Abstract
Introduction
Although alcohol-attributable mortality risk increases with consumption, harm may be distributed across the wider drinking population. Understanding this distribution is important for designing equitable, population-level prevention strategies. This study examined whether alcohol-attributable deaths in Ireland were concentrated among the highest-consuming drinkers.
Methods
Mean annual alcohol-attributable deaths among residents of Ireland aged ≥15 years during 2022-2024 were estimated using comparative risk assessment. Consumption was estimated from the nationally representative Healthy Ireland Survey 2024 and calibrated to recorded per-capita sales. Mortality data were obtained from the General Mortality Register and relative risks from systematically identified meta-analyses. Drinkers were ranked by calibrated average daily consumption, separately by sex. Deaths and deaths per 100,000 drinkers were estimated for the highest-consuming 10% and remaining 90%.
Results
An estimated 1,420 deaths were alcohol-attributable annually, representing 4.0% of all deaths; 1,096 occurred among men and 324 among women. The highest-consuming 10% had calibrated consumption of at least 72.5 g/day among men and at least 32.5 g/day among women. Among men, the highest-consuming 10% accounted for 448 deaths (41%), while 649 (59%) deaths occurred in the remaining population. Corresponding estimates among women were 149 (46%) and 175 (54%). Mortality rates per 100,000 drinkers were higher in the highest-consuming 10% than in the remaining men (259.4 versus 33.8) and women (83.8 versus 8.7).
Conclusions
Although alcohol-attributable mortality rates were highest among the heaviest 10% of drinkers, more than half of alcohol-attributable deaths occurred in the remaining population. This is consistent with the prevention paradox. Effective and equitable alcohol prevention is therefore likely to require population-level measures alongside targeted support for those at highest risk.
Key messages
• Most alcohol-attributable deaths occurred outside the highest-consuming 10%, supporting population-level prevention alongside targeted support.
• Findings support equitable alcohol policies that reduce harm across the full drinking population, not only among the heaviest drinkers.