Alcohol drinking and overall and cause-specific mortality in China: nationally representative prospective study of 220 000 men with 15 years of follow-up

Abstract

Regular alcohol drinking contributes both favourably and adversely to health in the Western populations, but its effects on overall and cause-specific mortality in China are still poorly understood. A nationally representative prospective cohort study included 220,000 men aged 40-79 years from 45 areas in China in 1990-91, and >40,000 deaths occurred during 15 years of follow-up. Cox regression was used to relate alcohol drinking to overall and cause-specific mortality, adjusting for age, area, smoking and education. Overall, 33% of the participants reported drinking alcohol regularly at baseline, consuming mainly distilled spirits, with an estimated mean amount consumed of 372 g/week (46.5 units per week). After excluding all men with prior disease at baseline and the first 3 years of follow-up, there was a 5% [95% confidence interval (CI) 2-8] excess risk of overall mortality among regular drinkers. Compared with non-drinkers, the adjusted hazard ratios among men who drank <140, 140-279, 280-419, 420-699 and ≥ 700 g/week were 0.97, 1.00, 1.02, 1.12 and 1.27, respectively (P < 0.0001 for trend). The strength of the relationship appeared to be greater in smokers than in non-smokers. There was a strong positive association of alcohol drinking with mortality from stroke, oesophageal cancer, liver cirrhosis or accidental causes, a weak J-shaped association with mortality from ischaemic heart disease, stomach cancer and lung cancer and no apparent relationship with respiratory disease mortality. Among Chinese men aged 40-79 years, regular alcohol drinking was associated with a small but definite excess risk of overall mortality, especially among smokers.