1 Aalborg University Hospital, The Faculty of Medicine, Aalborg University, VBN2 Klinik Hjerte-Lunge, The Faculty of Medicine, Aalborg University, VBN3 Hjertemedicin (Kardiologi), The Faculty of Medicine, Aalborg University, VBN4 The Faculty of Medicine, Aalborg University, VBN5 International Agency for Research on Cancer, Lyon, France.6 Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.7 Potsdam-Rehbrücke Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany.8 Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromsø, Norway Department of Research, Cancer Registry of Norway, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Samfundet Folkhälsan, Helsinki, Finland.9 Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, France Université Paris Sud, UMRS 1018, Villejuif, France IGR, Villejuif, France.10 Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.11 Department of Public Health and Primary Care, University of Cambridge Addenbrooke's Hospital, Cambridge, UK.12 Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.13 Unit of Nutrition, Cancer Epidemiology Research Program, Environment and Cancer, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology (ICO), Barcelona, Spain.14 Navarre Public Health Institute, Pamplona, Spain Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Murcia, Spain.15 Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada, Granada, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Spain.16 CIBER Epidemiología y Salud Pública (CIBERESP), Spain Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain.17 Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Murcia, Spain Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Spain.18 Nutrition Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden.19 Danish Cancer Society Research Center, Copenhagen, Denmark.20 Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, Greece Hellenic Health Foundation, Athens, Greece.21 Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, Greece.22 Hellenic Health Foundation, Athens, Greece Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.23 Cancer Registry and Histopathology Unit, "Civic-MP Arezzo" Hospital, ASP Ragusa, Italy.24 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.25 Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Center for Cancer Prevention (CPO-Piemonte), Turin, Italy Human Genetics Foundation (HuGeF), Turin, Italy.26 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.27 Department of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany.28 Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.29 International Agency for Research on Cancer, Lyon, France Department of Statistics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.30 Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK.
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.