Men Are Dying in Their ‘40s

My friends are dying in their ‘40s due to liver cirrhosis. They used to boast drinking alcohol and show themselves as ‘cool’ dudes who always partied and enjoyed their lives. Not only that, in their teens they used to make fun of non-drinkers like us for being ‘bachcha’ (children). Result, at the same age I am still running high with energy and they are dead.

The pandemic of drinking alcohol has gripped Indian society for at least three decades now and there is no sign of this pandemic decreasing. The idea that drinking is ‘cool’ and makes one a complete ‘man’ has gripped Indians in such a manner that even Indian teens now fight with their dads to get their drinking ‘rights’ at home and to get their pocket money for drinking.

My neighbour’s son does so very often. Every time I see such things, I hold the drinkers responsible for this social evil. As the drinkers project drinking as cool, project drinking alcohol as being macho and a lot of fun, all other non-drinkers get attracted to drinking. We have already seen how Indians poured in large numbers to buy liquor when the liquor shops were opened for the first time during the Covid-19 lockdown.

Lancet Study in 2009 Warned Us

A Lancet study done in 2009 raised alarm bell for India but India hardly took any lesson from that.

Alcohol use on the rise in India (Lancet, 2009)

The study cautioned that more than half of Alcohol drinkers in India fall in the Hazardous drinking category. They also said that in India cutting across all classes of people the undocumented alcohol abuse is very high in the form of country liquor and spurious liquor.

In 2009, they found that alcohol consumers have grown at the rate of 8% in the previous 3 years and drinking grew by 21% in adult men and 2% in women. 20% of all drinkers needed ‘help’, meaning they were abusing alcohol.

Lancet also cautioned us about underage drinking that increased from 2% in 1994 to 14% in 2009. The drop in the age of starting alcohol consumption was a worrying factor. In Kerala they found that the average age of initiation to alcohol consumption dropped to 13 years from 19 years earlier.

In their report Lancet also observed that young Indian women consumed as much alcohol as young men did in any social event in Karnataka. And 50% of Indian drinkers have Binge drinking habits which over the years would have only grown.

Alcohol related problems account for more than 20% of hospital admissions, 18% of psychiatric emergencies, >20% of all brain injuries and 60% of all injuries reporting to Indian hospitals.

Poor are drinking more than they earn. A vicious cycle of drink and debt was established in a NIMHANS study that found 28,500 people in and around Bangalore spent more money on alcohol than they have earned in 2009.

NIMHANS study also calculated that direct and indirect costs associated with alcohol addiction in Karnataka is more than triple of alcohol taxation and several times more than annual health budget of Karanataka.

2017 Lancet Study on Alcoholism

A 2017 study by Lancet showed alarming rise in cirrhosis of liver deaths among men worldwide.

The graph above presented in the Lancet, 2017 study showed almost 50% growth in the male number of deaths were due to liver cirrhosis. The corresponding figures for the death of women were still less. Even though the age-standardised death rates (definition given in glossary) in both men and women have decreased.

Even though there may be different reasons for liver cirrhosis (including non-alcoholic one) the age-wise pattern of liver cirrhosis deaths and prevalence showed the most vulnerable sections of the society –

The DALY chart is removed from the above set of graphs as the concept is difficult to explain to the complete audience of this article.

From the above graphs, you will notice that the most vulnerable age groups (number of deaths) are from 30-years to 60-years of age. The rate of death by cirrhosis (determined by the slope of the lines showing ‘death rate’) sees first jump from the age above 70-years for men and 75-years for women and again accelerates for them after 90-years (notice a second slope change).

In terms of compensated and decompensated Cirrhosis (definitions given in the glossary) we find that the risk starts for men from the age of 30-years. Decompensated Cirrhosis – which is more serious in nature, accelerates in men after 40-years of age. Men are seen to have an increase in rates of both compensated and decompensated cirrhosis after the age of 90. However, there is not such second spike seen in women at older ages.

Out of all causes of cirrhosis, alcohol consumption takes the majority share –

According to this Lancet study – alcohol induced Cirrhosis deaths in 1990 was 215,000 globally (in 95% UI) and that was increased to over 332,000 in 2017. Out of these 332,000 deaths, 72.6% were men and 27.4% were women. The alcohol related liver disease caused 23.6 million cases of compensated cirrhosis and 2.46 million cases of decompensated cirrhosis in 2017. So, notably the alcohol induced cirrhosis has increased by over 54% between 1990 and 2017.

If we see other causes of liver cirrhosis, Hepatitis B and C were the leading causes, but Hepatitis B cases increased from 287,000 to 384,000 or 34% and Hepatistis C cases increased by 52%. NASH increase by 90% and other causes increased by 33%. NASH or Non-Alcoholic SteatoHepatitis which has increased maximum between these years, was due to increase in NASH cases in women. Lancet attributed the reason to the factors like – hormonal factors, lower prevalence of high-risk behaviour, higher prevalence of obesity, lower consumption of alcohol and diseases that exclusively effect women. Even though the number of NASH related Liver Cirrhosis cases were less compared to other cases, the growth was phenomenal and if you add women’s binge drinking trend in recent times, you will see why it is worthwhile considering women drinking alcohol as a crime as the result comes back to our society with the new generation of children –  

Read – Why Women Drinking Alcohol Is A Crime Against Humanity

Globally, the Lancet study found that on an average 27.3% of all cirrhosis deaths in men were attributed to alcohol abuse.

An Epidemiological study conducted in 2020 by three Chennai based researchers titled

Alcohol Abuse in India – Epidemiological review (NCBI, 2020)

found the growing menace of alcohol abuse in India. They mentioned in their paper that other than liver cirrhosis, many other causes of death are also attributed to alcohol consumption. These include – oral and pharyngeal cancers, inter-personal violence, self-harm, traffic injuries, tuberculosis (TB) and liver cancer.

This table gives important statistics about Alcohol consumption in different parts of India as found in different times. The habit of binge drinking and alcohol dependence among large number of people gives us a worrying feeling about alcohol consumption in India.

This report also states that Alcohol Used Disorder (AUD) in India in 2010 was 2.6% and in 2015-16 it was 9%. Alcohol attributable fraction of all causes of death was 5.4% and around 62.9% of Liver Cirrhosis cases in India was attributed to alcohol abuse.

Among other complications include – GI infections, Cancer, Changes in Genitourinary system (causing erectile dysfunction), Muscular weakness, Neurological complications, Psychiatric complications.

Is There any Benefit of alcohol consumption?

Some studies claim that moderate consumption of alcohol is good to prevent Coronary Artery Disease in some people. However, individual susceptibility plays an important role in alcohol related issues and American Heart Association (AHA) has already issues an advisory that people may not drink alcohol for its perceived benefits as there may not be any. We also need to understand that alcohol companies can fund such research to make alcohol look like good for your health.   

Conclusion

Whenever an Indian state bans alcohol in that state there is outrage in all spheres of life against the ban and it is portrayed that the government is trying to impose moral guidance on its people and taking away their liberty. The ban on alcohol is also not very successful as then the illicit liquor and spurious liquor trades increase. That causes even more health hazard. It is important that all of us together impose ban on alcohol in our near circles and awaken people about alcohol related deaths so that they stop consuming alcohol. It is more important for men to stop because it has become a status symbol for masculinity nowadays and men think that alcohol consumption is the easy remedy to alleviate stress and relationship issues. Time has come that we stop glorifying alcohol consumption else we will see more of our near and dear ones dying of alcohol abuse at a very young age.

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Glossary of terms

Age standardised death rate – The standardised death rate, abbreviated as SDR, is the death rate of a population adjusted to a standard age distribution. It is calculated as a weighted average of the age-specific death rates of a given population; the weights are the age distribution of that population.

Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs).

Compensated cirrhosis means the liver is scarred but still able to perform most its basic functions at some level.

Decompensated Cirrhosis – Decompensated cirrhosis is a term that doctors use to describe the complications of advanced liver disease. People with compensated cirrhosis may not have any symptoms as their liver continues to function but when liver function decreases, it becomes decompensated cirrhosis.

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