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

Author

Vasiliki Benetou, Isabelle Romieu, Antonia Trichopoulou, Teresa Norat, Joline W.J. Beulens, Kim Overvad, Larraitz Arriola, Elisabete Weiderpass, Eric J. Duell, Aurelio Barricarte, Paul Brennan, Anne Tjønneland, Peter Wallström, Rosario Tumino, Mattias Johansson, Guy Fagherazzi, Laure Dossus, Petra H.M. Peeters, Marc J. Gunter, Dimitrios Trichopoulos, David C. Muller, Carlotta Sacerdote, Laureen Dartois, Elio Riboli, Nicholas J. Wareham, Pietro Ferrari, Claudia Agnoli, Idlir Licaj, Anja Olsen, Esther Molina-Montes, Domenico Palli, Per Kragh Andersen, Kathryn E. Bradbury, Kuanrong Li, Heiner Boeing, Luciana Neves Nunes, Rudolf Kaaks, Carmen Navarro Sánchez, Kay-Tee Khaw, [Ferrari,P, Licaj,I, Muller,DC, Johansson,M, Nunes,L, Brennan,P, Romieu,I] International Agency for Research on Cancer, Lyon, France. [Andersen,PK] Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark. [Boeing,H] Potsdam-Rehbrücke Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany. [Weiderpass,E] Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromsø, Norway. Department of Research, Cancer Registry of Norway, Oslo, Norway. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Samfundet Folkhälsan, Helsinki, Finland. [Dossus,L, Dartois,L, Fagherazzi,G] Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women’s Health team, Villejuif, France. Université Paris Sud, UMRS 1018, Villejuif, France. IGR, Villejuif, France. [Bradbury,KE] Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. [Khaw,K] Department of Public Health and Primary Care, University of Cambridge Addenbrooke’s Hospital, Cambridge, UK. [Wareham,N] Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK. [Duell,EJ] Unit of Nutrition, Cancer Epidemiology Research Program, Environment and Cancer, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology (ICO), Barcelona, Spain. [Barricarte,A] Navarre Public Health Institute, Pamplona, Spain. [Barricarte,A, Arriola,L] Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Murcia, Spain. [Molina-Montes,E] Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada, Granada, Spain. [Molina-Montes,E, Navarro,C] CIBER Epidemiología y Salud Pública (CIBERESP), Spain. [Navarro,C] Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain. Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain. [Arriola,L] Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Spain. [Wallström,P] Nutrition Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden. [Tjønneland,A, Olsen,A] Danish Cancer Society Research Center, Copenhagen, Denmark. [Trichopoulou,A, Benetou,V] Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, Greece.[Trichopoulou,A, Trichopoulos,D] Hellenic Health Foundation, Athens, Greece. [Trichopoulos,D] Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece. [Tumino,R] Cancer Registry and Histopathology Unit, 'Civic-MP Arezzo' Hospital, ASP Ragusa, Italy. [Agnoli,C] Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. [Sacerdote,C] Unit of Cancer Epidemiology, AO Citta’ della Salute e della Scienza-University of Turin and Center for Cancer Prevention (CPO-Piemonte), Turin, Italy. Human Genetics Foundation (HuGeF), Turin, Italy. [Palli,D] Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Florence, Italy. [Li,K, Kaaks,R] Department of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany. [Peeters,P, Beulens,JW] Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands. [Nunes,L] Department of Statistics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. [Gunter,M, Norat,T, Norat,E] Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK. [Overvad,K] Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Funding This work was supported by the Direction Générale de la Santé (French Ministry of Health) (Grant GR-IARC-2003-09-12-01), by the European Commission (Directorate General for Health and Consumer Affairs) and the International Agency for Research on Cancer. The national cohorts are supported by the Danish Cancer Society (Denmark), the Ligue Contre le Cancer, the Institut Gustave Roussy, the Mutuelle Générale de l’Education Nationale and the Institut National de la Santé et de la Recherche Médicale (France), the Deutsche Krebshilfe, the Deutsches Krebsforschungszentrum, and the Federal Ministry of Education and Research (Germany), the Hellenic Health Foundation, the Stavros Niarchos Foundation and the Hellenic Ministry of Health and Social Solidarity (Greece), the Italian Association for Research on Cancer and the National Research Council (Italy), the Dutch Ministry of Public Health, Welfare and Sports, the Netherlands Cancer Registry, LK, Epidemiology and Data Science, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, and APH - Health Behaviors & Chronic Diseases

Subjects
Gerontology, Male, Time Factors, Etanol, Disease, DISEASE, Cause of Death, Neoplasms, Epidemiology, VDP::Medical disciplines: 700::Health sciences: 800::Health service and health administration research: 806, EPIDEMIOLOGY, Phenomena and Processes::Physiological Phenomena::Nutritional Physiological Phenomena::Nutritional Status [Medical Subject Headings], Prospective Studies, Estado Nutricional, Stroke, Nutrition and Dietetics, VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, Absolute risk reduction, Geographicals::Geographic Locations::Europe [Medical Subject Headings], Estudios Prospectivos, General Medicine, Diseases::Neoplasms [Medical Subject Headings], Middle Aged, Consumo de bebidas alcohólicas, COMPETING RISKS, Neoplasias, FRACTIONAL POLYNOMIALS, 3. Good health, European Prospective Investigation into Cancer and Nutrition, Europe, RATE ADVANCEMENT PERIODS, Cardiovascular Diseases, Cohort, Female, Europa, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, Alcohol Drinking, MODELS, Cardiology, Risk Assessment, Medicine, General & Internal, Diabetes mellitus, General & Internal Medicine, medicine, Humans, METAANALYSIS, Aged, VDP::Medisinske Fag: 700::Helsefag: 800::Helsetjeneste- og helseadministrasjonsforskning: 806, Science & Technology, Nutrition & Dietetics, business.industry, Research, CONSUMPTION, ADULTS, GLOBAL BURDEN, medicine.disease, Chemicals and Drugs::Organic Chemicals::Alcohols::Ethanol [Medical Subject Headings], Psychiatry and Psychology::Behavior and Behavior Mechanisms::Behavior::Drinking Behavior::Alcohol Drinking [Medical Subject Headings], VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, business, Demography
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.

Published
2014

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