Alcohol consumption - low risk guideline | National Cancer Control Indicators

Published

15 Mar, 2023

Alcohol is a known human carcinogen that increases the risk of oral, pharyngeal, laryngeal, oesophageal, liver, colorectal and female breast cancers.^1-3 There is also evidence that the risk of these cancers increases with higher levels of alcohol consumption (i.e., that there is a dose-response relationship).^{4, 5} Notably, even small amounts of alcohol can increase cancer risk.¹ In addition, the joint effect of alcohol consumption and behavioural risk factors such as smoking and poor dietary practices can further increase cancer risk.^{1, 2, 6}

Data

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NHMRC Guideline
Persons / Males / Females

Notes

1. Since 1987, the National Health and Medical Research Council (NHMRC) has published evidence-based guidelines to help Australians reduce the risk of harm associated with drinking alcohol. The charts above cover the following periods:
(a) From December 2020, the guideline advises "To reduce the risk of harm from alcohol-related disease or injury, healthy men* and women* should drink no more than 10 standard drinks a week and no more than 4 standard drinks on any one day."
(b) Previous to this, the guidelines (released in 2001 and summarised in 2009), advise "both men and women to drink no more than two standard drinks per day to reduce their health risks over a lifetime.
Further information at: https://www.nhmrc.gov.au/health-advice/alcohol
2. Error bars indicate 95% confidence intervals.
*age 18 years and over.

Proportion of adults exceeding the NHMRC lifetime risk alcohol guidelines by age and sex, 2001 to 2017-18 and 2020-21
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Notes

·  Data sourced from ABS 2001 to 2017-18 NHS and 2001 to 2018-19 National Aboriginal and Torres Strait Islander Health Survey; error bars indicate 95% confidence intervals.
·  Persons aged 18 years and over.
·  Exceeding lifetime risk alcohol guideline is defined as an average alcohol consumption of more than two standard drinks per day.
·  Proportions have been age standardised to the 2001 Australian population to account for differences in the age structure of the population over time.

Proportion of adults exceeding NHMRC lifetime alcohol risk guidelines by Indigenous status, 2001, 2011-13 and 2017-19 (age-standardised)
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Notes

• Data sourced from ABS National Health Surveys, 2011-12 to 2017-18.
• Remoteness was classified according to the Australian Statistical Geography Standard (ASGS) Remoteness Areas, see 'About the data' for more details.
• Rates are not age-standardised.
• Error bars indicate 95% confidence intervals.

Proportion of adults exceeding the NHMRC lifetime risk alcohol guidelines by sex and remoteness, 2011-12, 2014-15 and 2017-18 - Crude rates
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Notes

• Data sourced from ABS National Health Survey, 2011-12 to 1017-18.
• The Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-Economic Disadvantage (IRSD) was used to allocate participants to a SEIFA quintile based on their usual residence, see 'About the data' for more details.
• Rates are not age-standardised.
• Error bars indicate 95% confidence intervals.

Proportion of adults exceeding the NHMRC lifetime risk alcohol guidelines by sex and socioeconomic status, 2011-12, 2014-15 and 2017-18 - Crude rates

About this measure

It was estimated in 2010 that alcohol-attributable cancer was responsible for about 4% of all global cancer deaths, and 5% of all potential Years-of-Life-Lost from cancer.⁷ It has also been estimated that 3% to 6% of all cancer cases in Australia are attributable to consumption of alcohol.^{6, 8} On this basis, given that the number of newly diagnosed cancers in 2012 (excluding non-melanoma skin cancers) was 122,093 about 7,325 cancers could be attributed to the consumption of alcohol.

Consumption of alcohol increases the risk of developing cancer.² The National Health and Medical Research Council (NHMRC) provides evidence-based guidance on reducing health risks associated with alcohol consumption.⁹ The 2009 NHMRC Guidelines on reducing these health risks state that, for healthy men and women, drinking no more than two standard drinks on any one day reduces the lifetime risk of harm from alcohol-related disease or injury (Guideline I). A standard drink of alcohol in Australia is defined as approximately one shot of spirit.

In 2020, the NHMRC updated the Australian guidelines to reduce health risks from drinking alcohol. Guideline 1 now states that for healthy men and women no more than 10 standard drinks in a week should be consumed and that there should be no more than 4 standard drinks in any one day.⁹ The 2009 and updated 2020 guidelines will be discussed, although the data should not be compared directly.

Current status

In 2017-18, 16.1% of Australians aged 18 years and over consumed more than two standard drinks per day on average, exceeding the 2009 lifetime risk guideline.¹⁰ Males (24%) were almost three times as likely as females (9%) to exceed the guideline.

In 2020-21, 20% of Australians aged 18 years and over consumed more than 10 standard alcoholic drinks in the last week, exceeding the 2020 lifetime risk guideline. Males (27%) were twice as likely as females (13%) to exceed the guideline.

Aboriginal and Torres Strait Islander people

In 2018-19, 20% of Aboriginal and Torres Strait Islander people aged 18 years and over exceeded the lifetime risk guideline, with higher rates exceeding this risk guideline among males than females (30% compared with 10%).¹¹

After adjusting for differences in age structure, the proportion of people exceeding the lifetime risk guideline was higher in Indigenous (20%) than non-Indigenous (16%) populations.¹¹

Remoteness and socioeconomic disadvantage

In 2017-18, the proportion of people exceeding the lifetime risk guideline varied across geographic regions, with a higher proportion of people living in Outer Regional and Remote areas (24%) exceeding the guideline compared with people living in Major Cities (15%).¹⁰

In 2017-18, the proportion of people living in the least socioeconomically disadvantaged areas exceeding the lifetime risk guideline(18%) was higher than for than for people living in the most disadvantaged areas (14%).¹⁰Among adults living in the least disadvantaged areas, 25 % of males and 10% of females exceeded the guideline compared with 22% of males and 7% of females living in the most disadvantaged areas.¹⁰

Trends

2009 guideline

The proportion of adults exceeding the lifetime risk guideline increased from 2001 to 2004-05 but has since decreased over time.^10-16

From 2004-05 to 2017-18, the proportion of adults exceeding the lifetime risk guideline declined, from 33% to 24% for males and from 12% to 9% for females.^10, 13Among males, a reduction in the proportion exceeding the lifetime risk guideline was observed across every age group under 65 years. Among females, there was a similar trend for reductions across most age groups from 2004-05 to 2017-18, and the reduction was pronounced and unlikely to be due to chance among younger adults aged 18-24 and 25-34 years.

Aboriginal and Torres Strait Islander people

From 2001 to 2018-19, the proportion of Indigenous persons aged 18 years and over who exceeded the lifetime risk alcohol guideline increased slightly (19% in 2001 to 20%, in 2017-19).^{11, 17-19} After adjusting for differences in age distribution of Indigenous and non-Indigenous populations, the proportions of Indigenous people who exceeded the lifetime risk specified in alcohol guideline were similar for non-Indigenous people in 2001, 2004-05 and 2011-13 and were higher (20%) than for non-Indigenous people (16%) in 2018-19.^{11, 17, 18}

Remoteness and socioeconomic disadvantage

From 2011-12 to 2017-18, the crude proportion of people exceeding the lifetime risk guideline decreased for persons living in Major Cities. There were no important changes observed for people living in Inner regional, Outer regional and Remote areas.^{10, 15, 16} From 2011-12 to 2017-18, conspicuous reductions in the crude proportion of persons exceeding the lifetime risk guideline were observed across the less disadvantaged areas (SES 3 to 5).

About the data

This measure shows the proportions of people who:

Had consumed more than two standard drinks per day, exceeding the lifetime risk alcohol guideline in 2009; or
Had consumed more than 10 standard drinks in a week exceeding the 2020 lifetime risk alcohol guideline.

Numerator: Number of persons who consumed an average of more than two standard drinks per day.

Denominator: Number of persons aged 18 years and over.

In the 2016 Index of Relative Socio-Economic Disadvantage, attributes contributing to this index include low income, low educational attainment, high unemployment and jobs in relatively unskilled occupations. A lower Index of Disadvantage quintile (e.g., the first quintile) indicates a relatively greater disadvantage in general. A higher Index of Disadvantage (e.g., the fifth quintile) indicates a relative lack of disadvantage and greater advantage in general.

National Health Survey Data, 2020-21 Alcohol consumption risk levels have been assessed using guidelines from the National Health and Medical Research Council (NHMRC) released from 2009 and updated in 2020. The updated guidelines were released after the 2020-21 NHS commenced collection.

Analysis in the commentary of the 2020-21 NHS data has focussed on assessing alcohol consumption against the updated 2020 guideline. However, data have been provided in the Data Cubes to assess consumption against the 2009 guidelines to provide a closure of this analysis. Analysis of the updated 2020 guidelines cannot be directly compared to the 2009 guidelines and therefore represents a break in the time series.

2020-21 data uses more than 14 standard drinks consumed in a week as the numerator for analysis.

Methodology

Remoteness

The Australian Statistical Geography Standard (ASGS), was used to allocate participants to a remoteness area based on their area of usual residence.

Earlier data used the now superseded Australian Standard Geographical Classification (ASGC), 2011-12 data used the 2006 ASGC, 2014-15 data used the 2011 ASGC, and 2017-18 data used the ASGS 2016 Socioeconomic status.

The Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-Economic Disadvantage (IRSD) was used to allocate participants to a SEIFA quintile based on their usual residence.

For 2011-12 and 2014-15 data the 2011 IRSD was used and for 2017-18 data the 2016 IRSD was used.

Data sources:

ABS National Health Surveys – 2001, 2004-05, 2007-08, 2011-12, 2014-15, and 2017-18.
ABS National Aboriginal and Torres Strait Islander Health Surveys – 2001, 2004-05, 2012-13, and 2018-19.

References

Activity in this area

Data

Australian Bureau of Statistics 2018. 4364.0.55.001 - National Health Survey: First Results, 2017-18. Canberra: ABS. [Accessed November 2021]; https://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001.

Australian Bureau of Statistics 2019. 4715.0 – National Aboriginal and Torres Strait Islander Health Survey, 2018-19. Canberra: ABS. [Accessed November 2021]; https://www.abs.gov.au/ausstats/abs@.nsf/mf/4715.0.

Social Health Atlases of Australia: Population Health areas – Alcohol consumption data; [Accessed January 2022]; https://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-population-health-areas

Policy

National Health and Medical Research Council (NHMRC). Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC; 2020 [Accessed June 2022]; https://nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol

Australian Government, Department of Health. National Alcohol Strategy 2019-2028; 2019 [Accessed June 2022]; https://www.health.gov.au/resources/publications/national-alcohol-strategy-2019-2028

References

1.Cancer Australia 2015. Lifestyle risk factors and the primary prevention of cancer. Sydney: Cancer Australia. [Accessed: April 2020]; http://canceraustralia.gov.au/publications-and-resources/position-statements/lifestyle-risk-factors-and-primary-prevention-cancer.

2.International Agency for Research on Cancer 2012. Personal Habits and Indoor Combustions. Volume 100E. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Lyon: IARC.

3.World Cancer Research Fund/American Institute for Cancer Research. 2007. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. American Institute for Cancer Research, Washington, DC.

4.Bagnardi, V., Rota, M., Botteri, E., et al. 2015. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015;112(3):580-93.

5.Schutze, M., Boeing, H., Pischon, T., et al. 2011. Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ. 2011;342d1584.

6.Pandeya, N., Wilson, L. F., Webb, P. M., et al. 2015. Cancers in Australia in 2010 attributable to the consumption of alcohol. Aust N Z J Public Health. 2015;39(5):408-13.

7.Rehm, K. and Shield, K. D. 2013. Alcohol and mortality: Global alcohol-attributable deaths from cancer, liver cirrhosis, and injury in 2010. Alcohol Research: Current Reviews. 2013;35(2):174-183.

8.Winstanley, M. H., Pratt, I. S., Chapman, K., et al. 2011. Alcohol and cancer: a position statement from Cancer Council Australia. Med J Aust. 2011;194(9):479-82.

9.National Health and Medical Research Council (NHMRC) 2020 Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC. [Accessed: June 2022]; https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol

10.Australian Bureau of Statistics 2018. 4364.0.55.001 - National Health Survey: First Results, 2017-18. Canberra: ABS. [Accessed April 2020]; https://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001.

11.Australian Bureau of Statistics 2019. 4715.0 – National Aboriginal and Torres Strait Islander Health Survey, 2018-19. Canberra: ABS. [Accessed April 2020]; https://www.abs.gov.au/ausstats/abs@.nsf/mf/4715.0.

12.Australian Bureau of Statistics 2002. 4364.0 - National Health Survey: Summary of Results, 2001. Canberra: ABS. [Accessed: April 2020]; http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4364.0Main+Features12001.

13.Australian Bureau of Statistics 2006. 4364.0 - National Health Survey: Summary of Results, 2004-05. Canberra: ABS. [Accessed: April 2020]; http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4364.0Main+Features12004-05.

14.Australian Bureau of Statistics 2009. 4362.0 - National Health Survey: Summary of Results, 2007-2008 (Reissue) Canberra: ABS. [Accessed: April 2020]; http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4364.0History%20of%20Changes02007-2008%20(Reissue)?opendocument&tabname=Summary&prodno=4364.0&issue=2007-2008%20(Reissue)&num=&view=.

15.Australian Bureau of Statistics 2012. 4364.0.55.001 - Australian Health Survey: First Results, 2011-12. Canberra: ABS. [Accessed: April 2020]; http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.001main+features12011-12.

16.Australian Bureau of Statistics 2015. 4364.0.55.001 - National Health Survey: First Results, 2014-15. Canberra: ABS. http://www.abs.gov.au/ausstats/abs@.nsf/PrimaryMainFeatures/4364.0.55.001?OpenDocument.

17.Australian Bureau of Statistics 2002. 4715.0 - National Health Survey: Aboriginal and Torres Strait Islander Results, Australia, 2001. Canberra: ABS. [Accessed: April 2020]; http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4715.0Main+Features12001?OpenDocument.

18.Australian Bureau of Statistics 2006. 4715.0 - National Aboriginal and Torres Strait Islander Health Survey, 2004-05. Canberra: ABS. [Accessed: April 2020]; https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4715.0Main+Features12004-05

19.Australian Bureau of Statistics 2013. 4727.0.55.001 – Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-13. Canberra: ABS. [Accessed: September]; http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4727.0.55.001main+features12012-13.

Summary

Less than one in five adults exceeded the 2009 lifetime risk guidelineIn 2017-18, 16% of Australian adults consumed alcohol in excess of the 2009 NHMRC guideline for reducing the lifetime risk of harm from alcohol-related disease or injury.

One in five Australians exceeded the 2020 lifetime risk guidelineIn 2020-21, 20% of Australian adults consumed alcohol in excess of the 2020 NHMRC guideline for alcohol consumption that would reduce the lifetime risk of harm from alcohol-related disease or injury.

The proportion of adults exceeding the lifetime risk guideline has decreasedFrom 2004-05 to 2017-18, the proportion of adults consuming alcohol in excess of the 2009 NHMRC guideline that reduces the lifetime risk of harm from alcohol-related disease or injury decreased from 21% to 16%.

The proportion of Aboriginal and Torres Strait Islander adults exceeding the alcohol consumption guideline that reduces lifetime risk of harm has remained relatively steady over timeFrom 2001 to 2018-19, the proportion of Indigenous adults exceeding the 2009 NHMRC alcohol consumption guideline that reduces the lifetime risk of harm from alcohol-related disease or injury ranged from 19% to 20% (age-standardised).

Revision Type

Minor

Version Number

1.1

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Data

Summary

Less than one in five adults exceeded the 2009 lifetime risk guideline

One in five Australians exceeded the 2020 lifetime risk guideline

The proportion of adults exceeding the lifetime risk guideline has decreased

The proportion of Aboriginal and Torres Strait Islander adults exceeding the alcohol consumption guideline that reduces lifetime risk of harm has remained relatively steady over time

Related features

NCCI – About the Data