Research project DR/94 (Research action DR)
Tobacco and alcohol use are among the leading behavioural risk factors for ill health and premature death. Previously, the Belspo-funded SOCOST project assessed the social cost of legal and illegal drugs in Belgium, and identified the need for a more sustainable, tailored and integrated monitoring of the societal impact attributed to substance use. The Belgian national burden of disease study, coordinated by Sciensano, the Belgian institute for health, offers a platform for achieving this.
The aim of the SUBOD project is to perform the necessary methodological developments to integrate the burden attributable to tobacco and alcohol use in the Belgian national burden of disease study and initiate an improved and routine monitoring of these impacts. The global economic cost of tobacco and alcohol use is quantified using causal inference models, applied to the HISLink dataset, linking the Belgian Health Interview Survey data with the healthcare use data of the Intermutualistic Agency. The disease-specific burden of tobacco and alcohol use is quantified using the comparative risk assessment framework, which defines the burden of risk factors as the sum of the attributable burdens of the different causally related diseases. For each risk-outcome pair, the attributable burden is obtained by multiplying the overall burden of the health outcome (e.g. in terms of Disability-Adjusted Life Years or economic cost) with the population attributable fraction (PAF), which is obtained by integrating data on exposure (consumption) with the relative risks associating consumption with disease incidence or mortality.
The SUBOD project assesses the burden of tobacco and alcohol use in Belgium, leveraging local data and knowledge. First, SUBOD critically assesses available data sources on tobacco and alcohol use and sales in Belgium, with an aim to establish a methodology for monitoring the true extent of tobacco and alcohol use. Next, a scoping review is performed of relative risks for tobacco and alcohol use and their attributable diseases, leveraging scientific and grey literature, with an aim to establish an open access repository of best-evidence relative risks. Finally, the Belgian national burden of disease study is extended with causally associated health outcomes that are not yet included, so that the burden of tobacco and alcohol use can be quantified in terms of attributable deaths, Years of Life Lost, Disability-Adjusted Life Years, and costs, by age, sex, region, and year.
Knowledge translation and policy transfer are at the heart of the SUBOD project. The project is developed in close collaboration with key policy stakeholders, building on existing networks and interactions. Through pro-active project communication, SUBOD also contributes to an increased visibility of the concerned data collections.
The SUBOD project directly contributes to the federal tobacco and alcohol plans, which explicitly call for an improved monitoring of tobacco and alcohol use and their respective impacts. The project also provides the basis for studies evaluating the impact of interventions targeted at diminishing the alcohol and tobacco burden (e.g. evaluating the cost-effectiveness of such interventions). The project fits into the global strategic priorities of Sciensano, in terms of its scientific expertise and its core mission to provide advice to health authorities, and benefits from collaboration in international projects, such as the European Burden of Disease Network (www.burden-eu.net), chaired by the project coordinator.
