation of statistics data quality using Murray and Lopez (1996) garbage codes.
Introduction Harmful alcohol consumption causes around 3.3 million deaths (5.9%) all over the world. This level of alcohol consumption is considered responsible for more than 200 diseases and mental and behavioral disorders; it affects people of early ages generating disability, and account for up to 25% of deaths between the ages of 20 and 39 (World Health Organization, 2014). Most of these deaths are due to cardiovascular diseases, injuries, gastrointestinal diseases and cancer (World Health Organization, 2014). Alcohol consumption causes a considerable burden of disease in the Americas, surpassing global estimates: 5.4% of all deaths that could be attributed to alcohol consumption, with most of the burden falling on Central and South America (Rehm et al. 2006 cited by (Monteiro, 2007)). It is estimated that in 2002, alcohol caused the death of one person every two minutes in the Region (Monteiro, 2007). Alcohol consumption per capita of people aged 15 years and over in Argentina remained around 9.5 liters of pure alcohol (equivalent to 25 grams of alcohol per day) in recent years, 3.3 liters higher than the estimated worldwide. Psychoactive substances consumption survey carried out in Argentina in 2010 (called EnPreCoSP) detected a prevalence of alcohol consumption of 44.5% (95% CI: 42.8%- 46.2%). This prevalence has almost not changed between 2005 and 2011, according to other health surveys. Meanwhile, the prevalence of excessive episodic alcohol consumption in 2010 was 12.0% in general population and 20.4% of alcohol users (World Health Organization, 2014). As a result of the use of alcohol in Argentina, 3.6% of deaths in 2008 (N: 11.013) were caused by this risk factor. Of these, 73% occurred in men, affecting mainly young people whose causes of death were external causes. Life expectancy, as an indicator of the level of mortality, was affected four times more in men than in women (Acosta, Bertone & Peláez, 2012). Same authors affirm that in the Argentine Northwest, 2.5% of the deaths are attributed to alcohol consumption. Although it is a region in which this public health problem is apparently less important than in other regions, however, we aware that grouping the data can hide inequalities that must be considered. We aim to study the mortality attributable to alcohol consumption in the Argentine Northwest, given that there is updated data on alcohol consumption prevalence in Argentina (INDEC, 2011) and also on population attributable fraction (PAF) of causes of death related to alcohol consumption (Disease Control and Prevention, 2013). On the other hand, we simulate two scenarios to evaluate the impact of some national and provincial policies implemented in recent years that attempt to regulate alcohol consumption.
Objective This paper aims to study the mortality attributable to alcohol consumption in each of the provinces that make up the Argentine Northwest in 2011, assessing how it affects life expectancy in these populations. Methodology This is a quantitative, transversal and descriptive study considering the deaths produced in 2011 (the average number of deaths produced between 2010 and 2012) in each province. These deaths are studied according to causes of death directly and indirectly attributable to alcohol consumption. It is based on the methodology proposed by the Center for Disease Control and Prevention (CDC) (1990) and Mortality Attributable to Alcohol Consumption (MACA). Afterwards, to assess the impact on life expectancy at birth, the Years of Lost Life (YLL) is calculated (Arriaga, 1996). Data were provided by Health Statistics and Information Division (DEIS) of the Ministry of Health. We use deaths data from 2007 to 2012, according to causes of death attributable directly and indirectly to alcohol consumption. We also use population projections of the National Institute of Statistics and Census for each province of Northwest Argentina: Jujuy, Salta, Catamarca, La Rioja, Santiago del Estero y Tucumán. First, we make a death data quality analysis using garbage codes such as PAHO recommends. Secondly, we calculate Alcohol-Related Deaths. Third, we calculate the impact on life expectancy at birth in women and men with Years of Life Lost (YLL) performed by Arriaga (1996). We use two scenarios in order to assess the possible impact of certain public policies on alcohol-related mortality: a 10% reduction and a 20% reduction in deaths. For which, we use a calculation sheet from PAS package, prepared by Arriaga, called PLANMORT. In order to estimate the MACA for causes indirectly related to alcohol consumption, it was necessary to calculate the PAF 1 (Population Attributable Fraction), which requires the prevalence of the population for which the analysis is carried out (see Centers for Disease Control and Prevention, 2013). The prevalence of alcohol consumption was obtained from the National Survey on Prevalence of Psychoactive Substance Use in 2011 (EnPreCoSP-2011, INDEC),. Several variables have been taken from the Alcoholic Beverages block of that survey, which allowed the calculation of average daily alcohol consumption: [(Q*AF)+(BF*BQ)] 1 PAF is the proportional reduction in population disease or mortality that would occur if exposure to a risk factor were reduced to an alternative ideal exposure scenario
Where: Q is the average number of drinks per day, AF is the adjusted frequency of alcohol consumption: number of days on which alcohol is consumed minus the number of drunkennesses, BF is the number of drunks, BQ is the amount of drinks consumed in drunkenness. For the calculation of BQ the survey did not include a variable that shows the number of drinks consumed in a drinking event. However, there is a categorical variable regarding whether the respondent had excessive consumption of beer, wine or strong drinks. If this variable responds positively, it is assumed that at least 8 drinks of beer, 5 of wine and 3 of strong drinks have been consumed as defined by excessive consumption in the CDC. To determine the type of consumption, the cut-off points used are: Table 1 Cut-off points used to establish average consumption level Sex Males Females Consuption Low Up to 3,0 Up to 1,5 Medium 3,1 1,6 High 4,5 3,0 Source: English y col.,1995, y Ridolfo y Stevenson , 2001 Once this prevalence rate was obtained, it was applied to the FAP calculation: 1 1 1 2 1 2 r r r r PAF= 1 1 1 1 1 % 2 % p p Where: r1= comparison between medium and low relative risk (CDC, 2013) r2= comparison between high and low relative risk (CDC,2013) p1= prevalence of alcohol use, medium range (INDEC, 2011) p2= prevalence of alcohol use, high range (INDEC, 2011) After the FAPs of indirect causes have been obtained, the deaths attributable to alcohol consumption (MACA) were estimated from the deaths observed in the region. In addition to the causes indirectly related to alcohol consumption (CICA), there are certain causes directly related to alcohol consumption (CDCA), some of them are chronic and some acute. These are -by definition- attributable to the consumption of alcohol and are considered 100% attributable, so they have a FAP of 1.00.
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