Alcohol and mortality in Mexico: prospective study of 150 000 adults

Abstract

Background: Alcohol consumption is a leading cause of premature death globally, but there is no large-scale prospective evidence from Mexico.

Methods: The Mexico City Prospective Study recruited 150 000 adults aged 35 years or older between 1998 and 2004. Participants were followed up until Oct 1, 2022 for cause-specific mortality. Cox regression in those with no self-reported chronic disease at entry (adjusted for age, sex, district, education, physical activity, smoking, and diabetes) was used to relate baseline-reported alcohol consumption (never, former, occasional [less than monthly], and regular [at least monthly, split into <70, ≥70 to <140, ≥140 to <210, and ≥210 g/week]) to mortality at ages 35-74 from all causes, and from a pre-specified alcohol-related set of underlying causes. Heavy episodic drinking (normally consuming >5 [men] or >4 [women] drinks on a single occasion) and type of preferred drink were also examined.

Findings: Among 138 413 participants aged 35-74 years at recruitment, 21 136 (15%) were regular alcohol drinkers (14 863 [33%] men, 6273 [7%] women), of whom 13 383 (63%) favoured spirits and 6580 (31%) favoured beer. During follow-up, there were 13 889 deaths at ages 35-74 years, including 3067 deaths from the pre-specified alcohol-related causes. Overall, J-shaped associations with mortality were observed. Compared with occasional drinkers, those with baseline-reported consumption ≥210 g/week had 43% higher all-cause mortality (rate ratio [RR] 1·43 [95% CI 1·30-1·56]) and nearly three times the mortality from the pre-specified alcohol-related causes (2·77 [2·39-3·20]). Death from liver disease was strongly related to alcohol consumption; the RR comparing regular drinkers of ≥140 g/week with occasional drinkers was 4·03 (3·36-4·83). Compared with occasional light drinking, occasional heavy episodic drinking was associated with 20% higher alcohol-related mortality (1·20 [1·06-1·35]), and regular heavy episodic drinking was associated with 89% higher alcohol-related mortality (1·89 [1·67-2·15]). Drinks with alcohol percentages higher than spirits were associated with the greatest increased mortality risk, even after accounting for the total alcohol consumed.

Interpretation: In this Mexican population, higher alcohol consumption, episodic drinking, and very high percentage alcoholic products were all associated with increased mortality.

Funding: Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council.

Translation: For the Spanish translation of the abstract see Supplementary Materials section.

Figure 1. Alcohol consumption by year of birth

Bars correspond to percentages of participants that ever drunk alcohol in nine separate birth cohorts (pre-1930 to 1965−69).

Figure 2. Alcohol consumption amount and risk of all-cause and alcohol-related mortality at ages 35−74 years

Analyses are stratified by age-at-risk and district and adjusted for sex, education level, smoking, physical activity, and self-reported diabetes at baseline. Occasional drinkers are defined as those who reported drinking less than monthly. Regular drinkers are defined as those consuming alcohol at least on a monthly basis. The vertical lines through the top of each bar represent the group-specific 95% CIs. RR=mortality rate ratio.