高血压英文ppt精品课件alcohol alcohol use disorders and burden of

Alcohol, Alcohol Use Disorders and Burden of Disease,Jrgen Rehm 1-3 1) Centre for Addiction and Mental Health, Toronto, Canada 2) Dalla Lana School of Public Health, University of Toronto 3) Technische Universitt Dresden, Clinical Psychology and Psychotherapy,Thank you!,This work would not have been possible: without the participants of the Global Burden of Disease Comparative Risk Assessment for alcohol (more than 500 contributors; core group: G. Borges, G. Gmel, B. Grant, K. Graham,C. Parry, J. Rehm, R. Room) without the support or NIAAA (“Alcohol- and Drug-Attributable Burden of Disease and Injury in the US”; contract # HHSN267200700041C) and all the experts who contributed to the workshops from NIH, CDC and CAMH. Thanks a lot for CDC, NIAAA, NIDA for organizing these workshops! without the Toronto team: D. Baliunas, G. Gmel jr., H. Irving, T. Kehoe, J. Patra, L. Popova, M. Roerecke, A. Samokhvalov, B. Taylor without the collaboration of U. Frick without the collaboration of the Alcohol Research Group (J. Bond, T. Greenfield, W. Kerr, Y. Ye),age-weighted and 3% discounted (WHO norm values),Impressive numbers, but.,we need to know the process and its assumptions before we can comment on them for instance: Which disease categories are considered alcohol-attributable and why? How is the impact of alcohol modelled? What are DALYs and why are they discounted? Etc., etc.,Topics covered,Model to estimate alcohol-attributable disease burden What disease categories are related to alcohol and what is the dose-response relationship? How to measure exposure for estimating alcohol attributable burden of disease? The role of disability weights in a burden of disease framework,Topics covered,Model to estimate alcohol-attributable disease burden What disease categories are related to alcohol and what is the dose-response relationship? How to measure exposure for estimating alcohol attributable burden of disease? The role of disability weights in a burden of disease framework,Societal Factors,Drinking culture,Alcohol Policy,Drinking environment,Health care system,Population group,Gender,Age,Poverty Marginalization,(individual),Currently used model for alcohol CRA 2005,Basic formula,where Pa is the prevalence of lifetime abstainers RRa is the relative risk of lifetime abstainers (set to 1) Pex is the prevalence of former drinkers (all types of former drinkers with no drinking in last year) RRex is the relative risk of former drinkers x average volume of alcohol consumption per day among drinkers P(x) is the prevalence of alcohol with consumption x RR(x) is the relative risk of drinkers with consumption x Of course, instead of no consumption at all, other counterfactuals could be modelled. We programmed and implemented an R program to estimate these formulas including integration i.e., not 100 intervals but solving the integral).,Topics covered,Model to estimate alcohol-attributable disease burden What disease categories are related to alcohol and what is the dose-response relationship? How to measure exposure for estimating alcohol attributable burden of disease? The role of disability weights in a burden of disease framework,Main conditions with alcohol-attributable fractions of 100% (alcohol as a necessary condition),Alcoholic psychoses, Alcohol dependence syndrome, Harmful alcohol use, Alcoholic polyneuropathy, Alcoholic cardiomyopathy, Alcoholic gastritis, Alcoholic fatty liver, Acute alcoholic hepatitis, Alcoholic cirrhosis of liver, Alcoholic liver damage, unspecific, Alcohol-induced acute and chronic pancreatitis, Alcoholic hepatic failure, Fetal alcohol syndrome, Excess blood alcohol, Accidental poisoning and exposure to alcohol, Ethanol and methanol toxicity Practically there are no data on global level on most subcategories except alcohol dependence and FAS (new meta-analysis by our team), and the relation to alcohol may have to be determined based on RR (e.g., for liver cirrhosis as wider category),Alcohol-attributable disease and injury 2002 (green mainly protective),Chronic disease: Cancer: Mouth & oropharyngeal cancer, esophageal cancer, liver cancer, female breast cancer Neuropsychiatric diseases: Alcohol use disorders, unipolar major depression, primary epilepsy Diabetes Cardiovascular diseases: Hypertensive diseases, ischemic heart disease, ischemic stroke, hemorrhagic stroke Gastrointestinal diseases: Liver cirrhosis Conditions arising during perinatal period: Low birth weight, FAS Injury: Unintentional injury: Motor vehicle accidents, drownings, falls, poisonings, other unintentional injuries Intentional injury: Self-inflicted injuries, homicide, other intentional injuries,New developments with respect to causality: inclusion of alcohol-attributable disease categories,Colorectal cancer included (IARC monograph meeting; Baan et al., 2007) Tuberculosis/pneumonia incidence and worsening the disease course included (see next slides) HIV incidence discussed but not included (not enough evidence for causality for incidence); enough evidence for alcohol worsening the disease cause, quantified based on recent meta-analyses Pancreatitis included (new disease category in GBD) Diverse new GBD injury categories (most injury categories have been causally linked to alcohol consumption) Revision of determination of risk relationship between alcohol consumption and primary epilepsy (excluding “alcoholic seizures” in collaboration with epilepsy experts in GBD),Alcohol & Infectious Diseases Technical Meeting 15 18 July 2008 Vineyard Hotel Cape Town, South Africa,Risk function and confidence interval for tuberculosis (threshold function),RR=1, for x40, 2.96 otherwise inf(RR)=1,for x40, 2.28 otherwise sup(RR)=1, for x40, 3.85 otherwise,Risk relation and confidence interval for breast cancer,lnRR=0.00879 x inf(lnRR)=0.00879 x-0.00151821*Sqrtx2 sup(lnRR)=0.00879 x+0.00151821*Sqrtx2,Risk relation and confidence interval diabetes mellitus,Men: RR=exp(-0.109786*(x+0.003570556640625)/10) + 0.0614931*(x+0.003570556640625)/10)*log(x+0.003570556640625)/10) Women: RR= if x80 : exp(-0.4002597*sqrt(x+0.003570556640625)/10) + 0.0076968*(x+0.003570556640625)/10)3), else: 16.59595,Risk relations and confidence interval for epilepsy,lnRR=1.22861 (0.5 +x) inf(lnRR)= 0.0122861 (0.5 +x)- 0.00272827 *Sqrt(0.5 +x)2 sup(lnRR)= 0.0122861 (0.5 +x)+ 0.00272827 *Sqrt(0.5 +x)2,Difference in scaling!,Risk relations and confidence intervals for ischemic heart disease,Risk relations and confidence intervals for lower respiratory infections,Risk relations and confidence interval for pancreatitis,lnRR= 0.000149643 (0.290001 +x)2 inf(lnRR)= 0.000149643 (0.290001+x)2-0.0000335294 Sqrt(0.290001+x)4 sup(lnRR)= 0.000149643 (0.290001+x)2+0.0000335294 Sqrt(0.290001+x)4,Risk relations and confidence interval for low birth weight: closer view,Topics covered,Model to estimate alcohol-attributable disease burden What disease categories are related to alcohol and what is the dose-response relationship? How to measure exposure for estimating alcohol attributable burden of disease? The role of disability weights in a burden of disease framework,Exposure,Most risk relations are with volume (alcohol related to more than 20 GBD codes) Triangulation of survey and per capita data derived from sales and production Main sources for per capita data: FAO, industry, government (WHO survey to all member states 2008) Algorithm about determining which data to use based on quality For the US - relatively low unrecorded consumption,Fitting different distributions for NESARC example of Non-Hispanic White men,Best fit: Weibull & Gamma,Gamma Distribution f(x; , k) = 1/( k (k) xk-1 exp- x / Mean Estimate for the Gamma Distribution = k Variance = 2k Empirical and theoretical Gamma estimates for mean have to be identical, and variance estimates were quite similar based on 100 surveys from 60 countries (see next slide). Better properties for transferring results to other populations than Weibull.,Prediction of standard deviation from mean of the distribution,Mean in g/day,Standard deviation of Gamma distri