Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study

Abstract

Objectives: To investigate the role of factors that modulate the association between alcohol and mortality, and to provide estimates of absolute risk of death.

Design: The European Prospective Investigation into Cancer and nutrition (EPIC).

Setting: 23 centres in 10 countries.

Participants: 380 395 men and women, free of cancer, diabetes, heart attack or stroke at enrolment, followed up for 12.6 years on average.

Main outcome measures: 20 453 fatal events, of which 2053 alcohol-related cancers (ARC, including cancers of upper aerodigestive tract, liver, colorectal and female breast), 4187 cardiovascular diseases/coronary heart disease (CVD/CHD), 856 violent deaths and injuries. Lifetime alcohol use was assessed at recruitment.

Results: HRs comparing extreme drinkers (≥30 g/day in women and ≥60 g/day in men) to moderate drinkers (0.1-4.9 g/day) were 1.27 (95% CI 1.13 to 1.43) in women and 1.53 (1.39 to 1.68) in men. Strong associations were observed for ARC mortality, in men particularly, and for violent deaths and injuries, in men only. No associations were observed for CVD/CHD mortality among drinkers, whereby HRs were higher in never compared to moderate drinkers. Overall mortality seemed to be more strongly related to beer than wine use, particularly in men. The 10-year risks of overall death for women aged 60 years, drinking more than 30 g/day was 5% and 7%, for never and current smokers, respectively. Corresponding figures in men consuming more than 60 g/day were 11% and 18%, in never and current smokers, respectively. In competing risks analyses, mortality due to CVD/CHD was more pronounced than ARC in men, while CVD/CHD and ARC mortality were of similar magnitude in women.

Conclusions: In this large European cohort, alcohol use was positively associated with overall mortality, ARC and violent death and injuries, but marginally to CVD/CHD. Absolute risks of death observed in EPIC suggest that alcohol is an important determinant of total mortality.

Keywords: Cardiology; Nutrition & Dietetics.

Figure 1

Number of deaths, person-years (PY) and multivariable HRs (Models were stratified by centre. Systematic adjustment was undertaken for age at recruitment, body mass index and height, former drinking, time since alcohol quitting, smoking status, duration of smoking, age at start smoking, educational attainment and energy intake. In women adjustment was undertaken for menopausal status, ever use of replacement hormones and number of full-term pregnancies.) with 95% CIs and p value of the Wald test for statistical significance for overall and cause-specific mortality by categories of lifetime alcohol use, in women and men.

Figure 2

Sex-specific plots displaying cumulative probabilities of death due to overall mortality, for heavy (=30 g/day in women and=60 g/day in men, continuous line) and moderate lifetime use (0.1–4.9 g/day) (dotted line), in smokers (black line) and never smokers (grey line), for study participants aged 60 years.

Figure 3

In competing risks analyses, sex-specific plots displaying cumulative probabilities of death due to CVD/CHD (red), alcohol-related cancers (blue) and violent death and injuries (green), for study participants aged 60 years according to heavy (=30 g/day in women and=60 g/day in men, continuous line) and moderate (0.1–4.9 g/day, dotted lines) lifetime alcohol use in current and never smokers in the EPIC study.