Analysis of International Approaches to Low-Risk Drinking Guidelines: Implications for Ireland

Abstract Background From 2016 to 2022, several countries, including the United Kingdom, France, Australia, and Canada, revised their alcohol low-risk drinking guidelines. These updates relied on advanced statistical models to assess the health risks associated with various levels of alcohol intake. In 2024, Ireland's Department of Health tasked the Health Information and Quality Authority (HIQA) with reviewing and providing evidence to inform the update of Ireland's guidelines. The aim of this study was to review international methodologies and outlines the strategy selected by HIQA. Methods A comparative assessment of international approaches was carried out to identify the most appropriate methodology for Ireland. The review focused on inputs-such as the range of diseases or injuries accounted for in the models-and modelling outcomes, such as lifetime risk of death, Years of Life Lost (YLL), or Disability-Adjusted Life years (DALYs). Results The comparative analysis revealed significant methodological differences. For instance, Canada used DALYs and YLL to quantify alcohol-related risks. Meanwhile, the UK and Australia drinking guidelines solely relied on the lifetime risk of death. Similarly, these two guidelines included drinking frequency as an additional metric, thereby emphasising health risks associated with binge drinking. Conclusions Despite overarching methodological similarities, the analysis revealed significant variations of low-risk drinking guidelines, reflecting the distinct policy environments and public health priorities of each country. The findings from the comparative review led HIQA to adopt a hybrid methodology, incorporating elements from the approaches studied. This tailored strategy seeks to ensure that Ireland's updated guidelines are evidence-based and aligned with national public health challenges associated with alcohol. Lessons learned from the various international experiences studied here play a significant role in shaping this process. Key messages • National drinking guidelines, though relying on statistical modelling approaches, vary widely to reflect unique public health priorities and diverse methods for assessing alcohol-related risks. • The international comparison of low-drinking guidelines and associated statistical modelling outlined the necessity of employing a hybrid approach to inform the Irish low-risk drinking guidelines.