MORTALITY IN RELATION TO CONSUMPTION OF ALCOHOL - 13 YEARS OBSERVATIONS ON MALE BRITISH DOCTORS
MORTALITY IN RELATION TO CONSUMPTION OF ALCOHOL - 13 YEARS OBSERVATIONS ON MALE BRITISH DOCTORS
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DOI：
10.1136/bmj.309.6959.911
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发表时间：
1994-10-08
影响因子：
--
通讯作者：
GRAY, R
中科院分区：
文献类型：
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作者：
DOLL, R;PETO, R;GRAY, R
设计前瞻性研究的死亡率与饮酒习惯在1978年，在未来13年（至1991年）寻求死亡原因，以评估死亡的风险与各种模式的酒精consumption.Subjects-12 321英国男性医生出生于1900年和1930年（平均1916年）之间，谁回答了邮寄问卷，在1978年。那些在1978年被写信给的人是一项长期的前瞻性研究的幸存者，该研究从1951年开始，至今仍在继续。结果-根据他们对1978年问卷的回答，根据他们是否患有任何类型的血管疾病、糖尿病、糖尿病和糖尿病，或“危及生命的疾病”，并根据他们的饮酒量分为七组。到1991年，几乎有三分之一的人死亡。所有死亡率的统计分析均按年龄、日历年和吸烟习惯进行标准化。全因死亡率与据报道的平均饮酒量之间呈U形关系;那些报告每周饮酒8-14个单位（相当于平均每天一到两个单位）的人风险最低。死亡原因分为三大类：“酒精增加”原因（占所有死亡的6%：肝硬化，肝癌，上呼吸消化道（口腔，食道，喉和咽）癌症，酒精中毒，中毒或损伤），缺血性心脏病（占所有死亡的33%）和其他原因。少数死于酒精增加的原因表明，至少在经常饮酒的人中，有一种渐进的趋势，风险随着剂量的增加而增加。相比之下，缺血性心脏病的死亡人数在经常饮酒者中没有明显的趋势，但经常饮酒者的死亡率明显低于不饮酒者。所有其他原因的总和显示出与全因死亡率相似的U形剂量-反应关系，无论既往病史、年龄（75岁以下或75岁及以上）和随访期（前5年和后8年）如何，相似的差异持续存在。一些，但显然不是很多，在非饮酒者的超额死亡率可以归因于其中包括一小部分的前drinkers. Conclusion酒精的消费似乎减少缺血性心脏病的风险，在很大程度上无论金额。在经常饮酒者中，所有原因导致的死亡率随着每周饮酒量超过21单位而逐渐增加。在英国中年或老年男性中，平均每天消费一到两个单位的酒精与全因死亡率显著低于不饮酒或大量饮酒的人。超过每天约三个单位（两个美国单位）的酒精，逐渐增加的消费水平与逐渐增加的全因死亡率有关。
Objective-To assess the risk of death associated with various patterns of alcohol consumption.Design-Prospective study of mortality in relation to alcohol drinking habits in 1978, with causes of death sought over the next 13 years (to 1991).Subjects-12 321 British male doctors born between 1900 and 1930 (mean 1916) who replied to a postal questionnaire in 1978. Those written to in 1978 were the survivors of a long running prospective study of the effects of smoking that had begun in 1951 and was still continuing.Results-Men were divided on the basis of their response to the 1978 questionnaire into two groups according to whether or not they had ever had any type of vascular disease, diabetes, or ''life threatening disease'' and into seven groups according to the amount of alcohol they drank. By 1991 almost a third had died. All statistical analyses of mortality were standardised for age, calendar year, and smoking habit. There was a U shaped relation between all cause mortality and the average amount of alcohol reportedly drunk; those who reported drinking 8-14 units of alcohol a week (corresponding to an average of one to two units a day) had the lowest risks. The causes of death were grouped into three main categories: ''alcohol augmented'' causes (6% of all deaths: cirrhosis, liver cancer, upper aerodigestive (mouth, oesophagus, larynx, and pharynx) cancer, alcoholism, poisoning, or injury), ischaemic heart disease (33% of all deaths), and other causes. The few deaths from alcohol augmented causes showed, at least among regular drinkers, a progressive trend, with the risk increasing with dose. In contrast, the many deaths from ischaemic heart disease showed no significant trend among regular drinkers, but there were significantly lower rates in regular drinkers than in non-drinkers. The aggregate of all other causes showed a U shaped dose-response relation similar to that for all cause mortality, Similar differences persisted irrespective of a history of previous disease, age (under 75 or 75 and older), and period of follow up (first five and last eight years). Some, but apparently not much, of the excess mortality in non-drinkers could be attributed to the inclusion among them of a small proportion of former drinkers.Conclusion-The consumption of alcohol appeared to reduce the risk of ischaemic heart disease, largely irrespective of amount. Among regular drinkers mortality from all causes combined increased progressively with amount drunk above 21 units a week. Among British men in middle or older age the consumption of an average of one or two units of alcohol a day is associated with significantly lower all cause mortality than is the consumption of no alcohol, or the consumption of substantial amounts. Above about three units (two American units) of alcohol a day, progressively greater levels of consumption are associated with progressively higher all cause mortality.