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Mortality in England and Wales Attributable to Alcohol Consumption
Adverse health consequences of alcohol use include various cancers, hypertension, liver disease, accidents and violence, but moderate drinking decreases the risk of ischaemic heart disease (IHD). For that reason, all-cause mortality has a U-shaped relationship with alcohol use. The precise shape of the U depends on various factors including age and sex since IHD afflicts a larger proportion of older than younger people.

The aim of this study was to quantify mortality attributable to any alcohol use and mortality attributable to consumption above specified levels based on a previous study in England and Wales in which the nadir was found to be zero use for men under 35 and women under 55 years of age, increasing to 8 units/week for men over 65 and 3 units/week for women over 65, with 1 unit corresponding with 9g alcohol.

All-cause mortality correlated with alcohol use based on cause-specific mortality models from a systematic review and the distribution of alcohol use and causes of death by age and sex in England and Wales in 1997. The deaths and person-years of life lost until the age of 65 were estimated that were attributable to any alcohol use, drinking above the nadir (the drinking level associated with the lowest risk), and drinking in excess of the British Royal Colleges’ recommended limits of 21 units/week for men and 14 units/week for women.

IHD deaths prevented by alcohol use (11,276 men, 4050 women) roughly balanced deaths attributable to drinking (9246 men, 4216 women). Overall, 0.8% of all deaths in men were prevented by alcohol use while 0.1% of all deaths were prevented in women. Drinking above the recommended limits was responsible for 2.1% of deaths for men and 0.8% for women while 2.8% and 1.2% of deaths, respectively, were attributable to drinking above the nadir. Of all person-years of life lost until the age of 65, 10.3% and 5.6% were attributable to any alcohol use in men and women, respectively, 8.5% and 4.0% to drinking above recommended limits and 12.6% and 6.0% to drinking above the nadir.

Although overall risks and benefits of alcohol use appear to be roughly equal, the authors conclude that drinking above recommended limits remains responsible for many deaths and a large loss of person-years of life.

Source : White IR, Altmann DR, Nanchahal K. Mortality in Englan d and Wales attributable to any drinking, drinking above sensible limits and drinking above lowest risk level, Addiction 99 (2004) 749-756

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