Alcohol consumption over time and mortality in the Swedish Women’s Lifestyle and Health cohort

Abstract

BackgroundAlcohol consumption is steadily increasing in high-income countries but the harm and possible net benefits of light-to-moderate drinking remain controversial. We prospectively investigated the association between time-varying alcohol consumption and overall and cause-specific mortality among middle-aged women.MethodsAmong 48 249 women at baseline (33 404 at follow-up) in the prospective Swedish Women's Lifestyle and Health cohort, age 30–49 years at baseline, we used repeated information on alcohol consumption and combined this method with multiple imputation in order to maximise the number of participants and deaths included in the analyses. Multivariable Cox regression models were used to calculate HRs for overall and cause-specific mortality.ResultsDuring >900 000 person/years, a total of 2100 deaths were recorded through Swedish registries. The median alcohol consumption increased from 2.3 g/day in 1991/1992 (baseline) to 4.7 g/day in 2004 (follow-up). Compared with light drinkers (0.1–1.5 g/day), a null association was observed for all categories of alcohol consumption with the exception of never drinkers. The HR comparing never with light drinkers was 1.46 (95% CI 1.22 to 1.74). There was a statistically significant negative trend between increasing alcohol consumption and cardiovascular and ischaemic heart diseases mortality. The results were similar when women with prevalent conditions were excluded.ConclusionsIn conclusion, in a cohort of young women, light alcohol consumption was protective for cardiovascular and ischaemic heart disease mortality but not for cancer and overall mortality.

Alcohol Consumption in Later Life and Mortality in the United States: Results from 9 Waves of the Health and Retirement Study

“…While numerous studies have examined the relationship between alcohol consumption and mortality, methodological limitations have abounded. In a recent meta‐analysis (Stockwell et al., ), Stockwell and colleagues noted that of 87 studies, at least 65 used a reference group of abstainers that included former drinkers, suggesting the potential for selection bias (Licaj et al., ; Ortolá et al., ). Similar biases were highlighted in an additional meta‐analysis examining alcohol consumption and cardiovascular disease (Zhao et al., ).…”

“…Relative to abstainers and heavy drinkers, moderate drinkers are wealthier and present more protective factors for cardiometabolic health (Cerdá et al., ; Dawson et al., ; French et al., ; Lang et al., ; Naimi et al., ; Rehm et al., ; Skog, ), and many studies do not have comprehensive information sufficient for confounder control. Further, the extent to which associations arise because of reverse causation (individuals reducing consumption due to illness) remains a threat to validity (Licaj et al., ; Ortolá et al., ; Stockwell et al., ). An instrumental variable approach like Mendelian randomization, which does not rely on standard confounder control, demonstrates little evidence for a protective effect of moderate consumption on cardiovascular disease (Cho et al., ; Holmes et al., ; Millwood et al., ; Taylor et al., ).…”

Risk of lung cancer and physical activity by smoking status and body mass index, the Norwegian Women and Cancer Study

“…Our chained imputation models included all variables for the final Cox proportional hazards regression models and additional variables in order to predict incomplete variables or to predict whether the incomplete variable was missing [57]. This method has been developed and proved robust in several of studies within the NOWAC study [31][32][33]58], and the consistency with the complete-case analysis strengthens the results. Nevertheless, we cannot rule out that some of the information is still missing-not-at-random which may lead to biased estimations.…”

“…The pattern of missing was confirmed arbitrary. We used a similar imputation process as described in previous publications [31][32][33]. To reduce sampling variability, we created 20 replicate datasets from the imputation simulation [34].…”

Role of cytokines and chemokines in alcohol-induced tumor promotion

“…Alcohol consumption is one of the risk factors that correlate with high cancer mortality rates,14 and this is mainly because chronic alcohol consumption often leads to advanced TNM stages, greater vessel invasion, and poorer prognosis 9. The underlying mechanism may be that alcohol consumption activates the expression of some cytokines, such as VEGF, MCP-1, and NF- κ B, which are associated with tumor progression and metastasis 8–10…”