Quantifying the global contribution of alcohol consumption to cardiomyopathy

Abstract

BackgroundThe global impact of alcohol consumption on deaths due to cardiomyopathy (CM) has not been quantified to date, even though CM contains a subcategory for alcoholic CM with an effect of heavy drinking over time as the postulated underlying causal mechanism. In this feasibility study, a model to estimate the alcohol-attributable fraction (AAF) of CM deaths based on alcohol exposure measures is proposed.MethodsA two-step model was developed based on aggregate-level data from 95 countries, including the most populous (data from 2013 or last available year). First, the crude mortality rate of alcoholic CM per 1,000,000 adults was predicted using a negative binomial regression based on prevalence of alcohol use disorders (AUD) and adult alcohol per capita consumption (APC) (n = 52 countries). Second, the proportion of alcoholic CM among all CM deaths (i.e., AAF) was predicted using a fractional response probit regression with alcoholic CM crude mortality rate (from Step 1), AUD prevalence, APC per drinker, and Global Burden of Disease region as predictions. Additional models repeated these steps by sex and for the wider Global Burden of Disease study definition of CM.ResultsThere were strong correlations (>0.9) between the crude mortality rate of alcoholic CM and the AAFs, supporting the modeling strategy. In the first step, the population-weighted mean crude mortality rate was estimated at 8.4 alcoholic CM deaths per 1,000,000 (95% CI: 7.4–9.3). In the second step, the global AAFs were estimated at 6.9% (95% CI: 5.4–8.4%). Sex-specific figures suggested a lower AAF among females (2.9%, 95% CI: 2.3–3.4%) as compared to males (8.9%, 95% CI: 7.0–10.7%). Larger deviations between observed and predicted AAFs were found in Eastern Europe and Central Asia.ConclusionsThe model proposed promises to fill the gap to include AAFs for CM into comparative risk assessments in the future. These predictions likely will be underestimates because of the stigma involved in all fully alcohol-attributable conditions and subsequent problems in coding of alcoholic CM deaths.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-017-0137-1) contains supplementary material, which is available to authorized users.

Comparison of different approaches for estimating age-specific alcohol-attributable mortality: The cases of France and Finland

“…On the other hand, the estimates that account for underlying causes of death only can be considered estimates of the minimum burden of alcohol on mortality. In addition, causes of death wholly attributable to alcohol may not be fully recorded in death certificates due to stigma associated with alcohol-related health problems, which has been shown to be the case at least for alcoholic liver cirrhosis and alcoholic cardiomyopathy [ 39 , 40 ]. One of the approaches using underlying causes of death included all underlying liver cirrhosis ( main underlying ), and showed a similar age-specific pattern as the other underlying cause-of-death approaches (except the HFA-DB ).…”

Dilated cardiomyopathy

“…Chronic alcohol abuse is an important cause of DCM, occurring most often in men of 30-55 years of age who have been heavy consumers of alcohol for at least 10 years 110 . The proportion of alcoholic cardiomyopathy among all cardiomyopathy deaths was estimated at 6.9% globally 111 , and alcoholic DCM occurred more often in men (8.9%) than in women (2.9%). Studies in animals have demonstrated that acute and chronic ethanol administration impairs cardiac contractility 112 and decreases the contractile protein α-myosin heavy chain 110 .…”

National, regional and global mortality due to alcoholic cardiomyopathy in 2015

“…In some former Soviet countries including Belarus, Kyrgyzstan, Russia and Ukraine, autopsies have been legally required for deceased persons under a certain age threshold 10. As autopsies are vital for recognising cardiomyopathy (described in detail below) and form an important step in classification of ACM as cause of death, detection rate of ACM might be above average in these countries.…”

“…The methods used were developed and described in detail elsewhere 10. We will restrict ourselves to sketching out the main modelling strategy here.…”

“…Thus, a systematic assessment of ACM mortality on a global scale requires mortality modelling for countries without available data 10. Recently, ACM deaths and related disability have been included in the Global Burden of Disease (GBD) mortality analyses for the first time 11.…”