The association of pattern of lifetime alcohol use and cause of death in the European prospective investigation into cancer and nutrition (EPIC) study

Abstract

Background: There is limited evidence for an association between the pattern of lifetime alcohol use and cause-specific risk of death.

Methods: Multivariable hazard ratios were estimated for different causes of death according to patterns of lifetime alcohol consumption using a competing risks approach: 111 953 men and 268 442 women from eight countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included. Self-reported alcohol consumption at ages 20, 30, 40 or 50 years and at enrollment were used for the analysis; 26 411 deaths were observed during an average of 12.6 years of follow-up.

Results: The association between lifetime alcohol use and death from cardiovascular diseases was different from the association seen for alcohol-related cancers, digestive, respiratory, external and other causes. Heavy users (>5 drinks/day for men and >2.5 drinks/day for women), regardless of time of cessation, had a 2- to 5-times higher risk of dying due to alcohol-related cancers, compared with subjects with lifetime light use (≤1 and ≤0.5 drink/week for men and women, respectively). Compared with lifetime light users, men who used <5 drinks/day throughout their lifetime had a 24% lower cardiovascular disease mortality (95% confidence interval 2-41). The risk of death from coronary heart disease was also found to be 34-46% lower among women who were moderate to occasionally heavy alcohol users compared with light users. However, this relationship was only evident among men and women who had no chronic disease at enrollment.

Conclusions: Limiting alcohol use throughout life is associated with a lower risk of death, largely due to cardiovascular disease but also other causes. However, the potential health benefits of alcohol use are difficult to establish due to the possibility of selection bias and competing risks related to diseases occurring later in life.

Keywords: EPIC; Prospective study; cause-specific mortality; lifetime alcohol use.

Figure 1

Study population of the European Prospective Investigation into Cancer and Nutrition study and exclusions in the current analysis

Figure 2

Definition of exclusive categories of pattern of alcohol use during lifetime ^a(American Heart Association; World Cancer Research Fund/American Institute for Cancer Research; National Institute of Alcoholism and Alcohol Abuse)

Figure 3

Spline regression of the association of g/day alcohol use at enrolment and causes of death among men participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, whose alcohol use was >0 at that time, stratifying by centre and age, and adjusting for body mass index, height, waist circumference, intake of fruits, vegetables, red meat and meat products, dietary fibre, physical activity, education, smoking and prevalent disease (self-reported cancer, myocardial infarction, stroke, diabetes mellitus or hypertension). P–values for linearity and for general effect respectively were for CHD = 0.151 and 0.004, CVD = 0.001 and 0.001, alcohol-related cancers = 0.059 and <0.001, other neoplasms = 0.172 and <0.001, respiratory causes = <0.001 and <0.001, digestive causes = <0.001 and <0.001, external causes = 0.044 and <0.001 and other causes = <0.001 and <0.001. CHD, coronary heart disease; CVD, cardiovascular disease other than CHD; AC, alcohol-related cancer; ON, other neoplasms; R, respiratory system; D, digestive system; E, external causes; OC, other causes

Figure 4

Spline regression of the association of g/d alcohol use at enrolment and causes of death among women participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, whose alcohol use was >0 at that time; stratifying by centre and age and adjusting for body mass index, height, waist circumference, intake of fruits, vegetables, red meat and meat products, dietary fibre, physical activity, education, smoking, menopausal hormone use, number of live births, menopausal status and prevalent disease (self-reported cancer, myocardial infarction, stroke, diabetes mellitus or hypertension). P-values for linearity and for general effect respectively were for CHD = 0.028 and <0.001, CVD = 0.089 and 0.061, alcohol-related cancers = 0.076 and 0.028, other neoplasms = 0.013 and 0.033, respiratory causes = 0.001 and 0.003, digestive causes = 0.950 and 0.002, external causes = 0.399 and 0.602 and other causes = 0.001 and <0.001. CHD, coronary heart disease; CVD, cardiovascular disease other than CHD; AC, alcohol-related cancer; ON, other neoplasms; R, respiratory system; D, digestive system; E, external causes; OC, other causes