Australian alcohol-attributable harm visualisation tool

This visualisation tool, a collaboration between Curtin University’s National Drug Research Institute (NDRI) and University of Victoria’s Canadian Institute for Substance Use Research (CISUR), can be used to identify local, state and national trends in alcohol-attributable deaths and hospitalisations in Australia. It was developed as part of the National Alcohol Indicators Project, a project coordinated by the National Drug Research Institute aimed at tracking and reporting on trends in alcohol-attributable harm in Australia. The tool presents 'net' alcohol-attributable deaths and hospitalisations by taking into account the protective effects of alcohol at low dose for cardiovascular, digestive and endocrine conditions.

Please reference use of this tool as:

Gilmore, W., Lensvelt, E., Jones, P., Dorocicz, J., Sherk, A., Churchill, S., Stockwell, T., Chikritzhs, T. (2021). Australian alcohol-attributable harm visualisation tool. National Drug Research Institute, Curtin University and Canadian Institute for Substance Use Research, University of Victoria. www.alcoholharmtool.info

How to use

Estimating alcohol-attributable harm

Australia-specific alcohol-attributable fractions (AAFs) for all alcohol-attributable health conditions by age and gender were calculated in International Model of Alcohol Harms and Policies (InterMAHP) v2.1 (an open access online alcohol harm estimator [1,2]) using relative risk functions from the alcohol epidemiology literature and Australian data on alcohol consumption.

The protective effects of alcohol at low dose for Ischaemic heart disease, Haemorrhagic stroke, Ischaemic stroke (within Cardiovascular diseases group), Acute pancreatitis (within Digestive diseases group) and Diabetes Type 2 (within Endocrine conditions group) have been applied to the data (as per [1,2]) and this is why you may see negative counts or rates of alcohol-attributable harm for these conditions. For Ischaemic heart disease where there are options within InterMAHP for which relative risk functions to use we chose to follow Roerecke and Rehm's methods [2,3,4] as these produce the most conservative estimates of alcohol-attributable harm. To see estimated counts of alcohol-attributable harm in Australia for 2017 by health condition, age and gender by the various protective effect methods (detailed in [1]), including 'no protective effect', please click here for hospitalisations and here for deaths (this tool presents scenario 1 estimates).

For certain conditions we reverted to AAFs calculated under the National Alcohol Indicators Project using the more traditional method of calculating aetiologic fractions from relative risks [6]. This was either because conditions were not included in InterMAHP or there were relative risk sources deemed more applicable to the Australian population (e.g. [7]). These conditions include: Road traffic crash injury (non-pedestrians), Road traffic crash injury (pedestrians), Intentional self-harm injury, Assault injury (age 0-14), Stomach cancer. For 'Unspecified' stroke, we applied the same AAFs as Ischaemic stroke (calculated in InterMAHP v2.1).

The AAFs were applied to Australian hospitalisation and death data to estimate counts of alcohol-attributable harm. Age-specific and age-standardised rates per 100,000 resident population were then calculated. Directly age-standardised rates (calculated for the All (15+) category only) allow for better comparison of overall rates between states and territories, by adjusting for their different age structures.

Alcohol-attributable health conditions

100% attributable where alcohol is specified; otherwise, partly attributable.

ICD-10 code ranges used for each condition in some instances differ slightly to those specified in InterMAHP [1]. For included ICD-10 codes click here.

Cancers:
Oral cavity and pharynx cancer, Oesophageal cancer, Liver cancer, Laryngeal cancer, Breast cancer, Pancreatic cancer, Stomach cancer, Colorectal cancer
Cardiovascular diseases:
Hypertension, Alcoholic cardiomyopathy, Atrial fibrillation and cardiac arrhythmia, Haemorrhagic stroke, Oesophageal varices, Ischaemic stroke, Unspecified stroke, Ischaemic heart disease
Digestive diseases:
Alcoholic gastritis, Acute pancreatitis, Chronic pancreatitis, Alcohol-induced pancreatitis, Liver cirrhosis, Alcoholic Liver cirrhosis
Endocrine conditions:
Diabetes mellitus (Type 2), Alcohol-induced pseudo-Cushing’s syndrome
Infectious diseases:
Tuberculosis, HIV, Lower respiratory tract infections
Injuries (intentional):
Intentional self-harm, Assault, Intentional self-poisoning by alcohol
Injuries (unintentional):
Road traffic crashes (non-pedestrians), Road traffic crashes (pedestrians), Falls, Fires, Drowning, Aspiration, Accidental poisoning by alcohol, Occupational machine injuries
Neuropsychiatric conditions:
Alcoholic psychoses, Alcohol dependence, Alcohol abuse, Epilepsy, Alcoholic polyneuropathy, Degeneration of nervous system due to alcohol, Alcoholic myopathy
Data sources

Alcohol consumption data (2010, 2013, 2016) were sourced from Australian Institute of Health and Welfare (AIHW) National Drug Strategy Household Survey and Australian Bureau of Statistics (ABS) Apparent Consumption of Alcohol publications.

Hospitalisation data (2010/11-2017/18) were provided by the AIHW from the National Hospital Morbidity Database for all states.

Death data (2010-2017) were provided by the Australian Coordinating Registry (ACR) at the Queensland Registry of Birth, Deaths and Marriages who act on behalf of the custodians of the data, which include staff in the eight jurisdictional Registries of Birth, Deaths and Marriages, eight jurisdictional Coroners and the National Coronial Information System.

Population data (2010-2017) were sourced from ABS Estimated Resident Population.

Data caveats

The data presented is for Australian adults aged 15 years and over (15+), except in the case of Assault injury (within intentional injuries group) where we have included data for those aged under 15 years (0-14).

Combinations where the actual hospitalisation or death counts (before AAFs applied) are less than or equal to 5 are suppressed for confidentiality reasons.

In the hospitalisation data ‘State’ is the state or territory of hospitalisation and ‘Region type’ is based on where patient resident. In the death data both ‘State’ and ‘Region type’ are based on place of residence.

Metro and Non-metro areas are defined differently for hospitalisations (using ABS Remoteness Areas classification) and deaths (using ABS Greater Capital City Statistical Areas). In both hospitalisation and death data the A.C.T. has been classified as Metro only and the Northern Territory and Tasmania have been classified as Non-metro only. Due to some unit records missing sub-state residence information, ‘Metro’ plus ‘Non-metro’ counts do not always equal ‘All’.

Counts of alcohol-attributable harm have been included for transparency but should not be used for direct comparison between years, states, regions, genders or age groups due to differences in the underlying population.

Funding

The National Drug Research Institute at Curtin University is supported by funding from the Australian Government under the Drug and Alcohol Program.

Acknowledgements

We thank the ABS, AIHW, ACR and all jurisdictional departments for access to data.

Resources

References

  1. Sherk, A., Stockwell, T., Rehm, J., Dorocicz, J., Shield, K.D. (2017). The International Model of Alcohol Harms and Policies (InterMAHP): A comprehensive guide to the estimation of alcohol-attributable morbidity and mortality. Version 1.0: December 2017. Canadian Institute for Substance Use Research, University of Victoria, British Columbia, Canada.
  2. Sherk, A., Stockwell, T., Rehm, J., Dorocicz, J., Shield, K.D. (2019). The International Model of Alcohol Harms and Policies (InterMAHP). Version 2.1: 2019. Canadian Institute for Substance Use Research, University of Victoria, British Columbia, Canada.
  3. Roerecke, M., & Rehm, J. (2012). The cardioprotective association of average alcohol consumption and ischaemic heart disease: a systematic review and meta‐analysis. Addiction, 107(7), 1246-1260.
  4. Roerecke, M., & Rehm, J. (2010). Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis. American journal of epidemiology, 171(6), 633-644.
  5. Roerecke, M., & Rehm, J. (2011). Ischemic heart disease mortality and morbidity rates in former drinkers: a meta-analysis. American journal of epidemiology, 173(3), 245-258.
  6. Chikritzhs, T. (2009). Tools for Policy and Prevention: The Australian National Alcohol Indicators Project. Contemporary Drug Problems, 36(3-4), 607-624.
  7. Ridolfo, B., Stevenson, C. (2001). The quantification of drug-caused mortality and morbidity in Australia, 1998. Canberra: AIHW.