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Originalarbeit

Reduzierung alkoholbedingter Mortalität durch Behandlung der Alkoholabhängigkeit

Published Online:April 24, 2014https://doi.org/10.1024/0939-5911.a000299

Abstract

Fragestellung: Ziel dieser Studie ist es, die von riskantem Trinken und von Alkoholabhängigkeit in Deutschland verursachte Krankheitslast zu quantifizieren. Weiterhin sollen die erwartbaren Auswirkungen eines verbesserten Zugangs von Alkoholabhängigen zu effektiven Therapien auf die alkoholbedingte Sterblichkeit abgeschätzt werden. Methodik: Die Krankheitslast wurde anhand von „Attributable Fractions“ berechnet, die den durch die jeweilige Exposition bedingten Anteil an den Todesfällen einer umfassenden Liste von durch Alkohol verursachten Krankheiten beziffern. Mögliche Auswirkungen eines verbesserten Zugangs zu Behandlungen wurden berechnet durch modellgemäße Veränderungen in der Zusammensetzung der trinkenden Bevölkerung. Alle Modelle legten das Jahr 2004 und die Bevölkerung zwischen 15 und 64 Jahren zugrunde, d. h. ausschließlich vorzeitige Todesfälle wurden berücksichtigt. Ergebnisse: Riskantes Trinken ist bei Frauen für rund 58 % und bei Männern für rund 71 % aller vorzeitigen alkoholbedingten Todesfälle ursächlich. Die entsprechenden Anteile der mit riskantem Trinken stark überlappenden Kategorie der Alkoholabhängigkeit liegen bei 40 % (Frauen) und 68 % (Männer). Eine Erhöhung der gegenwärtigen Behandlungsquote auf 40 % aller Alkoholabhängigen zeitigte eine Verringerung um bis zu 13,1 % bei den männlichen und 10,7 % bei den weiblichen alkoholbedingten Todesfällen innerhalb eines Jahres, eine Erhöhung auf 20 % war mit einer Verringerung um bis zu 6.5 % bei den männlichen und 5.3 % bei den weiblichen alkoholbedingten Todesfällen verbunden. Schlussfolgerungen: Durch einen verbesserten Zugang besonders der abhängig Erkrankten zu effektiven therapeutischen Interventionen könnte ein bedeutsamer Teil der alkoholbedingten Krankheitslast vermindert werden.


Decrease in Alcohol-attributable Mortality by Treatment of Alcohol Dependents

Aims: The aim of this article is to estimate for Germany the health burden attributable to heavy alcohol consumption and to alcohol dependence. In addition, we estimated the potential effects of increasing the treatment coverage rate for alcohol dependence on alcohol-attributable mortality. Methods: Attributable fractions were used to estimate the proportion of mortality that was attributable to heavy alcohol consumption and to alcohol dependence. The effects of treatment interventions were estimated by means of Monte Carlo simulations. Results: In Germany in 2004, for people in the age group of 15 to 64 years, heavy alcohol consumption was responsible for 58 % and 71 % of all alcohol-attributable deaths in women and men respectively, and alcohol dependence was responsible for 40 % and 68 % of all alcohol-attributable deaths in women and men, respectively. It should be noted that the groups of heavy drinkers and people with alcohol dependence overlap considerably. If the proportion of people with alcohol dependence undergoing the most effective treatment rose to 40 %, 10.7 % and 13.1 % of all alcohol-attributable deaths in women and men, respectively, could be prevented within one year; a treatment coverage rate of 20 % was estimated to result in the prevention of 5.3 % and 6.5 % of all alcohol-attributable deaths in women and men, respectively. Conclusions: Alcohol consumption and, more specifically, alcohol dependence are responsible for a large proportion of the burden of disease in Germany. Increasing the availability of effective treatment interventions to a greater number of people with alcohol dependence could reduce this burden.

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