Sameer Imtiaz1,2, Kevin D Shield1,2, Michael Roerecke1,3, Joyce Cheng1,4, Svetlana Popova1,2,3,5, Paul Kurdyak1,4,6, Benedikt Fischer1,6,7, Jürgen Rehm1,2,3,6,8. 1. Centre for Addiction and Mental Health, Toronto, Canada. 2. Institute of Medical Science, University of Toronto, Toronto, Canada. 3. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 4. Institute for Clinical Evaluative Sciences, Toronto, Canada. 5. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. 6. Department of Psychiatry, University of Toronto, Toronto, Canada. 7. Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada. 8. Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Abstract
BACKGROUND AND AIMS: Cannabis use is associated with several adverse health effects. However, little is known about the cannabis-attributable burden of disease. This study quantified the age-, sex- and adverse health effect-specific cannabis-attributable (1) mortality, (2) years of life lost due to premature mortality (YLLs), (3) years of life lost due to disability (YLDs) and (4) disability-adjusted life years (DALYs) in Canada in 2012. DESIGN: Epidemiological modeling. SETTING: Canada. PARTICIPANTS: Canadians aged ≥ 15 years in 2012. MEASUREMENTS: Using comparative risk assessment methodology, cannabis-attributable fractions were computed using Canadian exposure data and risk relations from large studies or meta-analyses. Outcome data were obtained from Canadian databases and the World Health Organization. The 95% confidence intervals (CIs) were computed using Monte Carlo methodology. FINDINGS: Cannabis use was estimated to have caused 287 deaths (95% CI = 108, 609), 10,533 YLLs (95% CI = 4760, 20,833), 55,813 YLDs (95% CI = 38,175, 74,094) and 66,346 DALYs (95% CI = 47,785, 87,207), based on causal impacts on cannabis use disorders, schizophrenia, lung cancer and road traffic injuries. Cannabis-attributable burden of disease was highest among young people, and males accounted for twice the burden than females. Cannabis use disorders were the most important single cause of the cannabis-attributable burden of disease. CONCLUSIONS: The cannabis-attributable burden of disease in Canada in 2012 included 55,813 years of life lost due to disability, caused mainly by cannabis use disorders. Although the cannabis-attributable burden of disease was substantial, it was much lower compared with other commonly used legal and illegal substances. Moreover, the evidence base for cannabis-attributable harms was smaller.
BACKGROUND AND AIMS: Cannabis use is associated with several adverse health effects. However, little is known about the cannabis-attributable burden of disease. This study quantified the age-, sex- and adverse health effect-specific cannabis-attributable (1) mortality, (2) years of life lost due to premature mortality (YLLs), (3) years of life lost due to disability (YLDs) and (4) disability-adjusted life years (DALYs) in Canada in 2012. DESIGN: Epidemiological modeling. SETTING: Canada. PARTICIPANTS: Canadians aged ≥ 15 years in 2012. MEASUREMENTS: Using comparative risk assessment methodology, cannabis-attributable fractions were computed using Canadian exposure data and risk relations from large studies or meta-analyses. Outcome data were obtained from Canadian databases and the World Health Organization. The 95% confidence intervals (CIs) were computed using Monte Carlo methodology. FINDINGS: Cannabis use was estimated to have caused 287 deaths (95% CI = 108, 609), 10,533 YLLs (95% CI = 4760, 20,833), 55,813 YLDs (95% CI = 38,175, 74,094) and 66,346 DALYs (95% CI = 47,785, 87,207), based on causal impacts on cannabis use disorders, schizophrenia, lung cancer and road traffic injuries. Cannabis-attributable burden of disease was highest among young people, and males accounted for twice the burden than females. Cannabis use disorders were the most important single cause of the cannabis-attributable burden of disease. CONCLUSIONS: The cannabis-attributable burden of disease in Canada in 2012 included 55,813 years of life lost due to disability, caused mainly by cannabis use disorders. Although the cannabis-attributable burden of disease was substantial, it was much lower compared with other commonly used legal and illegal substances. Moreover, the evidence base for cannabis-attributable harms was smaller.
Keywords:
Burden of disease; Canada; cannabis; comparative risk assessment; disability-adjusted life years; marijuana; mortality; years of life lost due to disability; years of life lost due to premature mortality
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