Editor—As a simple measure of human nature, I suspect the initial impact of the paper by White et al on alcohol consumption and mortality will depend on the age of the reader1; as someone in the two unit a week group (by a whisker of course) I was drawn to read the article in more depth.
Although it is clear what the paper adds, it is harder to decide how it affects what we do as health professionals and as part of society. The last comment made by the authors in the discussion is particularly pertinent: “Finally, as most deaths attributable to alcohol at younger ages are due to injuries, a greater focus could be placed on avoiding risky patterns of drinking rather than on reducing average alcohol consumption.”
Injuries are a significant cause of death in young adults; even looking at all age death rates given in table 1 in the paper, this category is the third largest cause of death. It would therefore be simplistic to respond to this paper by reviewing recommended alcohol intake alone and ignoring behaviour. Taking drink driving as an obvious example, I have been interested to see the New Zealand approach to this problem since moving here from the United Kingdom. Until recently, New Zealand had one of the highest per capita death rates for road traffic injuries in the world, and alcohol played a large part in this (between 1987 and 1992, 35-46% of fatally injured drivers tested were over the limit—two thirds to three quarters were tested).2 Most of these alcohol related deaths were in the age group 15-44 (peak 20-24 years), which reflects the risk findings of the paper.
One of the strategies that has probably helped to reduce this figure (20% of fatally injured drivers in 2000) has been to vary the legal alcohol limit by age. The legal limit under the age of 20 years is 30 mg/100 ml (blood)—this is effectively zero tolerance. Penalties at all ages are high: financially, through suspension, and through potential custodial sentence. With alcohol as the intervention and death as the outcome, one of the key consequences of this paper should be to continue to seek ways of minimising or avoiding the processes that link them together.
References
- 1.White IR, Altmann DR, Nanchahal K. Alcohol consumption and mortality: modelling risks for men and women at different ages. BMJ. 2002;325:191. doi: 10.1136/bmj.325.7357.191. . (27 July.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Land Transport Safety Authority. Blood alcohol limits. www.ltsa.govt.nz/research/annual_statistics_2000/blood_alcohol.html (accessed 17 September 2002).