Aims: The majority of prospective studies on alcohol use and mortality risk indicate that non-drinkers are at increased risk of death compared to moderate drinkers. This article investigates the association between middle-aged women's alcohol use and mortality, controlling for socio-demographic and health variables. An association between alcohol use and hospital in-patient care is also analysed.
Methods: Baseline data were collected during 1995-2000 in a population-based cohort of 6917 women aged 50-59 years living in southern Sweden, the Women's Health in Lund Area (WHILA). After 9 years, a register follow-up was performed from the National cause-of-death register and the Swedish hospital discharge register. Cox proportional hazards regression were used to analyse differences in survival.
Results: During the observation period, 201 (2.9%) women died. In a crude model, non-drinkers had a significantly increased risk for death. When including socio-demographic predictors in the model, there was a strong indication that non-drinkers were at increased risk for death compared to moderate drinkers. Adding health predictors, not drinking alcohol was no longer a risk factor for death. Further, analyses of in-patient care indicate that non-drinkers had poorer health during their entire adult life.
CONCLUSIONS THIS STUDY UNDERLINES THE IMPORTANCE OF INCLUDING HEALTH STATUS AT BASE-LINE WHEN PROSPECTIVELY STUDYING THE ASSOCIATION BETWEEN ALCOHOL USE AND MORTALITY, OTHERWISE MODERATE ALCOHOL CONSUMPTION MAY APPEAR MORE BENEFICIAL THAN IS THE CASE.
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.
Alcohol has previously been shown to have a U-shaped association with type 2 diabetes (T2D) risk, but less is known regarding the specific association with wine. To evaluate for the first time the associations between T2D risk and both baseline wine consumption and trajectories of wine consumption frequency throughout life, estimated using an innovative group-based trajectory modeling strategy. A total of 66,485 women from the French prospective E3N-EPIC cohort were followed between 1993 and 2007; 1,372 incident cases of T2D were diagnosed during the follow-up. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (95 % CI) for T2D risk. The average consumption of wine, among alcohol consumers, was 0.81 drinks/day (1 drink = 150 mL). Associations between wine and T2D were restricted to overweight women (Pinteraction = 0.0084). Among them, wine consumption was inversely associated with T2D risk (Ptrend = 0.0022). A lower risk was observed for overweight women having two or more drinks/day [HR 0.59 (0.43-0.82)] when compared with non-alcohol consumers. Women who started to drink wine early in life (around age 10-15 years) were at a significantly lower risk than lifetime abstainers. In our study, wine drinking was inversely associated with T2D risk but only in overweight women. Our results also suggest a potential beneficial, cumulative effect of moderate wine consumption throughout life for overweight women, who would already be at higher risk of T2D. We encourage other cohort studies with information on wine consumption to investigate these associations.
Moderate wine consumption has been associated with reduced cardiovascular (CV) risk, but most investigations have been conducted in Caucasian populations. To investigate the relationship of wine consumption to CV risk markers, we studied a multi-ethnic sample of middle-aged, healthy women (N = 2900; 48% white, 28% black, 7% Hispanic, 8% Chinese, 9% Japanese) participating in SWAN over 7 years with repeated assessments of CV risk factors. Consumption of wine was stable and common with 20% reporting none, 69% light (<1/day), 7% moderate ( = 1/day), and 4% heavy (>1/day). To guard against underreporting, we took the maximum reported wine consumption over 7 years as the predictor. We used mixed models with a random intercept and random time to assess the relationship between wine consumption and CV risk factors with moderate consumption as the reference. Outcome variables were log-transformed where necessary. Longitudinal models were adjusted for ethnicity, age, and time-varying menopausal status, hormone therapy use, overall alcohol consumption, high density lipoprotein (HDL), statin use, and a healthy lifestyle score based on physical activity, not smoking, and weight maintenance. Interactions of wine consumption with time were not significant. Moderate wine consumers had significantly lower levels of C-reactive protein (CRP, p < .001), fibrinogen (p < .001), factor VII (p < .01), and plasminogen activator inhibitor (PAI-1, p < .05) than women who drank no or little wine. These associations were independent of significant effects of healthy lifestyle and overall alcohol consumption and similar across ethnic groups. Moderate wine consumption may protect against CVD via inflammatory and clotting pathways.