Daily Dose: Daily Alcohol Intake & Risk of All-cause Mortality

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On April 6, 2023, we reported on a study published in JAMA Network Open that evaluated the association between mean daily alcohol consumption and all-cause mortality.

The study

Investigators conducted a systematic review and meta-analysis of 107 cohort studies involving more than 4.8 million participants. Mixed linear regression models were used to model relative risks, first pooled for all studies and then stratified by cohort median age (<56 vs ≥56 years) and sex. Researchers identified 724 risk estimates of all-cause mortality due to alcohol intake across the 107 studies (n=4 838 825 and 425 564 deaths available).

The findings

In models that were adjusted for the potential confounding effects of sampling variation across studies, former drinker bias, and other prespecified quality criteria for individual studies, investigators found that compared with lifetime nondrinkers, there was no significantly reduced risk of all-cause mortality among occasional drinkers (>0 to <1.3 g/day; relative risk [RR], 0.96; 95% CI, 0.86-1.06; P= .41) or low-volume drinkers (1.3-24.0 g/day; RR, 0.93; P= .07).

In the model fully adjusted for a wide range of covariates, investigators found a nonsignificant increase in risk for all-cause mortality among participants who drank 25 to 44 g/day (RR, 1.05; P = .28). Risk significantly increased, however, at greater amounts consumed per day to 1.19 for drinkers who ingested 45 to 64 g/day and to 1.35 for those consuming ≥65 g/day (P<.001 for both).

Among women who consumed alcohol, mortality risks were significantly larger compared with women who were never drinkers (RR, 1.22; P = .03).

The investigators also found that women who drank had a higher RR of all-cause mortality vs men across all levels of alcohol consumption and that the dangers of excess consumption began at lower levels of daily consumption. They report also that mortality risks were significantly higher among women who drank compared with women who were lifetime nondrinkers (RR, 1.22; P = .03).

Note from authors

"This updated meta-analysis did not find significantly reduced risk of all-cause mortality associated with low-volume alcohol consumption after adjusting for potential confounding effects of influential study characteristics. Future longitudinal studies in this field should attempt to minimize lifetime selection biases by not including former and occasional drinkers in the reference group, and by using younger cohorts (ie, age distributions that are more representative of drinkers in the general population) at baseline."

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