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Cited by 105Alcohol Consumption and Health EffectsSubstance Abuse Treatment and OutcomesNutritional Studies and Diet

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

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Ferrari, Pietro, Licaj, Idlir, Muller, David C, Kragh Andersen, Per, Johansson, Mattias, Boeing, Heiner, Weiderpass, Elisabete, Dossus, Laure, Dartois, Laureen, Fagherazzi, Guy, Bradbury, Kathryn E, Khaw, Kay-Tee, Wareham, Nick, Duell, Eric J, Barricarte, Aurelio, Molina-Montes, Esther, Sanchez, Carmen Navarro, Arriola, Larraitz, Wallström, Peter, Tjønneland, Anne, Olsen, Anja, Trichopoulou, Antonia, Benetou, Vasiliki, Trichopoulos, Dimitrios, Tumino, Rosario, Agnoli, Claudia, Sacerdote, Carlotta, Palli, Domenico, Li, Kuanrong, Kaaks, Rudolf, Peeters, Petra, Beulens, Joline WJ, Nunes, Luciana, Gunter, Marc, Norat, Teresa, Overvad, Kim, Brennan, Paul, Riboli, Elio, Romieu, Isabelle·2014·BMJ Open
DOI 10.1136/bmjopen-2014-005245PMC PMC4091394
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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.

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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 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.CC BY · PubMed Central
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 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.CC BY · PubMed Central
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.
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.CC BY · PubMed Central

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Authors
Ferrari, P., Licaj, I., Muller, D. C., Kragh Andersen, P., Johansson, M., Boeing, H., Weiderpass, E., Dossus, L., Dartois, L., Fagherazzi, G., Bradbury, K. E., Khaw, K.-T., Wareham, N., Duell, E. J., Barricarte, A., Molina-Montes, E., Sanchez, C. N., Arriola, L., Wallström, P., Tjønneland, A., Olsen, A., Trichopoulou, A., Benetou, V., Trichopoulos, D., Tumino, R., Agnoli, C., Sacerdote, C., Palli, D., Li, K., Kaaks, R., Peeters, P., Beulens, J. W., Nunes, L., Gunter, M., Norat, T., Overvad, K., Brennan, P., Riboli, E., & Romieu, I.
Affiliations
  • Centre international de recherche sur le cancer (FR)
  • German Institute of Human Nutrition (DE)
  • Karolinska Institutet (SE)
  • Université Paris-Sud (FR)
  • University of Oxford (GB)
  • University of Cambridge (GB)
  • Institut d'Investigació Biomédica de Bellvitge (ES)
  • Instituto de Salud Pública de Navarra (ES)
  • Basque Government (ES)
  • Lund University (SE)
  • Danish Cancer Society (DK)
  • National and Kapodistrian University of Athens (GR)
  • Harvard University (US)
  • Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
  • Italian institute for Genomic Medicine (IT)
  • Istituto per lo Studio e la Prevenzione Oncologica (IT)
  • German Cancer Research Center (DE)
  • University Medical Center Utrecht (NL)
  • Universidade Federal do Rio Grande do Sul (BR)
  • Imperial College London (GB)
  • Aarhus University (DK)
Corresponding author
Ferrari, Pietro
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2014-07
Volume
4
Issue
7
Pages
e005245
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2014-005245
PMC
PMC4091394
OpenAlex
W2171583333
Cited by
105
References
34
Citations by year
2026: 2 · 2025: 4 · 2024: 5 · 2023: 10 · 2022: 10 · 2021: 11 · 2020: 7 · 2019: 16 · 2018: 9 · 2017: 7 · 2016: 13 · 2015: 9 · 2014: 2
FWCI
7.67
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • VBN Forskningsportal (Aalborg Universitet) (publishedVersion, other-oa)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • Lund University Publications (Lund University) (submittedVersion, other-oa)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • HighWire Press Open Archive (submittedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-sa)
  • RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
  • World Health Organization
  • Kræftens Bekæmpelse
  • Deutsches Krebsforschungszentrum (RD06/0020)
  • Centre International de Recherche sur le Cancer (RD06/0020)
  • Wellcome Trust
  • Cancer Research UK (RD06/0020, 14136, 16491)
  • National Institute for Health and Care Research (NF-SI-0512-10114)
  • British Heart Foundation
  • Food Standards Agency
  • Stroke Association
  • European Commission (RD06/0020)
  • Institut National de la Santé et de la Recherche Médicale (RD06/0020)
  • Bundesministerium für Bildung und Forschung (RD06/0020)
  • Cancerfonden
  • Ligue Contre le Cancer (RD06/0020)
  • Stavros Niarchos Foundation (RD06/0020)
  • NordForsk
  • Deutsche Krebshilfe (RD06/0020)
  • Institut Gustave-Roussy (RD06/0020)
  • Mutuelle Générale de l'Education Nationale (RD06/0020)
  • Ministry of Health and Social Solidarity, Greece
  • Hellenic Health Foundation (RD06/0020)
  • Medical Research Council (RD06/0020)
  • World Cancer Research Fund (RD06/0020)
  • Instituto de Salud Carlos III (RD06/0020)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
lifetime alcohol use, alcohol-related mortality, alcohol-related cancer, cardiovascular mortality, coronary artery disease, sex differences, competing risks, EPIC cohort
MeSH terms
Adult, Aged, Alcohol Drinking, Cardiovascular Diseases, Cause of Death, Europe, Female, Humans, Male, Middle Aged, Neoplasms, Prospective Studies, Time Factors, Risk Assessment

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