Abstract
The aim of this study was to assess the association between alcohol intake and premature mortality (younger than 65 years) and to explore the effect of potential alcohol underreporting by heavy drinkers. We followed-up 20272 university graduates. Four categories of alcohol intake were considered (abstainer, light, moderate and heavy consumption). Repeated measurements of alcohol intake and updated information on confounders were used in time-dependent Cox models. Potential underreporting of alcohol intake by some heavy drinkers (likely misclassified as light or moderate drinkers) was explicitly addressed in an attempt to correct potential underreporting by using indirect information. During 12·3 years of median follow-up (interquartile range: 6·8-15·0), 226 participants died before their 65th birthday. A higher risk of early mortality was found for the highest category of alcohol intake (≥50 g/d) in comparison with abstention (multivariable-adjusted hazard ratio (HR) = 2·82, 95 % CI 1·38, 5·79). In analyses of alcohol as a continuous variable, the multivariable-adjusted HR was 1·17 (95 % CI 1·08, 1·26), for each 10 g/d of alcohol. This harmful linear association was present both in uncorrected models and in models corrected for potential underreporting. No significant inverse association between light or moderate alcohol intake and premature mortality was observed, even after correcting for potential misclassification. Alcohol intake exhibited a harmful linear dose-response association with premature mortality (<65 years) in this young and highly educated Mediterranean cohort. Our attempts to correct for potential misclassification did not substantially change these results.
Highlights
Heavy alcohol intake increases all-cause mortality and is an important contributor to the global burden of disease[1]
The aim of this study was to assess the association between alcohol intake and premature mortality and to explore the effect of potential alcohol underreporting by heavy drinkers
Participants with higher alcohol consumption exhibited substantially greater consumption of tobacco and coffee and more frequent pre-existent chronic diseases at baseline than abstainers. Inconsistencies in their self-reports of smoking habits, alcohol consumption and other food habits were higher in heavy drinkers than in other categories
Summary
Heavy alcohol intake increases all-cause mortality and is an important contributor to the global burden of disease[1]. With long-term follow-up and repeated measures, the lowest mortality was found for alcohol intakes between 5 and 30 g/d(9). These findings support a Jshaped dose–response curve. In the absence of such a trial, prospective cohorts can provide the most useful information, but some biases must be controlled: [1] misclassification of former drinkers who quitted because of previous disease (the ‘sick quitter’ hypothesis), [2] the failure to separate occasional drinkers (drinking once a month or less) from complete abstainers[14] and [3] the underreporting of the amount of alcohol consumed by some heavy drinkers[15]. There is scarcity of cohort studies assessing only early mortality as an alcoholrelated outcome
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