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.