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Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study
Open accessAbstract
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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“Female never-drinkers were at increased risk of CVD death (RR: 1.31; 95% CI: 1.13 to 1.53) compared with moderate drinkers (0.1 to 4.9 g/d); but the association was not significant for male never-drinkers (RR: 1.20; 95% CI: 0.89 to 1.62).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [274]
In the citing paper
“Female never-drinkers were at increased risk of CVD death (RR: 1.31; 95% CI: 1.13 to 1.53) compared with moderate drinkers (0.1 to 4.9 g/d); but the association was not significant for male never-drinkers (RR: 1.20; 95% CI: 0.89 to 1.62).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [274]
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“The EPIC (European Prospective Investigation on Cancer and Nutrition) study monitored 380,395 participants for 13 years (4,187 CVD deaths) (274).”
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Metadata
- 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
- Ferrari, Pietro
- Licaj, Idlir
- Muller, David C
- Johansson, Mattias
- Weiderpass, Elisabete
- Dossus, Laure
- Fagherazzi, Guy
- Bradbury, Kathryn E
- Khaw, Kay-Tee
- Duell, Eric J
- Barricarte, Aurelio
- Arriola, Larraitz
- Wallström, Peter
- Tjønneland, Anne
- Olsen, Anja
- Tumino, Rosario
- Agnoli, Claudia
- Sacerdote, Carlotta
- Palli, Domenico
- Li, Kuanrong
- Kaaks, Rudolf
- Peeters, Petra
- Beulens, Joline WJ
- Nunes, Luciana
- Gunter, Marc
- Overvad, Kim
- Brennan, Paul
- Romieu, Isabelle
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2014-07
- Volume
- 4
- Issue
- 7
- Pages
- e005245
- ISSN
- 2044-6055 (ISSN-L)
- 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
- gold
- doi.org
- 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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