Is burden of disease differentially linked to spirits? A systematic scoping review and implications for alcohol policy

• Published in: Alcohol (Fayetteville, N.Y.) N.Y.), 2020-02, Vol.82, p.1-10
• Main Authors: Rehm, Jürgen, Hasan, Omer S.M.
• Format: Article
• Language: English
• Subjects: Alcohol Drinking - adverse effects; Alcohol Drinking - economics; Alcohol Drinking - epidemiology; Alcohol Drinking - prevention & control; Alcohol use; Alcohol-Related Disorders - economics; Alcohol-Related Disorders - epidemiology; Alcohol-Related Disorders - prevention & control; Alcoholic beverages; Alcoholic Beverages - adverse effects; Alcoholic Beverages - economics; Alcoholic Beverages - legislation & jurisprudence; Alcoholic strength; Alcoholism; Animals; Attributable burden; Beer; Beer - adverse effects; Beverages; Cancer; Causality; Comparative studies; Drinking behavior; Epidemiology; Ethanol; Ethanol - adverse effects; Ethanol - economics; Humans; Intoxication; Mortality; Poisoning; Policy Making; Public Health - economics; Public Health - legislation & jurisprudence; Risk Assessment; Risk Factors; Spirits; Systematic review; Taxation; Taxes; Wine; Wine - adverse effects
• ISSN: 0741-8329; 1873-6823
• DOI: 10.1016/j.alcohol.2019.06.005

Most epidemiological research on alcohol as a risk factor is based on the assumption that outcomes are linked to pattern and level of alcohol exposure, where different beverages are converted into grams of ethanol. This review examines this basic assumption, that alcohol has the same impact, independent of beverage type. We conducted a systematic search on comparative research of beverage-specific alcohol exposure and consequences. Research was divided by methodology (survey, case–control, cohort, time-series analyses, interventional research). Overall, many studies showed higher risks for spirits compared to beer or wine; however, most research was not controlled adequately for confounders such as patterns of drinking. While there is no conclusive evidence for spirits being associated with more harm, given the same pattern and level of alcohol exposure, some evidence supports for certain outcomes such as injuries and poisonings, a potential excess risk with spirits consumption due to rapid ethanol intake and intoxication. Accordingly, encouraging people to opt for beverages with lower alcohol content via taxation strategies has the potential to reduce alcohol-attributable harm. This does not necessarily involve switching beverage type, but also can achieved within the same beverage category, by shifting from higher to lower concentration beverages. •Estimates of alcohol burden are based on ethanol content without differentiating beverage type.•However, epidemiological studies point to differential burden by beverage type.•As per our review, often spirits have been associated with higher burden.•However, most research has not adequately controlled for confounders (in particular patterns of drinking).•There are some indications that favoring lower strength alcohol may result in less harm.