ESTIMATED NUMBERS OF DEATHS FROM CORONARY HEART-DISEASE CAUSED AND PREVENTED BY ALCOHOL - AN EXAMPLE FROM FINLAND

Objective: Epidemiological studies show that moderate alcohol consumpt ion rather than abstention is associated with a lower risk of coronary heart disease (CHD) mortality. Our objective was to adjust establishe d methods for calculating attributable fractions to a situation where the risk function is J-shaped and to estimate the number of CHD deaths ''caused'' and ''prevented'' by alcohol in Finland. Method: Point est imates of relative risk were obtained by a meta-analysis. They were po oled by fitting a nonparametric cubic smoothing spline to the data. Al cohol consumption distribution was estimated from survey data (N = 4,8 18; 2,488 women). The consequences of various assumptions about change s in alcohol consumption distribution on CHD mortality were estimated. The most detailed analyses are presented for men aged 30-69. The resu lts for the men and women aged 30-79 are summarized. Results: Among me n aged 30-69, the beneficial effects of light to moderate alcohol cons umption ''prevent'' some 400 CHD deaths each year which corresponds to 12-14% of the observed CHD deaths. Around 20 CHD deaths are ''caused' ' by alcohol consumption exceeding the estimated optimum level. Among men aged 70-79 and women aged 30-79, the numbers of CHD deaths ''preve nted'' by alcohol consumption were approximately 200 and 100, respecti vely, whereas there were only a few CHD deaths ''caused'' by alcohol. Conclusions: Our best estimates suggest that approximately one-tenth o f the observed number of CHD deaths among middle-aged men in Finland i s ''prevented'' by alcohol, while the relative effect is considerably smaller among older men and all women.