Alcohol Consumption Over Time and Risk of Death: A Systematic Review and Meta-analysis

Harindra Jayasekara; Dallas R. English; Robin Room; Robert J. MacInnis


Am J Epidemiol. 2014;179(9):1049-1059. 

In This Article

Abstract and Introduction


The results from the few cohort studies that have measured usual alcohol consumption over time have not been summarized. We therefore conducted a systematic review and meta-analysis to quantify mortality risk. Pertinent studies were identified by searching the Medline, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Scopus databases through August 2012 using broad search criteria. Studies reporting relative mortality risks for quantitatively defined categories of alcohol consumption over time were eligible. Nine cohort studies published during 1991–2010 (comprising 62,950 participants and 10,490 deaths) met the inclusion criteria. For men, there was weak evidence of lower mortality risk with low levels of alcohol intake over time but higher mortality risk for those with intakes over 40 g/day compared with abstainers using a random-effects model (P for nonlinearity = 0.02). The pooled relative risks were 0.90 (95% confidence interval: 0.81, 0.99) for 1–29 g/day, 1.19 (95% confidence interval: 0.89, 1.58) for 30–59 g/day, and 1.52 (95% confidence interval: 0.78, 2.98) for 60 or more g/day compared with abstention. There was moderate between-study heterogeneity but no evidence of publication bias. Studies including women were extremely scarce. Our findings include a curvilinear association between drinking over time and mortality risk for men overall and widespread disparity in methods used to capture exposure and report results.


In 1926, Raymond Pearl first showed that drinking alcohol in moderation was associated with greater longevity than abstaining or drinking heavily.[1] In recent times, much attention has been focused on the J-shaped curve for the association between alcohol and ischemic heart disease, and hence, mortality risk.[2–4] On the other hand, a large proportion of global deaths are attributable to heavier alcohol intake, which is a major avoidable risk factor for chronic disease.[5]

The quality of the epidemiologic evidence relating to a protective effect of low-dose alcohol consumption has been challenged. Some consider that the choice of reference group might explain the protective association.[6,7] Whereas Pearl used estimates of the decedent's lifetime drinking patterns reported by relatives as the alcohol measure,[1] most cohort studies have measured alcohol consumption only at baseline (typically for the past year), although consumption is likely to vary over life,[8,9] and misclassification of intake has the potential to change the magnitude and direction of the dose-response relationship. Consumption over a prolonged period of time is believed to correlate more closely with biological processes that have a chronic effect on health compared with current drinking, which correlates more with acute alcohol effects.[10] Results of the few cohort studies that have measured alcohol intake over time and its association with death have not been systematically reviewed.

We conducted a systematic review of the literature and a meta-analysis of data from cohort studies that measured usual alcohol consumption over time collected either as repeated measures or as recall of alcohol intake before baseline and the risk of death from all causes. We performed a dose-response meta-analysis to estimate the shape of the association between alcohol consumption and risk of death from all causes.