Report outlines alcohol's health effects, seeks public comment

A draft HHS report highlights the morbidity and mortality caused by alcohol use in the U.S.

The report came from a scientific review panel comprised of six external scientists with expertise in alcohol epidemiology, alcohol's health effects, cancer epidemiology, and research. The panel focused on the relationship between alcohol and injuries, lifetime risks of alcohol-attributable mortality and morbidity by amount of alcohol consumed, and the burden of alcohol and related health conditions.

The report, along with the National Academies of Sciences, Engineering, and Medicine's Review of Evidence on Alcohol and Health, is open to a 30-day public comment period. The two complementary reports are intended to help inform HHS and the U.S. Department of Agriculture in developing the Dietary Guidelines for Americans, 2025-2030.

Most of the evidence in the HHS report stems from systematic reviews and meta-analyses of observational cohort studies. It did not include data from quasi-experimental studies or randomized controlled trials. The report assessed relationships between different levels of alcohol consumption and the risk of dying of health conditions that are causally related to alcohol.

Among its findings are the following:

• The risk of dying from alcohol use begins at low levels of average use. Higher levels of alcohol consumption are linked with progressively higher mortality risk. Depending on the level of use, men and women are at similar risks of health harms from alcohol use.
• Men and women have a 1 in 1,000 risk of dying from alcohol use if they consume more than seven drinks per week, increasing to 1 in 100 if they consume more than nine drinks per week.
• Men and women who consumed one drink a day had an increased risk of liver cirrhosis, esophageal cancer, oral cancer, and injuries, but a lower risk for ischemic stroke. Drinking patterns shape risk, and even infrequent binge drinking may eliminate the stroke benefit. Women had a higher risk for liver cancer and a lower risk for diabetes if they drank one drink a day.
• Alcohol use is associated with increased mortality from seven types of cancer: colorectal, female breast, liver, oral cavity, pharynx, larynx, and squamous-cell-type esophagus. Increased risk for these cancers begins with any alcohol use and increases with higher levels of use. Women have a much greater risk of an alcohol-attributable cancer per drink consumed.
• Binge drinking increases risk of injuries. Risks increase starting at one drink per occasion and are particularly pronounced for women consuming more than three drinks and men consuming more than four drinks per occasion.
• For individuals who start consuming alcohol at age 15 years, the risk of an alcohol-attributable death between the ages of 15 and 20 years varies by consumption level, increasing linearly with alcohol consumption. Most of these alcohol-attributable deaths are caused by car crashes, unintentional injuries, and intentional injuries and represent a substantial proportion of all deaths for individuals 15 to 20 years of age.

“Both the amount of alcohol consumed and the patterns of consumption influence risk,” the report stated. “The lifetime risk curves for diseases directly take into account the amount of alcohol consumed and indirectly take into consideration the patterns of drinking (i.e., the underlying risk functions used take into consideration the average drinking patterns of the underlying cohorts).” The report noted that the cohorts in the included studies were from many different countries and that the study populations' drinking patterns may not be representative of the general U.S. population.