One in 25 deaths across the world are linked to alcohol consumption, Canadian experts have suggested.
Writing in the Lancet, the team from the University of Toronto added that the level of disease linked to drinking affects poorest people the most.
Worldwide, average alcohol consumption is around 12 units a week - but in Europe that soars to 21.5.
The report authors warn the effect of alcohol disease is similar to that of smoking a decade ago.
We face a large and increasing alcohol-attributable burden
Dr Jurgen Rehm
The analysis also found that 5% of years lived with disability are attributable to alcohol consumption.
The paper says that, although there have been some benefits of moderate drinking in relation to cardiovascular disease, these are far outweighed by the detrimental effects of alcohol on disease and injury.
In addition to diseases directly caused by drinking, such as liver disorders, a wide range of other conditions such as mouth and throat cancer, colorectal cancer, breast cancer, depression and stroke are linked to drinking.
Drinking patterns do vary around the world, and the researchers point out that most of the adult population - 45% of men and 66% of women - abstain from drinking alcohol for most of them for their life.
Across the Americas, average consumption is 17 units per week, while the Middle East was the lowest at 1.3 units per week.
Death rates
For 2004, the latest year for which comparable data are available on a global level, 3.8% of all global deaths (around 1 in 25) were attributable to alcohol.
Overall, alcohol-attributable deaths have increased since 2000 mainly because of increases in the number of women drinking.
Europe had the highest proportion of deaths related to alcohol, with 1 in 10 deaths directly attributable.
Within Europe, the former Soviet Union countries had the highest proportion at 15%, or around one in seven deaths.
This study is a global wake-up call
Professor Ian Gilmore, Royal College of Physicians president
Globally, men are five times more likely to die from alcohol-related illness than women.
And young people are more likely to have a disease linked to alcohol than older people.
Of all years lived with disability attributable to alcohol, 34% were experienced by people aged 15-29, 31% in the 30-44 age group, and 22% by those aged 45-59.
Writing in The Lancet, the researchers led by Dr Jurgen Rehm said: "Globally, the effect of alcohol on burden of disease is about the same size as that of smoking in 2000, but it is greatest in developing countries."
But they added: "This finding is not surprising since global consumption is increasing, especially in the most populous countries of India and China.
"We face a large and increasing alcohol-attributable burden at a time when we know more than ever about which strategies can effectively and cost-effectively control alcohol-related harms."
'Irresponsible sale'
Professor Ian Gilmore, president of the Royal College of Physicians and chair of the Alcohol Health Alliance UK, said: "This study is a global wake-up call.
"We need an international framework convention for alcohol control, similar to that on tobacco, as soon as possible, to put into practice the evidence-based measures needed to reduce alcohol-related harm.
"These include increasing the price of alcohol, reducing its availability and banning advertising, and the action needs to start now."
Alcohol Concern chief executive Don Shenker added: "These statistics are unfortunately reflected in England, where we have seen deaths caused by alcohol increase almost a fifth since the beginning of the decade.
"On both a national and global scale we're facing a disease burden of huge proportions.
"There is no longer any doubt that if a society drinks large amounts of alcohol, we'll see high levels of harm as a result."
He added: "Many countries are investigating new ways to cut deaths and disease and reduce the burden on health services by using the price of alcohol to lower consumption.
"As the chief medical officer has identified, putting a stop to the irresponsible sale of low cost alcohol would be an effective step in the right direction.
We face a large and increasing alcohol-attributable burden 
