Worldwide, more people abstain from alcohol than drink it, say the authors of the Lancet study that examined links between alcohol consumption and mortality. (Toby Talbot/Associated Press)

One in every 25 deaths worldwide can be linked to diseases or injuries related to alcohol consumption, concludes a Canadian-led study, which equates the libation's burden of harm to that of smoking almost a decade ago.

In 2004, the most recent year for which global statistics are available, 3.8 per cent of all deaths were attributable to alcohol (6.3 per cent for men and 1.8 per cent for women), the study found.

Most of the deaths blamed on booze result from injuries, cancer, cardiovascular disease, liver disorders like cirrhosis and violence, say the authors, whose study is one in a series of papers on the global impact of alcohol published in The Lancet this week.

The high death toll attributed to alcohol is even more startling when viewed in the context of overall global consumption.

"Worldwide, more people abstain than drink," principal researcher Jurgen Rehm, a senior scientist at the Centre for Addiction and Mental Health in Toronto, said Thursday.

"It's not only Muslim countries — of course they contribute to this — but also countries like India where about 95 per cent of the women abstain, where about 80 per cent of the males abstain."

"And India has more than one billion inhabitants, so they really count."

Disability link

Rehm said alcohol consumption is also responsible for five per cent of "years lived with disability" among the global population.

"Alcohol has links to cancer, to accidents where people are killed, but if you then go into the neuropsychiatry diseases or alcohol dependence, a lot of those diseases do not kill you, they just disable you," Rehm said.

Imbibing — especially in significant quantities over time — has been strongly linked to a number of cancer types, among them: head and neck malignancies, especially esophageal tumours, and breast and colorectal cancer.

While some positive effects on heart health have been reported with moderate intake of quaffing, Rehm said heavier drinking is known to actually contribute to cardiovascular disease.

The researchers say two different aspects of alcohol consumption affect health: the amount one drinks on average and one's pattern of tippling, including binge or heavy drinking.

Globally, average alcohol consumption was equivalent to 6.2 litres of pure ethanol per year, or about a dozen 10-ml units per person per week, the study found.

In Europe, the figure is higher, at almost 22 10-ml units per week. North Americans take in an average of 18 units weekly, while eastern Mediterranean countries have the lowest average consumption at 1.3 units per week.

Ten millilitres of ethanol is equivalent to what would be found in a bottle of beer, a medium glass of wine or a shot of spirits.

Former Soviet countries top list

Europe had one of the highest death rates related to alcohol — one in 10. Within Europe, the former Soviet Union countries had the highest proportion at 15 per cent, or around one in every seven deaths.

"Lest familiarity with alcohol engenders complacency," says a Lancet editorial, "consider the example of Russia — where in some industrial cities, adult workers may drink one bottle of vodka per day."

A paper in the journal's series shows that if "associations with alcohol consumption are causal, then over half of deaths in men aged 15 to 54 years during 1990-2001 in the three Russian cities studied were due to alcohol," says the editorial, possibly helping to explain why the life expectancy of Russian men is just 59 years.

Dr. Tim Stockwell, director of Centre for Addictions Research of B.C., said the rigorously conducted study is actually "very conservative" in its calculations of alcohol-related deaths worldwide.

"The data have been coming out on this kind of thing for years and because alcohol is our favourite drug, we kind of put it away in a too-hard basket or one we don't believe," Stockwell, who was not involved in the study, said from Victoria.

"The fact is there's been proven causal connections between alcohol consumption and 60 causes of death. But you don't have to be an alcoholic to experience these things. We're talking about drinking at unsafe levels, so the regular drip, drip, drip into the body."

No more than 2-3 daily drinks

Experts generally agree that men should limit alcohol consumption to three drinks a day, while women should not exceed two a day, Stockwell said.

"If you're getting much above that on average a day, you're certainly increasing your risk of premature death."

Rehm said the big worry when it comes to disease and deaths from booze is the developing world, especially Asia, where increased industrialization and globalization are leading to consumption rates creeping upward.

"We're not talking about the poorest of the poor, we're not talking about Africa. We're talking about those emerging economies like China, like Thailand, who are right now increasing their cross-national product, who are getting more and more westernized in a lot of ways, and that is where alcohol is currently the Number 1 risk factor."

"And it's where consumption and alcohol-related harm is increasing."

Rehm said the global burden of disease from drinking is about the same size as that of smoking in 2000 (tobacco use rates have been steadily dropping in some countries due to public health measures), but is sure to get worse as more people add wine, beer and spirits to their list of libations.

"The big message is treat alcohol like tobacco," not as a substance that is relatively benign except for "those bad alcoholics," he said. "That is not true, neither for Canada nor globally."

"So we need to rethink alcohol completely as a risk factor. Of course, we will not prohibit alcohol, but we should make it more expensive so it's consumed in smaller quantities and in quantities which are actually not as detrimental for health."