BACKGROUND: Alcohol-related mortality and morbidity are high in socioeconomically disadvantaged populations compared with individuals from advantaged areas. It is unclear if this increased harm reflects differences in alcohol consumption between these socioeconomic groups, reverse causation (ie, downward social selection for high-risk drinkers), or a greater risk of harm in individuals of low socioeconomic status compared with those of higher status after similar consumption. We aimed to investigate whether the harmful effects of alcohol differ by socioeconomic status, accounting for alcohol consumption and other health-related factors.

METHODS: The Scottish Health Surveys are record-linked cross-sectional surveys representative of the adult population of Scotland. We obtained baseline demographics and data for alcohol consumption (units per week and binge drinking) from Scottish Health Surveys done in 1995, 1998, 2003, 2008, 2009, 2010, 2011, and 2012. We matched these data to records for deaths, admissions, and prescriptions. The primary outcome was alcohol-attributable admission or death. The relation between alcohol-attributable harm and socioeconomic status was investigated for four measures (education level, social class, household income, and area-based deprivation) using Cox proportional hazards models. The potential for alcohol consumption and other risk factors (including smoking and body-mass index [BMI]) mediating social patterning was explored in separate regression models. Reverse causation was tested by comparing change in area deprivation over time.

FINDINGS: 50 236 participants (21 777 men and 28 459 women) were included in the analytical sample, with 429 986 person-years of follow-up. Low socioeconomic status was associated consistently with strikingly raised alcohol-attributable harms, including after adjustment for weekly consumption, binge drinking, BMI, and smoking. Evidence was noted of effect modification; for example, relative to light drinkers living in advantaged areas, the risk of alcohol-attributable admission or death for excessive drinkers was increased (hazard ratio 6.12, 95% CI 4.45-8.41 in advantaged areas; and 10.22, 7.73-13.53 in deprived areas). We found little support for reverse causation.

INTERPRETATION: Disadvantaged social groups have greater alcohol-attributable harms compared with individuals from advantaged areas for given levels of alcohol consumption, even after accounting for different drinking patterns, obesity, and smoking status at the individual level.

FUNDING: Medical Research Council, NHS Research Scotland, Scottish Government Chief Scientist Office

The relation of alcohol consumption with disease burden remains debated partly due to opposite associations with cardiovascular disease (CVD) and cancer. The relation of alcohol consumption with disease burden expressed in disability-adjusted life years (DALYs) summarizes opposing associations of alcohol consumption on chronic diseases. This study aimed to investigate the association of alcohol consumption with chronic disease burden expressed in DALYs based on individual-participant data. The study was a prospective study among 33,066 men and women from the EPIC-NL cohort. At baseline, alcohol consumption was assessed with a validated food-frequency questionnaire. Participants were followed for occurrence of and mortality from chronic diseases and DALYs were calculated. After 12.4 years follow-up, 6647 disease incidences and 1482 deaths were documented, resulting in 68,225 healthy years of life lost (6225 DALYs). Moderate drinkers (women 5-14.9 g/day, men 5-29.9 g/day) had a lower chronic disease burden (mean DALYs -0.27; 95% CI -0.43; -0.11) than light drinkers (0-4.9 g/day), driven by a lower disease burden due to CVD (-0.18: -0.29; -0.06) but not cancer (-0.05: -0.16; 0.06). The associations were most pronounced among older participants (>/=50 years; -0.32; -0.53; -0.10) and not observed among younger women (-0.08; -0.43; 0.35), albeit non-significant (pinteraction > 0.14). Substantial drinking (women 15-29.9 g/day, men 30-59.9 g/day) compared to light drinking was not associated with chronic disease burden. Our results show that moderate compared to light alcohol consumption was associated with living approximately 3 months longer in good health. These results were mainly observed among older participants and not seen among younger women.

Published in General Health

PURPOSE OF REVIEW: Previous research suggests that low-moderate alcohol consumption may have cardioprotective effects, while heavy or binge-pattern drinking is harmful. New evidence and research methodology may inform safe thresholds of alcohol use. This review examines recent evidence regarding alcohol's effect on cardiovascular disease, with a special consideration of pattern, drink type, and total quantity.

RECENT FINDINGS: New epidemiologic research confirms the potential harmful cardiovascular effects of heavy episodic alcohol use and does not support the previous observation that low-moderate alcohol use protects against stroke. Alcohol consumption also appears to have a continuous positive relationship with the risk of atrial fibrillation. In addition, Mendelian randomization analyses suggest that alcohol may have a direct causal role in adverse cardiovascular effects. Recent studies have confirmed that heavy alcohol use (>14 drinks per week in women and >21 drinks per week in men) and heavy episodic drinking are associated with an increased risk of mortality. New research raises concerns that even low-moderate alcohol use may not offer cardio- or cerebrovascular protection. Drinking >/=3 drinks per day on a regular basis or >/=5 drinks in any one episode should be discouraged.

Published in Cardiovascular System

BACKGROUND: Deaths from cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke are expected to increase in Latin America. Moderate and regular alcohol consumption confers cardiovascular protection, while binge drinking increases risk. We estimated the effects of alcohol use on the number of annual CHD and stroke deaths and disability-adjusted life years (DALYs) in Argentina.

METHODS: Alcohol use data were obtained from a nationally representative survey (EnPreCosp 2011), and etiological effect sizes from meta-analyses of epidemiological studies. Cause-specific mortality rates were from the vital registration system.

RESULTS: There were 291,475 deaths in 2010 including 24,893 deaths from CHD and 15,717 from stroke. 62.7% of men and 38.7% of women reported drinking alcohol in the past year. All heavy drinkers (i.e. women who drank >20g/day and men who drank >40g/day of alcohol) met the definition of binge drinking and therefore did not benefit from cardioprotective effects. Alcohol drinking prevented 1,424 CHD deaths per year but caused 935 deaths from stroke (121 ischemic and 814 hemorrhagic), leading to 448 CVD deaths prevented (58.3% in men). Alcohol use was estimated to save 85,772 DALYs from CHD, but was responsible for 52,171 lost from stroke.

CONCLUSIONS: In Argentina, the cardioprotective effect of regular and moderate alcohol drinking is slightly larger than the harmful impact of binge drinking on CVD. However, considering global deleterious effects of alcohol in public health, policies to reduce binge drinking should be enforced, especially for young people. Studies are still needed to elucidate effects on cardiovascular health.

Published in Cardiovascular System
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The authors have taken reasonable care in ensuring the accuracy of the information herein at the time of publication and are not responsible for any errors or omissions. Read more on our disclaimer.