A New Tool for Assessing AlcoholRelated Health Impacts

1
A New Tool for Assessing Alcohol-Related Health
Impacts

• Mandy Stahre, MPH
• Bob Brewer, MD, MSPH
• Alcohol Team
• CDC Chronic Disease Center

2
Outline

• NCCDPHP Alcohol Team
• Background on software update
• Scientific Methods
• Examples of web pages
• Future Directions

3
Alcohol Team

• Established in July 2001
• Surveillance on alcohol use and alcohol-related
  conditions
• Applied research on health impacts and
  intervention effectiveness
• State capacity building technical assistance

4
Alcohol-Related Disease Impact (ARDI) Software

• Released in 1989
• Lotus 1, 2, 3 spreadsheet
• Estimated alcohol-related deaths, Years of
  Potential Life Lost (YPLL), and economic costs
• One risk factor for multiple conditions
• Not updated since release

5
Purpose of Project

• Update ARDI software
• Internet-based application (similar to SAMMEC)
• Target state health departments
• Initial focus on health outcomes
• Funding from RWJF to CDCF

6
Scientific Methods

• Convened Scientific Work Group
• -Decided on Conceptual Approach
• -Selected risk estimates or alcohol-attributable
  fractions
• -Chose prevalence cut-points indexing methods
• -Updated list of AR conditions

7
Conditions included in ARDI

• Chronic conditions
• Liver diseases
• Gastrointestinal diseases
• Cancers
• Acute conditions
• Violence
• Unintentional injuries

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Key References

• Relative Risk estimates for indirect AAFs
• English Holman. The quantification of
  drug-cause morbidity and mortality in Australia,
  1995 edition
• Corrao G, et al (1999). Exploring the
  dose-response relationship between alcohol
  consumption and the risk of several
  alcohol-related conditions.
• Bagnardi, V., et al (2001). A meta-analysis of
  alcohol drinking and cancer risk.

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Key References

• Direct Estimates for Direct AAFs
• Parrish, K, Dufour, M, et al. Average daily
  alcohol consumption during adult life among
  decedents with and without cirrhosis.
• Smith, et al. Fatal non-traffic injuries
  involving alcohol A meta-analysis. 1999
• National Highway Traffic Safety Administration,
  Fatality Analysis Reporting System FARS (updated
  annually)

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General Approach

• Emphasize impact of medium and high alcohol use
• Consider separately chronic and acute conditions
• Consider separately harms and benefits
• Use best available science

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Data Sources

• Vital statistics
• Deaths (underlying cause of death)
• Life expectancy
• Behavioral Risk Factor Surveillance System
  (BRFSS)
• Prevalence of alcohol consumption
• 3 core alcohol questions - responses indexed

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Design Principles

• Focus on Typical Users
• Emphasize usability
• State level data
• Accommodate use of custom data
• Simple and clear reports
• Clear help screens and documentation

13
Calculating AAFs

• 100 Alcohol attributable
• Alcoholic Liver Cirrhosis
• Partial attribution
• Direct AAFs
• ExMotor-vehicle traffic crashes
• Indirect AAFs
• Chronic conditions
• Use relative risk estimates and prevalence

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Report Formulas

• AAF (Pe)(RR 1) (Pe)(RR 1)
• 1 (Pe)(RR 1) 1 (Pe)(RR
  1)
• AAF x Total deaths Alcohol-Attributable Deaths
• AAF x Total deaths x YPLR YPLL

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Examples of calculations

• Liver Cancer, Males
• Medium and High alcohol consumption
• AAF
• (0.023)(2.091)
  (0.025)(2.481)
• 1 (0.023)(2.091) 1
  (0.025)(2.481)
• 0.06 x 1428 (total deaths)
• 86 Alcohol-Attributable Deaths

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Examples of Web Pages

• ARDI Home Page (http//apps.nccd.cdc.gov/ardi/Home
  page.aspx)
• Alcohol-Attributable Deaths Report
• Years of Potential Life Lost (YPLL) Report
• Alcohol-Attributable Fractions Report

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Updates

• Released in 2004 reporting 2001 data
• Released in 2008 reporting 2001-2005 data
• Under 21 report added to application
• Easier uploading of custom datasets

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Limitations

• Underreporting of alcohol consumption
• Former drinkers not included
• Underlying cause of death only
• Age-specific estimates generally unavailable
• No risk estimates for some AR conditions
• No information on state level estimates for AAFs
• No information broken out by race/ethnicity

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Contact Information

• Mandy Stahre
• Phone [phone]
• E-mail mstahre_at_cdc.gov
• Bob Brewer
• Phone [phone]
• E-mail bbrewer1_at_cdc.gov