Estimated alcohol‐attributable health burden in New Zealand: A comparative risk assessment

AIMS: To estimate the alcohol-attributable morbidity and mortality in New Zealand (NZ) as measured by deaths, cancer registrations, hospitalisations and Accident Compensation Corporation (ACC) injury claims. DESIGN: Comparative risk assessment methodology. SETTING AND PARTICIPANTS: The 2018 NZ population aged > 14 years, by ethnicity (Māori/non-Māori), age and sex. MEASUREMENTS: Alcohol-attributable fractions (AAF) for 26 alcohol-related conditions were generated in the International Model of Alcohol Harms and Policies (v3.0) using 2016 Global Burden of Disease Study relative risk functions and 2018 NZ alcohol exposure statistics. AAFs were applied to enumerated outcomes, with age-sex standardised rates computed using the 2018 estimated resident population. Primary results present net outcomes (allowing potential protective effects at low consumption where supported by risk curves); gross outcomes are presented in sensitivity analyses. Main outcomes included deaths, cancer registrations, publicly funded hospitalisations and ACC injury claims. FINDINGS: In 2018, an estimated 901 deaths [95% uncertainty interval (UI) = 681-1104], 1250 cancer cases (95% UI = 1084-1383), 29 282 hospitalisations (95% UI = 25 713-32 318) and 128 963 ACC injury claims (95% UI = 114 324-140 681) were attributable to alcohol. Māori (Indigenous population in NZ) experienced a disproportionately high health burden: 4.7% of all deaths, 5.2% of all cancers, 3.4% of hospitalisations and 9.9% of ACC claims among Māori were attributable to alcohol, compared with 2.5%, 4.7%, 2.7% and 8.7% for non-Māori, respectively. Age-sex standardised rates of alcohol-attributable (AA) mortality, cancer registrations and hospitalisations were ~20-100% higher for Māori than non-Māori. Males accounted for the majority of health harms (e.g. 83% of AA deaths and 64% of AA hospitalisations). Assuming no protective effects (gross outcomes), an estimated 1379 deaths (95% UI = 1202-1528) and 31 484 hospitalisations (95% UI = 28 209-34 204) were attributable to alcohol. CONCLUSIONS: Alcohol caused substantial, inequitable health loss in New Zealand in 2018. Māori bore a markedly higher age-sex standardised burden than non-Māori.