Mortality in Relation to Consumption of Alcohol
Mortality in relation to consumption of alcohol: 13 years’
observations on
male British doctors.
BMJ, Oct 8, 1994 v309 n6959 p911-8 (3K)
MDX Health Digest
by Doll R; Peto R; Hall E; Wheatley K; Gray R
OBJECTIVE–To assess the risk of death associated with various
patterns of alcohol consumption. DESIGN–Prospective study of mortality
in relation to alcohol drinking habits in 1978, with causes of death
sought over the next 13 years (to 1991). SUBJECTS–12,321 British male
doctors born between 1900 and 1930 (mean 1916) who replied to a postal
questionnaire in 1978. Those written to in 1978 were the survivors of a
long running prospective study of the effects of smoking that had begun
in 1951 and was still continuing.
RESULTS–Men were divided on the basis of their response to the 1978
questionnaire into two groups according to whether or not they had ever
had any type of vascular disease, diabetes, or “life threatening disease”
and into seven groups according to the amount of alcohol they drank. By
1991 almost a third had died. All statistical analyses of mortality were
standardised for age, calendar year, and smoking habit. There was a U
shaped relation between all cause mortality and the average amount of
alcohol reportedly drunk; those who reported drinking 8-14 units of
alcohol a week (corresponding to an average of one to two units a day)
had the lowest risks. The causes of death were grouped into three main
categories: “alcohol augmented” causes (6% of all deaths: cirrhosis,
liver cancer, upper aerodigestive (mouth, oesophagus, larynx, and
pharynx) cancer, alcoholism, poisoning, or injury), ischaemic heart
disease (33% of all deaths), and other causes. The few deaths from
alcohol augmented causes showed, at least among regular drinkers, a
progressive trend, with the risk increasing with dose. In contrast, the
many deaths from ischaemic heart disease showed no significant trend
among regular drinkers, but there were significantly lower rates in
regular drinkers than in non-drinkers. The aggregate of all other causes
showed a U shaped dose-response relation similar to that for all cause
mortality. Similar differences persisted irrespective of a history of
previous disease, age (under 75 or 75 and older), and period of follow up
(first five and last eight years). Some, but apparently not much, of the
excess mortality in non-drinkers could be attributed to the inclusion
among them of a small proportion of former drinkers. CONCLUSION–The
consumption of alcohol appeared to reduce the risk of ischaemic heart
disease, largely irrespective of amount. Among regular drinkers mortality
from all causes combined increased progressively with amount drunk above
21 units a week. Among British men in middle or older age the consumption
of an average of one or two units of alcohol a day is associated with
significantly lower all cause mortality than is the consumption of no
alcohol, or the consumption of substantial amounts. Above about three
units (two American units) of alcohol a day, progressively greater levels
of consumption are associated with progressively higher all cause
mortality.
Keywords:
Alcohol use; Mortality; Great Britain; Research; Heart disease
MESH Headings:
