Alcohol consumption and cause-specific mortality in Cuba: prospective study of 120 623 adults

Abstract

Background The associations of cause-specific mortality with alcohol consumption have been studied mainly in higher-income countries. We relate alcohol consumption to mortality in Cuba. Methods In 1996-2002, 146 556 adults were recruited into a prospective study from the general population in five areas of Cuba. Participants were interviewed, measured and followed up by electronic linkage to national death registries until January 1, 2017. After excluding all with missing data or chronic disease at recruitment, Cox regression (adjusted for age, sex, province, education, and smoking) was used to relate mortality rate ratios (RRs) at ages 35–79 years to alcohol consumption. RRs were corrected for long-term variability in alcohol consumption using repeat measures among 20 593 participants resurveyed in 2006-08. Findings After exclusions, there were 120 623 participants aged 35-79 years (mean age 52 [SD 12]; 67 694 [56%] women). At recruitment, 22 670 (43%) men and 9490 (14%) women were current alcohol drinkers, with 15 433 (29%) men and 3054 (5%) women drinking at least weekly; most alcohol consumption was from rum. All-cause mortality was positively and continuously associated with weekly alcohol consumption: each additional 35cl bottle of rum per week (110g of pure alcohol) was associated with ∼10% higher risk of all-cause mortality (RR 1.08 [95%CI 1.05-1.11]). The major causes of excess mortality in weekly drinkers were cancer, vascular disease, and external causes. Non-drinkers had ∼10% higher risk (RR 1.11 [1.09-1.14]) of all-cause mortality than those in the lowest category of weekly alcohol consumption (<1 bottle/week), but this association was almost completely attenuated on exclusion of early follow-up. Interpretation In this large prospective study in Cuba, weekly alcohol consumption was continuously related to premature mortality. Reverse causality is likely to account for much of the apparent excess risk among non-drinkers. The findings support limits to alcohol consumption that are lower than present recommendations in Cuba. Funding Medical Research Council, British Heart Foundation, Cancer Research UK, CDC Foundation (with support from Amgen)

Association Between Daily Alcohol Intake and Risk of All-Cause Mortality

“…There were 724 estimates of the risk relationship between level of alcohol consumption and all-cause mortality from 107 unique studies, including 4 838 825 participants and 425 564 deaths available for the analysis. Table 1 describes the sample characteristics of the metadata.…”

“…Table 1 describes the sample characteristics of the metadata. Of 39 studiesreporting RR estimates for men and women separately, 33 were for males only, 8 for females only, and 30 for both sexes. Twenty-one studies (220 risk estimates) were free from abstainer bias (ie, had a reference group of strictly defined lifetime abstainers).…”

“…There were 87 studies identified by Stockwell et al 8 After inclusion of 20 new studies meeting inclusion criteria, there were a total of 107 cohort studies (eTable 1 in Supplement 1). [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Three coders (J. Z., F. A., and J. C.) reviewed all eligible studies to extract and code data independently from all studies fulfilling the inclusion criteria.…”

Alcohol Consumption and Cardiovascular Disease Risk: Placing New Data in Context

“…Even more recent observational studies have focused on specific niches of the relationship between alcohol consumption and CVD, testing the hypothesis that the relationship between alcohol and CVD does not fit into a one-size-fits-all approach and that the conflicting results found in previous studies might be due to differences within subpopulations. For example, investigators have observed apparent differences in the alcohol-CVD relationship between African-Americans, Asian-Americans and other race/ethnicity groups found [ 28 – 32 ] (perhaps related to well-known genetic differences in alcohol metabolism [ 33 , 34 ]). Other recent papers have addressed drinking patterns, suggesting that regular drinking and drinking with meals may be associated with a lower risk of mortality [ 35 – 37 ] and beverage types, arguing for unique anti-oxidative and anti-inflammatory effects of red wine consumption [ 38 ].…”

Direct and indirect costs attributed to alcohol consumption in Brazil, 2010 to 2018

“…A prospective study conducted in Cuba revealed that weekly alcohol consumption was positively associated with premature mortality from all causes, and the risk of death from any cause increased by 10% for each bottle of rum (the main drink consumed in the country) added weekly. The main causes of excessive mortality were cancers, vascular diseases and external causes [ 4 ].…”