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FAQ (Frequently Asked Questions)

 

General Information on ARDI

Alcohol-Attributable Fractions (AAF)

Prevalence of Alcohol Consumption

Alcohol-Attributable Deaths (AAD)

Custom Data

User Help




General Information on ARDI

Why are the ARDI estimates important?

The Alcohol-Related Disease Impact (ARDI) application generates estimates of alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) due to alcohol consumption. These estimates provide vital information to better understand the health consequences of excessive alcohol use in the United States. In addition to estimating the national health effects of alcohol consumption, the ARDI application can produce state estimates of AAD and YPLL. Such state-specific analyses are needed because the prevalence of excessive alcohol use, particularly binge drinking, is known to vary substantially by location. State-specific estimates of alcohol-related health outcomes can better focus discussions of evidence-based public health strategies (e.g., increasing alcohol excise taxes and screening for alcohol misuse in clinical settings) aimed at preventing consequences associated with excessive alcohol use.

Who is the intended audience for ARDI?

The primary audience for ARDI is state governments, particularly state health departments and state substance abuse agencies interested in determining the health impact of excessive alcohol use in their state for policy and informational purposes. In addition, academic researchers, particularly from schools of public health, will also benefit from using the ARDI application to estimate alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) for research and analysis purposes.

The secondary audience includes those organizations involved with alcohol-related treatment and prevention programs, as well as state health policy organizations. These organizations include, but are not limited to, health-related nonprofit organizations, primary care associations, advocacy groups, as well as local boards of health, and city and county health departments.

Can ARDI be used to evaluate the effectiveness of public health programs?

ARDI is designed to estimate the health effects of excessive alcohol consumption over a specified period of time (e.g., over a 5-year period). Therefore, these estimates are not intended to be used to evaluate the effectiveness of public health programs or policies aimed at reducing alcohol consumption. Furthermore, these estimates are subject to year-to-year variations, which although reduced by using multiple years of data, are still subject to anomalies in the collection of mortality data that may not reflect changes in actual alcohol consumption resulting from public health programs.

Can ARDI be used to study trends over time in alcohol-attributable deaths (AAD) or years of potential life lost (YPLL)?

The ARDI application is used to assess AAD or YPLL over a specified period of time, usually 5 years. The application is not set up to examine trends in AAD or YPLL over time mainly due to the year-to-year variations in these estimates that may not be due to alcohol consumption.

Can ARDI be used to compare my state’s alcohol-related outcomes to other states or national estimates?

The estimates provided in ARDI are the total number of alcohol-attributable deaths (AAD) or years of potential life lost (YPLL) for the location specified. To accurately compare states to each other or to national estimates, the AAD and YPLL must be adjusted appropriately to reflect differences in demographics between locations (e.g., regional differences in average age of the population). ARDI does not report adjusted AAD or YPLL; therefore, the estimates provided in the ARDI reports should not be compared between locations.

Can I obtain a breakdown of alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) by race and ethnicity from ARDI?

No, the current version of ARDI is only able to stratify AAD and YPLL by sex and age.

How can you have an alcohol-attributable death (AAD) or years of potential life lost (YPLL) less than one (i.e., <1)?

ARDI assigns a value of less than one when there was exactly one death from a specific cause that is not 100% alcohol-attributable (i.e., a condition with an alcohol-attributable fraction (AAF) less than one). Under these circumstances, the number of deaths from this cause equals the AAF for this cause. However, it is important to note that while the reported value is shown as less than one, ARDI includes the actual value (i.e., the AAF for this condition) in calculations of YPLL.

Why are beneficial effects associated with alcohol consumption reported for some causes but not for others?

Alcohol consumption has been shown to reduce the risk of death from some causes (e.g., cholethiases).  For these causes, the relative risk estimates included in ARDI are less than one. When these estimates are used to calculate indirect alcohol-attributable fractions (AAF), the result is a negative AAF. When this negative AAF is then multiplied by the total number of deaths for that condition, the resulting number of deaths is negative. This indicates that there are net lives saved from alcohol use at a particular consumption level for these causes.

Why are alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) among persons younger than 21 years of age described as being caused by “exposure” to alcohol?

The term “exposure” is used to describe AAD and YPLL for persons younger than 21 years of age because deaths in this age group may result from an individual’s own drinking, or from the second-hand effects of someone else’s drinking (e.g., deaths from riding in a vehicle with an alcohol-impaired driver). Some causes of death in ARDI specifically affect infants and children (e.g., child maltreatment, fetal alcohol syndrome, and low birth weight, etc.) are entirely the result of another person’s (e.g., the infant’s mother’s) drinking. Therefore, while all the AAD and YPLL included in the younger than 21 reports are attributable to alcohol exposure, many of them are actually due to someone else’s alcohol consumption.

How often are the data updated in ARDI?

Default data on deaths by cause, life expectancy, and prevalence of alcohol consumption are updated periodically to reflect newly available mortality estimates. Risk estimates and alcohol-attributable fractions (AAF) are re-examined periodically as new scientific estimates become available.

Alcohol-Attributable Fractions (AAF)

What are alcohol-attributable fractions (AAF)?

Alcohol-attributable fractions (AAF) are used to express the extent to which alcohol consumption contributes to a health outcome. In ARDI, AAF measure the total proportion of deaths from various causes that are directly or indirectly attributable to alcohol consumption.

How are alcohol-attributable fractions (AAF) calculated?

Information on the calculations of the AAF used in ARDI can be found in the Methods section.

Why is the Fatal Accident Reporting System (FARS) used to obtain alcohol-attributable fractions (AAF) for motor-vehicle crash deaths?

The FARS, which is administered by the National Highway Traffic and Safety Administration (http://www.nhtsa.dot.gov), provides annual estimates of alcohol involvement for all traffic crashes that occurred on United States roadways in a given year. The FARS protocol for determining alcohol involvement in a crash also makes it possible to calculate age-specific AAF. Therefore, FARS is considered the best and most timely source of AAF for motor-vehicle crash deaths.

Prevalence of Alcohol Consumption

How does ARDI determine the prevalence of alcohol consumption to calculate indirect estimates of alcohol-attributable fractions (AAF)?

The prevalence of alcohol consumption, measured as the average number of drinks consumed per day, is estimated using self-reported information on alcohol consumption from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), www.cdc.gov/BRFSS.  The BRFSS includes three questions on the core survey about alcohol use in the past 30 days: the frequency of drinking days, the quantity of drinks consumed on drinking days, and the frequency of binge drinking. The total quantity and frequency of drinking is combined to form an estimate of the average amount of alcohol consumed per day. More detailed information regarding the calculation of average daily alcohol consumption and the cutpoints used in calculating indirect AAF are explained in the ARDI Methods section under Prevalence Data.

Can prevalence data from other sources besides the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) be used to determine the prevalence of alcohol consumption?

The Custom Data section of ARDI allows users to enter their own mortality and prevalence data. Prevalence data can be used from surveys other than the BRFSS as long as questions regarding both the quantity and frequency of alcohol consumption are used and the survey is administered to a representative sample.

Why are there two different prevalence cutpoints for alcohol consumption listed in ARDI, and how do I know which one is used to calculate alcohol-attributable fractions (AAF) for a given condition?

ARDI uses several meta-analyses to obtain the risk estimates for several chronic causes of death included in the application. Prevalence cutpoints for defining levels of alcohol consumption are determined by the authors of these analyses and included in the Methods section. Therefore, the prevalence cutpoints that are used to calculate the indirect AAF for a particular cause correspond to the meta-analysis that was used to identify risk estimates for these causes. Most of the chronic causes of death used relative risk estimates from the meta-analysis performed by English et al. (1995) and Ridolfo and Stevenson (2001); however, for three causes (ischemic stroke, hemorrhagic stroke and prostate cancer) the relative risk estimates are drawn from a meta-analysis by Corrao et al. (1999) and Bagnardi et al. (2001).

Alcohol-Attributable Deaths (AAD)

How were the alcohol–related causes of death included in ARDI selected?

The US Centers for Disease Control and Prevention (CDC) convened a scientific work group comprised of experts on alcohol and health to guide the development of the ARDI application. One of the group’s tasks was to select alcohol-related causes of death based upon ones that were previously examined in meta-analyses. Some causes (e.g., tuberculosis, pneumonia, and hepatitis C) were not included in this version of ARDI because suitable pooled relative risk estimates or alcohol-attributable fractions (AAF) were not available for them at the time the work group convened.

How do I know if a cause of death is alcohol-attributable?

ARDI currently includes a list of 54 causes of death with enough scientific evidence to show alcohol-attribution. The ICD codes associated with these deaths are found at Alcohol-Related ICD Codes. ARDI uses the underlying cause of death listed on death certificates to determine if the death was alcohol-attributable.

Does ARDI calculate the number of deaths due to binge drinking?

Of the nearly 88,000 average annual alcohol-attributable deaths reported in ARDI for 2006–2010, more than 50% are due to binge drinking. This is because the studies that were used to obtain alcohol-attributable fractions for the acute causes of death (e.g., injuries) included in the ARDI application defined a death as being alcohol-attributable if the decedent, or another person who was responsible for a death (e.g., the driver of a vehicle in a fatal motor vehicle crash), had a blood alcohol concentration (BAC) greater than or equal to 0.10 g/dL at the time of death, and this BAC level is greater than the level used by the National Institute on Alcohol Abuse and Alcoholism to define binge drinking (i.e., greater than or equal to 0.08 g/dL).

Custom Data

Can I use ARDI to estimate alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) for different years — that is, for years other than those already included in ARDI?

Yes, in the Custom Data section, you can enter death data and prevalence data for any given year or a range of years; however, both the death data and the prevalence data should be for the same time period.

Can I use ARDI to estimate alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) for cities, counties, or other geographic areas?

Through the Custom Data section in ARDI, users can enter data on total deaths and the prevalence of alcohol consumption for other geographic areas besides state-level. The Custom Data section allows reports to be produced estimating alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) for the specified locations.

Is there a minimum population size needed to estimate alcohol-attributable deaths (AAD) or years of potential life lost (YPLL) in the Custom Data section of ARDI?

There is no minimum population size needed to run ARDI. However, the smaller the sample size, the more variable and less reliable are the results. In general, it is recommended that analyses be limited to populations of 500,000 persons or more.

Can I use different alcohol-attributable fractions (AAF) than those included in ARDI?

In the Custom Data section of ARDI, users can change the AAF for the acute causes of death if the information is available for the geographic area specified by both deaths and prevalence of alcohol consumption.

User Help

Who do I contact if I am having problems with the site?

Please contact us through the online form.

How do users cite ARDI as a reference/resource in publications?

Please use the following citation for ARDI if using the data in publication:

Centers for Disease Control and Prevention. Alcohol Related Disease Impact (ARDI) application, 2013. Available at www.cdc.gov/ARDI.

Can I use ARDI to calculate economic impacts related to alcohol use?

No. This feature is not available in the current version of the ARDI application.

Where can I find more information on the health and social impacts of alcohol consumption?

More information on the health and social impacts of alcohol consumption is available at the CDC's Alcohol and Public Health Web site (http://www.cdc.gov/alcohol).

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