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Are alcohol-attributable mortality estimates reliable?

The paper by Guerin et al. 1 on alcohol-attributable mortality in France deals with a major public health issue. It shows higher estimates than recent ones obtained in France2 or by the World Health Organization.3,4

In this paper, and this is the case in similar studies, the main part of accounted deaths is due to conditions that are not directly but only partly attributable to alcohol. Attributable fractions are obtained by means of a statistical calculation. Data used to perform such a calculation are of three different types: 

1. Risk functions putting alcohol consumption level into relation with mortality incidence from a given cause, obtained from epidemiological studies,

2. Alcohol consumption distribution in the general population, obtained from population surveys,

3. Mortality by cause of death, obtained from the national mortality register.



Many sources of uncertainty lead to the use of these data with care:

First, the data types (i) and (ii) have to be compatible to be combined, i.e. alcohol consumption data have to be measured in a comparable manner in both sources. The international literature systematically identifies a strong under-estimation of alcohol consumption in self-reported surveys.5 To take this …