Alcohol consumption and mortality: modelling risks for men and women at different ages

doi:10.1136/bmj.325.7357.191

BMJ 2002;325:191 ( 27 July )

Papers

Alcohol consumption and mortality: modelling risks for men and women at different ages

Ian R White, medical statistician, Dan R Altmann, medical statistician, Kiran Nanchahal, medical statistician.

Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT

Correspondence to: I R White, Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge CB2 2SR ian.white{at}mrc-bsu.cam.ac.uk

Objective: To estimate the relation between alcohol consumptionand risk of death, the level of alcohol consumption at which riskis least, and how these vary with age andsex.
Design: Analysis using published systematic reviewsand populationdata.
Setting: England and Wales in1997.
Main outcome measures: Death from any of the following causes: cancerof lip, oral cavity, pharynx, oesophagus, colon, rectum, liver,larynx, and breast, essential hypertension, coronary heart disease,stroke, cirrhosis, non-cirrhotic chronic liver disease, chronicpancreatitis, andinjuries.
Results: A direct dose-response relation exists betweenalcohol consumption and risk of death in women aged 16-54 andin men aged 16-34. At older ages the relation is U shaped. Thelevel at which the risk is lowest increases with age, reaching3 units a week in women aged over 65 and 8 units a week in menaged over 65. The level at which the risk is increased by 5% abovethis minimum is 8 units a week in women aged 16-24 and 5 unitsa week in men aged 16-24, increasing to 20 and 34 units a weekin women and men aged over 65,respectively.
Conclusions: Substantially increased risks of all causemortality can occur even in people drinking lower than recommendedlimits, and especially among youngerpeople.

What is already known on this topic
Non-drinkers and heavy drinkers have higher all cause mortality rates than light drinkers $---$ the U shaped curve

The precise shape and location of the U are likely to depend on age and sex, but this has not been quantified

What this study adds
The level of alcohol consumption that carries the lowest mortality ranges from 0 in men and women aged under 35 to 3 units a week in women aged over 65 and 8 units a week in men aged over 65

The level of alcohol consumption that carries a 5% increase in mortality increases with age from 8 to 20 units a week in women and from 5 to 34 units a week in men

Our calculations were for England and Wales in 1997: nadirs are likely to be lower in the future and in countries with less ischaemic heart disease

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