Alcohol-attributable mortality and years of life lost in Belgium: 2013–2022

Alcohol use is a leading risk factor for premature death and disability worldwide, contributing to a wide range of chronic diseases, injuries, and social harms. While many countries have reported declines in alcohol-related harm, Belgium continues to face high levels of consumption. Despite its significant public health impact, national data on the burden of alcohol use remain scarce. This study provides estimates of alcohol-attributable mortality and years of life lost (YLL) in Belgium from 2013 to 2022, applying the Comparative Risk Assessment (CRA) approach. We applied the CRA framework to estimate alcohol-attributable burden in Belgium, using data from the Belgian Health Interview Survey, alcohol sales, and the Belgian National Burden of Disease study. Population attributable fractions were calculated for each sex, region, age group, and disease outcome. Rates and the number of deaths and YLL attributable to alcohol use were computed for individuals aged 15 and above. In 2022, alcohol use was responsible for an estimated 4,602 deaths, an increase of 361 deaths (8.5%) since 2013, despite a decline in the age-standardized mortality rate. The burden remained consistently higher among men, who accounted for the majority of deaths throughout the study period. Alcohol-related mortality rates decreased among adults younger than 65 years but increased among older adults, particularly those aged 85 years and above. In contrast, YLL declined overall, from 119,973 in 2013 to 111,872 in 2022. YLL remained highest among individuals aged 45–64 years, reflecting the continuing impact of premature mortality in middle age, although YLL rates increased among older adults. Neoplasms, cirrhosis of the liver, and mental and substance use disorders were leading contributors to alcohol-attributable mortality. Alcohol-attributable deaths have increased in Belgium since 2022, particularly among older adults, while the burden of premature mortality remains high in middle-aged groups. These findings highlight the need to strengthen population-wide alcohol control measures. The estimates can serve as a baseline for monitoring alcohol-attributable mortality in Belgium in the context of the national action plan on the harmful use of alcohol.