Abstract
Background
Substance use is responsible for a large burden of disease in Canada, however updated data are needed for health care planning and policy development. This study replicates and makes improvements on 1992 estimates of substance-attributable morbidity and mortality for the year 2002. There are two objectives, the main one being to compare the substance-attributable morbidity and mortality in 1992 with 2002 using the same methods of calculation, and the second, to compare the two different methods of estimating the substance-attributable mortality and morbidity in 2002.
Method
Estimates of substance-attributable burden were made by combining relative risk data with exposure prevalence data and disease-related mortality and morbidity information from national databases. First, identical relative risk estimates for 1992 were used with the 2002 data in order to draw direct comparisons. In a second analysis, updated relative risk and attributable disease information (post-1992) was used to better estimate the mortality and morbidity for Canada in 2002.
Results
Overall, from 1992 to 2002, there were relative increases in substanceattributable mortality estimates for alcohol and illegal drugs, where the latter relatively increased more; and a relative decrease in tobacco-attributable mortality. In terms of absolute numbers in combined risk factors, deaths and hospital days for those under 70 years of age decreased mainly due to tobacco. Comparisons of the two methods showed that the updated method resulted in more conservative numbers than previous calculations.
Interpretation
There is an unacceptably high burden of substance-attributable disease in Canada in the early 2000s. Exposure changes and epidemiological shifts in population and diseases over the last 10 years have affected where the burden lies, but it is still vital to incorporate policy-based initiatives that have proven to be effective in reducing substanceattributable burden in practice.
Résumé
Contexte
La consommation de substances toxiques (alcool, drogue ou tabac) contribue beaucoup au fardeau des maladies au Canada, mais on manque de données à jour pour la planification et l’élaboration des politiques de santé. Cette étude reprend, en les améliorant, des estimations de 1992 portant sur la morbidité et la mortalité attribuables aux substances toxiques pour l’année 2002. Nous avions deux objectifs, le principal étant de comparer la morbidité et la mortalité attribuables à ces substances en 1992 et en 2002 à l’aide des mêmes méthodes de calcul, et le second, de comparer les deux méthodes utilisées pour estimer la mortalité et la morbidité attribuables aux substances en 2002.
Méthode
Nous avons estimé le fardeau des maladies attribuables aux substances toxiques en combinant les données sur le risque relatif, les données sur la prévalence de l’exposition et les données sur la mortalité et la morbidité liées aux maladies, tirées des bases de données nationales. Pour commencer, nous avons utilisé des estimations identiques du risque relatif pour 1992 et pour 2002 afin de pouvoir faire des comparaisons directes. Dans un deuxième temps, nous avons utilisé des données mises à jour sur le risque relatif et les données sur la mortalité et la morbidité liées aux maladies (après 1992) pour mieux estimer la mortalité et la morbidité au Canada en 2002.
Résultats
Globalement, entre 1992 et 2002, il y a eu des augmentations relatives dans les estimations de la mortalité attribuable à l’alcool et à la drogue (ces augmentations étaient relativement plus fortes dans le cas de la drogue), et une diminution relative de la mortalité attribuable au tabac. En chiffres absolus combinant tous les facteurs de risque, les décès et les jours d’hospitalisation chez les personnes de moins de 70 ans ont principalement diminué en raison du tabac. Nos comparaisons des deux méthodes montrent que la nouvelle méthode de calcul donne des estimations plus prudentes que la méthode antérieure.
Interprétation
Le fardeau des maladies attribuables aux substances toxiques était intolérablement élevé au Canada au début des années 2000. Les variations dans les niveaux d’exposition et les changements épidémiologiques dans la population et les maladies au cours des 10 dernières années ont contribué à repositionner ce fardeau, mais il est encore crucial d’adopter des initiatives stratégiques éprouvées pour le réduire dans la pratique.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
World Health Organization. The World Health Report 2002 — Reducing risks, promoting healthy life. Geneva, Switzerland: World Health Organization, 2002.
Ezzati M, Lopez AD, Rodgers A, Vander Horn S, Murray CJL, and the Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet 2002;360:1347–60.
Single E, Robson L, Xie X, Rehm J. The costs of substance abuse in Canada. Ottawa, ON: Canadian Centre on Substance Abuse, 1996.
Rehm J, Baliunas D, Brochu S, Fischer B, Gnam W, Patra J, et al. The social costs of substance abuse in Canada 2002. Ottawa: Canadian Centre on Substance Abuse, 2006.
Hill, AB. The environment and disease: Association or causation? Proc Royal Soc Med 1965;58:295–300.
English DR, Holman CDJ, Milne E, Winter MJ, Hulse GK, Codde G, et al. The quantification of drug caused morbidity and mortality in Australia 1995. Canberra, Australia: Commonwealth Department of Human Services and Health, 1995.
Rothman KJ, Greenland S. Causation and causal inference. In: Rothman KJ, Greenland S (Eds.), Modern Epidemiology 2nd, ed. Philadelphia, PA: Lippincott-Raven Publishers, 1998;7–28.
Gutjahr E, Gmel G, Rehm J. Relation between average alcohol consumption and disease: An overview. Eur Addict Res 2001;7(3):117–27.
Ridolfo B, Stevenson C. The quantification of drug-caused mortality and morbidity in Australia 1998. Canberra: Australian Institute of Health and Welfare, 2001.
Rehm J, Room R, Monteiro M, Gmel G, Graham K, Rehn N, et al. Alcohol use. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL (Eds.), Comparative Quantification of Health Risks. Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Geneva: World Health Organization, 2004;959–1109.
Corrao G, Bagnardi V, Zambon A, Arico S. Exploring the dose-response relationship between alcohol consumption and the risk of several alcohol-related conditions: A meta-analysis. Addiction 1999;94:1551–73.
Corrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K. Alcohol and coronary heart disease: A meta-analysis. Addiction 2000;95(10):1505–23.
Reynolds K, Lewis B, Nolen JD, Kinney GL, Sathya B, He J. Alcohol consumption and risk of stroke: A meta-analysis. JAMA 2003;289(5):579–88.
Traffic Injury Research Foundation of Canada. Alcohol-crash problem in Canada: 2002. Canadian Council for Motor Transport Administrators Standing Committee on Road Safety Research and Policies and Transport Canada. Ottawa, Canada, 2004.
Transport Canada. Road Safety in Canada — 2001. 2004. Available online at: https://doi.org/www.tc.gc.ca/roadsafety/tp/tp13951/2001/ menu.htm (Accessed September 15, 2004).
Council of Canadian Fire Marshals and Fire Commissioners. Fire losses in Canada. Annual report 2000. Ottawa: Council of Canadian Fire Marshals and Fire Commissioners, 2003.
Geduld J, Gatali M, Remis RS, Archibald, CP. Estimates of HIV prevalence and incidence in Canada, 2002. Canada Communicable Disease Report 2003;29:197–208.
Remis, RS. Estimating the Incidence and Prevalence of Hepatitis C Infection in Canada, 2002. 2nd Canadian Conference on Hepatitis C. Vancouver, BC, March 27–31, 2004. Available online at: https://doi.org/www.phs.utoronto.ca/ohemu/ Presentations.html (Accessed February 21, 2005).
MacDonald S, Anglin-Bodrug K, Mann R, Erickson P, Hathaway A, Chipman M, et al. Review: Injury risk associated with cannabis and cocaine use. Drug and Alcohol Dependence 2003;72:99–115.
Popova S, Rehm J, Patra J. Illegal drugattributable mortality and potential years of life lost in Canada 2002: Conclusions for prevention and policy. Cont Drug Problems 2006;33(3):343–66.
Tredaniel J, Boffetta P, Buiatti E, Saracci R, Hirsch A. Tobacco smoking and gastric cancer: Review and meta-analysis. Int J Cancer 1997;72(565):573.
Simonato L, Agudo A, Ahrens W, Benhamou E, Benhamou S, Boffetta P, et al. Lung cancer and cigarette smoking in Europe: An update of risk estimates and an assessment of inter-country heterogeneity. Int J Cancer 2001;91:876–87.
Plummer M, Herrero R, Franceschi S, Meijer CJ, Snijders P, Bosch FX, et al. Smoking and cervical cancer: Pooled analysis of the IARC multi-centric case-control study. Cancer Causes & Control 2003;14:805–14.
Zeegers MP, Tan FE, Dorant E, van Den Brandt, PA. The impact of characteristics of cigarette smoking on urinary tract cancer risk: A metaanalysis of epidemiologic studies. Rev Cancer 2000;89(3):630–39.
Hunt JD, van der Hel OL, McMillan GP, Boffetta P, Brennan P. Renal cell carcinoma in relation to cigarette smoking: Meta-analysis of 24 studies. Int J Cancer 2005;114:101–8.
Brennan P, Bogillot O, Cordier S, Greiser E, Schill W, Vineis P, et al. Cigarette smoking and bladder cancer in men: A pooled analysis of 11 case-control studies. Int J Cancer 2000;86:289–94.
Brennan P, Bogillot O, Greiser E, Chang-Claude J, Wahrendorf J, Cordier S, et al. The contribution of cigarette smoking to bladder cancer in women (pooled European data). Cancer Causes & Control 2001;12:411–17.
Brownson RC, Novotny TE, Perry, MC. Cigarette smoking and adult leukemia: A metaanalysis. Arch Intern Med 1993;153:469–75.
Law MR, Morris JK, Wald, NJ. Environmental tobacco smoke exposure and ischaemic heart disease: An evaluation of the evidence. BMJ 1997;315(7114):973–80.
Law MR, Wald, NJ. Environmental tobacco smoke and ischemic heart disease. Prog Cardiovasc Dis 2003;46:31–38.
U.S. Department of Health and Human Services. The health consequences of smoking: A report of the Surgeon General. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 2004.
Health Promotion Survey. [Catalogue 82 M0007GPE]. Ottawa: Statistics Canada, 1990.
Alcohol and Other Drugs Survey. Canada’s Alcohol and Other Drugs Survey 1994: A Discussion of the Findings. Catalogue, No. H39-338/1-1994E, 1994.
Canadian Centre on Substance Abuse. Canadian Addiction Survey 2004: Microdata eGuide. Ottawa: Canadian Centre on Substance Abuse, 2004.
General Social Survey, cycle 6. Statistics Canada. Housing, Family and Social Statistics Division, 1991.
Canadian Community Health Survey (CCHS), cycle 2.1. [Catalogue, No. 82M0013XCB]. Ottawa: Statistics Canada, 2003.
Popova S, Rehm J, Fischer B. An overview of illegal opioid use and health services utilization in Canada. Public Health 2006;120(4):320–28.
Rehm J, Patra J, Popova S. Alcohol-attributable mortality and potential years of life lost in Canada 2001: Implications for prevention and policy. Addiction 2006;101:373–84.
Baliunas D, Patra J, Rehm J, Popova S, Kaiserman M, Taylor B. Smoking-attributable mortality in Canada 2002: Conclusions for prevention and policy. Chron Dis Can (in press).
Fischer B, Medved W, Gliksman L, Rehm J. Illicit opiates in Toronto: A profile of current users. Addict Res 1999;7(5):377–415.
Moses S, Mestery K, Kaita KD, Minuk, GY. Viral hepatitis in a Canadian street-involved population. Can J Public Health 2002;93(2):123–28.
Roy E, Haley N, Lemire N, Boivin J, Leclerc P, Vincelette J. Hepatitis B virus infection among street youths in Montreal. CMAJ 1999;161:689–93.
Walter, SD. The estimation and interpretation of attributable risk in health research. Biometrics 1976;32:829–49.
Walter, SD. Prevention of multifactorial disease. Am J Epidemiol 1980;112:409–16.
Taylor B, Rehm J. When risk factors combine: The interaction between alcohol and smoking for aerodigestive cancer, coronary heart disease, and traffic and fire injury. Addict Behav 2006;31(9):1522–35.
Collins DJ, Lapsley, HM. Counting the cost: Estimates of the social costs of drug abuse in Australia 1998–99. National Drug Strategy Monograph Series, no. 49. ISBN 0 642 82181 X. Canberra: Commonwealth Department of Health and Ageing, 2002.
Statistics Canada, CANSIM, Table 051-0001. Accessed December 16, 2005.
Public Health Agency of Canada. Cardiovascular disease surveillance on-line. 2002. Available online at: http://www.dsol-smed.phac-aspc.gc.ca/dsol-smed/cvd/c_time_e.html (Accessed September 16, 2004).
Taylor B, Rehm J, Patra J, Popova S, Baliunas D. Alcohol-attributable morbidity and resulting health care costs in Canada in 2002: Recommendations for policy and prevention. J Stud Alcohol Drugs 2007;68:36–47.
Rehm J, Patra J, Popova S. Alcohol-attributable mortality and potential years of life lost in Canada 2001: Implications for prevention and policy. Addiction 2006;101(3):373–84.
Rehm J, Monteiro M, Room R, Gmel G, Jernigan D, Frick U, et al. Steps towards constructing a global comparative risk analysis for alcohol consumption: Determining indicators and empirical weights for patterns of drinking, deciding about theoretical minimum, and dealing with different consequences. Eur Addict Res 2001;7(3):138–47.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Patra, J., Taylor, B., Rehm, J.T. et al. Substance-attributable Morbidity and Mortality Changes to Canada’s Epidemiological Profile. Can J Public Health 98, 228–234 (2007). https://doi.org/10.1007/BF03403718
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03403718