Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study
Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study
复制标题
DOI：
10.1136/bmjopen-2014-005245
复制
发表时间：
2014-01-01
期刊：
影响因子：
2.9
通讯作者：
Romieu, Isabelle
中科院分区：
文献类型：
--
作者：
Ferrari, Pietro;Licaj, Idlir;Romieu, Isabelle
目的：研究酒精与死亡率之间相关性的调节因素的作用，并提供死亡绝对风险的估计。设计：欧洲癌症与营养前瞻性调查（EPIC）。设置：10个国家的23个中心。参与者：380 395名男性和女性，在登记时没有癌症、糖尿病、心脏病发作或中风，平均随访12.6年。主要结果指标：20 453起致命事件，其中2053起与酒精有关的癌症（ARC，包括上呼吸消化道癌症、肝癌、结直肠癌和女性乳腺癌），4187起心血管疾病/冠心病（CVD/CHD），856起暴力死亡和伤害。结果：极端饮酒者（女性>= 30 g/天，男性>= 60 g/天）与中度饮酒者（0.1-4.9 g/天）的HR比较，女性为1.27（95%CI 1.13 - 1.43），男性为1.53（1.39 - 1.68）。观察到ARC死亡率（尤其是男性）和暴力死亡和伤害（仅男性）之间存在强相关性。饮酒者中未观察到CVD/CHD死亡率的相关性，其中从不饮酒者的HR高于中度饮酒者。总体死亡率似乎与啤酒的使用比葡萄酒的使用更密切相关，特别是在男性中。对于60岁的女性，饮酒超过30克/天的10年总体死亡风险分别为5%和7%，从不吸烟和目前吸烟。在从不吸烟和目前吸烟的男性中，每天消费超过60克的相应数字分别为11%和18%。在竞争的风险分析，由于CVD/CHD的死亡率是更明显的男性比ARC，而CVD/CHD和ARC的死亡率是类似的幅度在women.Conclusions：在这个大的欧洲队列，酒精的使用与整体死亡率，ARC和暴力死亡和受伤，但轻微的CVD/CHD。EPIC中观察到的绝对死亡风险表明，酒精是总死亡率的一个重要决定因素。
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.