ALCOHOL-CONSUMPTION AND ALL-CAUSE MORTALITY

Background. Prospective studies of alcohol and mortality in middle-age d men almost universally find a U-shaped relationship between alcohol consumption and risk of mortality. This review demonstrates the extent to which different studies lead to different risk estimates, analyses the putative influence of abstention as a risk factor and uses availa ble data to produce point and interval estimates of the consumption le vel apparently associated with minimum risk from two studies in the UK . Method. Data from a number of studies are analysed by means of logis tic-linear modelling, taking account of the possible influence of abst ention as a special risk factor. Separate analysis of British data is performed. Results. Logistic-linear modelling demonstrates large and h ighly significant differences between the studies considered in the re lationship between alcohol consumption and all-cause mortality. The re sults support the identification of abstention as a special risk facto r for mortality, but do not indicate that this alone explains the appa rent U-shaped relationship. Separate analysis of two British studies i ndicates minimum risk of mortality in this population at a consumption level of about 26 (8.5 g) units of alcohol per week. Conclusions. The analysis supports the view that abstention may be a specific risk fac tor for all-cause mortality, but is not an adequate explanation of the apparent protective effect of alcohol consumption against all-cause m ortality. Future analyses might better be performed on a case-by-case basis, using a change-point model to estimate the parameters of the re lationship. The current misinterpretation of the sensible drinking lev el of 21 units per week for men in the UK as a limit is not justified, and the data suggest that alcohol consumption is a net preventive fac tor against premature death in this population.