South African Medical Journal

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Estimating the burden of disease attributable to alcohol use in South Africa in 2000

M Schneider, R Norman, C Parry, D Bradshaw, A Pluddemann, South African Comparitive Risk Assessment Collaboration Grou


Objectives. To make quantitative estimates of the burden of
disease attributable to alcohol use by sex and age group in
South Africa in 2000.
Design. The analysis follows the World Health Organization
comparative risk assessment (CRA) methodology. Populationattributable
fractions (PAFs) calculated from modelled
prevalence estimates and relative risks based on the global
review were applied to the burden of disease estimates from
the revised South African National Burden of Disease study
for 2000. The alcohol-attributable fractions for injuries were
directly determined from blood alcohol concentrations (BAC
> 0.05 g/100 ml) at the time of injury. Monte Carlo simulationmodelling
techniques were used to quantify uncertainty in the
Setting. South Africa.
Subjects. Adults ≥ 15 years.
Outcome measures. Deaths and disability-adjusted life years
(DALYs) from ischaemic heart disease, stroke, hypertensive
disease, diabetes, certain cancers, liver cirrhosis, epilepsy,
alcohol use disorder, depression and intentional and
unintentional injuries as well as burden from fetal alcohol
syndrome (FAS) and low birth weight.
Results. Alcohol harm accounted for an estimated 7.1% (95%
uncertainty interval 6.6 - 7.5%) of all deaths and 7.0% (95%
uncertainty interval 6.6 - 7.4%) of total DALYs in 2000. Injuries
and cardiovascular incidents ranked first and second in terms
of attributable deaths. Top rankings for overall attributable
burden were interpersonal violence (39.0%), neuropsychiatric
conditions (18.4%) and road traffic injuries (14.3%).
Interpersonal violence accounted for 42.8% of the injury DALYs
attributed to alcohol in males and 25.9% in females. In terms of
alcohol-attributable disability, alcohol use disorders ranked first
(44.6%), interpersonal violence second (23.2%), and FAS third
Conclusions. Particular attention needs to be given to preventing
and reducing the burden of alcohol-related homicide and
violence, alcohol-related road traffic accidents, alcohol use
disorders, and FAS. Multilevel interventions are required to
target high-risk drinkers, in addition to creating awareness in
the general population of the problems associated with alcohol

South African Medical Journal Vol. 97 (8) Part 2 2007: pp. 664-672

AJOL African Journals Online