Health risks of alcohol consumption in Aotearoa New Zealand: modelling to inform low-risk-drinking guidelines.

Abstract

The present study aimed to estimate the alcohol-attributable mortality in Aotearoa New Zealand (Aotearoa) at varying levels of alcohol consumption to help inform low-risk-drinking guidelines (LRDGs) in Aotearoa. We used the New Zealand Alcohol Intervention Model-a multi-state life-table model parameterized with Aotearoa-specific alcohol and epidemiological data-to estimate the health risks associated with a daily alcohol intake of 0-100 g/day. We modelled a cohort of 12-year-olds for their life course, with exposure and disease rates fixed to 2018 levels. We used relative risk (RR) libraries developed by the World Health Organization (WHO) and Global Burden of Disease Study (GBD). The primary output was years of life lost (YLL), with 17.5 YLL used as a proxy for alcohol-related death, at lifetime-risk thresholds of 1-in-100 and 1-in-1000. When the WHO RR library was used, males reached a 1-in-100 risk of alcohol-attributable death at 8.6 standard drinks (SDs, 10 g of ethanol) [95% uncertainty interval (UI) 3.1-12.0] per week, while females reach this threshold at 9.2 SDs (95% UI 3.7-12.4). The removal of health conditions receiving a one-star evidence rating from the GBD substantially reduced the number of SDs to 2.7 (95% UI 2.1-4.6) for males and 3.5 (95% UI 2.9-4.4) for females. Across all analyses, use of the GBD RR library led to more permissive results. Ethnicity-specific results showed that Māori breach the risk thresholds at lower levels of consumption than non-Māori. Our modelling demonstrates that the Aotearoa LRDGs are outdated and need updating to reflect contemporary understandings of the harms associated with alcohol use.