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

Pietro Ferrari, Idlir Licaj, David C. Muller, Per Kragh Andersen, Mattias Johansson, Heiner Boeing, Elisabete Weiderpass, Laure Dossus, Laureen Dartois, Guy Fagherazzi, Kathryn E. Bradbury, Kay Tee Khaw, Nick Wareham, Eric J. Duell, Aurelio Barricarte, Esther Molina-Montes, Carmen Navarro Sanchez, Larraitz Arriola, Peter Wallström, Anne Tjønneland & 19 others Anja Olsen, Antonia Trichopoulou, Vasiliki Benetou, Dimitrios Trichopoulos, Rosario Tumino, Claudia Agnoli, Carlotta Sacerdote, Domenico Palli, Kuanrong Li, Rudolf Kaaks, Petra Peeters, Joline W J Beulens, Luciana Nunes, Marc Gunter, Teresa Norat, Kim Overvad, Paul Brennan, Elio Riboli, Isabelle Romieu

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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.

Original languageEnglish
Article numbere005245
JournalBMJ Open
Volume4
Issue number7
DOIs
Publication statusPublished - 2014

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AIDS-Related Complex
Alcohols
Mortality
Coronary Disease
Cardiovascular Diseases
Neoplasms
Wounds and Injuries
Wine
Drinking
Breast
Stroke
Myocardial Infarction
Outcome Assessment (Health Care)
Liver

ASJC Scopus subject areas

  • Medicine(all)

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Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study. / Ferrari, Pietro; Licaj, Idlir; Muller, David C.; Andersen, Per Kragh; 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 W J; Nunes, Luciana; Gunter, Marc; Norat, Teresa; Overvad, Kim; Brennan, Paul; Riboli, Elio; Romieu, Isabelle.

In: BMJ Open, Vol. 4, No. 7, e005245, 2014.

Research output: Contribution to journalArticle

Ferrari, P, Licaj, I, Muller, DC, Andersen, PK, Johansson, M, Boeing, H, Weiderpass, E, Dossus, L, Dartois, L, Fagherazzi, G, Bradbury, KE, Khaw, KT, Wareham, N, Duell, EJ, Barricarte, A, Molina-Montes, E, Sanchez, CN, 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, JWJ, Nunes, L, Gunter, M, Norat, T, Overvad, K, Brennan, P, Riboli, E & Romieu, I 2014, 'Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study', BMJ Open, vol. 4, no. 7, e005245. https://doi.org/10.1136/bmjopen-2014-005245
Ferrari, Pietro ; Licaj, Idlir ; Muller, David C. ; Andersen, Per Kragh ; 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 W J ; Nunes, Luciana ; Gunter, Marc ; Norat, Teresa ; Overvad, Kim ; Brennan, Paul ; Riboli, Elio ; Romieu, Isabelle. / Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study. In: BMJ Open. 2014 ; Vol. 4, No. 7.
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title = "Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study",
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.",
author = "Pietro Ferrari and Idlir Licaj and Muller, {David C.} and Andersen, {Per Kragh} and Mattias Johansson and Heiner Boeing and Elisabete Weiderpass and Laure Dossus and Laureen Dartois and Guy Fagherazzi and Bradbury, {Kathryn E.} and Khaw, {Kay Tee} and Nick Wareham and Duell, {Eric J.} and Aurelio Barricarte and Esther Molina-Montes and Sanchez, {Carmen Navarro} and Larraitz Arriola and Peter Wallstr{\"o}m and Anne Tj{\o}nneland and Anja Olsen and Antonia Trichopoulou and Vasiliki Benetou and Dimitrios Trichopoulos and Rosario Tumino and Claudia Agnoli and Carlotta Sacerdote and Domenico Palli and Kuanrong Li and Rudolf Kaaks and Petra Peeters and Beulens, {Joline W J} and Luciana Nunes and Marc Gunter and Teresa Norat and Kim Overvad and Paul Brennan and Elio Riboli and Isabelle Romieu",
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T1 - Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study

AU - Ferrari, Pietro

AU - Licaj, Idlir

AU - Muller, David C.

AU - Andersen, Per Kragh

AU - Johansson, Mattias

AU - Boeing, Heiner

AU - Weiderpass, Elisabete

AU - Dossus, Laure

AU - Dartois, Laureen

AU - Fagherazzi, Guy

AU - Bradbury, Kathryn E.

AU - Khaw, Kay Tee

AU - Wareham, Nick

AU - Duell, Eric J.

AU - Barricarte, Aurelio

AU - Molina-Montes, Esther

AU - Sanchez, Carmen Navarro

AU - Arriola, Larraitz

AU - Wallström, Peter

AU - Tjønneland, Anne

AU - Olsen, Anja

AU - Trichopoulou, Antonia

AU - Benetou, Vasiliki

AU - Trichopoulos, Dimitrios

AU - Tumino, Rosario

AU - Agnoli, Claudia

AU - Sacerdote, Carlotta

AU - Palli, Domenico

AU - Li, Kuanrong

AU - Kaaks, Rudolf

AU - Peeters, Petra

AU - Beulens, Joline W J

AU - Nunes, Luciana

AU - Gunter, Marc

AU - Norat, Teresa

AU - Overvad, Kim

AU - Brennan, Paul

AU - Riboli, Elio

AU - Romieu, Isabelle

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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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