Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020


Dana Bryazka, Institute for Health Metrics and Evaluation
Marissa B. Reitsma, Institute for Health Metrics and Evaluation
Max G. Griswold, RAND Corporation
Kalkidan Hassen Abate, Jimma University
Cristiana Abbafati, Sapienza Università di Roma
Mohsen Abbasi-Kangevari, Shahid Beheshti University of Medical Sciences
Zeinab Abbasi-Kangevari, Shahid Beheshti University of Medical Sciences
Amir Abdoli, Jahrom University of Medical Sciences
Mohammad Abdollahi, The Institute of Pharmaceutical Sciences (TIPS)
Abu Yousuf Md Abdullah, University of Waterloo
E. S. Abhilash, Sree Narayana Guru College, Chelannur
Eman Abu-Gharbieh, University of Sharjah
Juan Manuel Acuna, Khalifa University of Science and Technology
Giovanni Addolorato, Università Cattolica del Sacro Cuore, Campus di Roma
Oladimeji M. Adebayo, College of Medicine, University of Ibadan
Victor Adekanmbi, UT Medical Branch at Galveston
Kishor Adhikari, Teaching Hospital
Sangeet Adhikari, Arizona State University
Qorinah Estiningtyas Sakilah Adnani, Universitas Padjadjaran
Saira Afzal, King Edward Memorial Hospital
Wubetu Yimam Agegnehu, Mizan-Tepi University
Manik Aggarwal, Cleveland Clinic Foundation
Bright Opoku Ahinkorah, University of Technology Sydney
Araz Ramazan Ahmad, International Relations & Diplomacy
Sajjad Ahmad, Abasyn University
Tauseef Ahmad, Southeast University
Ali Ahmadi, Shahid Beheshti University of Medical Sciences
Sepideh Ahmadi, Shahid Beheshti University of Medical Sciences
Haroon Ahmed, COMSATS University Islamabad

Publication Name

The Lancet


Background: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods: For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding: Bill & Melinda Gates Foundation.

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National Institutes of Health



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