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Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study
  1. Pietro Ferrari1,
  2. Idlir Licaj1,
  3. David C Muller1,
  4. Per Kragh Andersen2,
  5. Mattias Johansson1,
  6. Heiner Boeing3,
  7. Elisabete Weiderpass4,5,6,7,
  8. Laure Dossus8,9,10,
  9. Laureen Dartois8,9,10,
  10. Guy Fagherazzi8,9,10,
  11. Kathryn E Bradbury11,
  12. Kay-Tee Khaw12,
  13. Nick Wareham13,
  14. Eric J Duell14,
  15. Aurelio Barricarte15,16,
  16. Esther Molina-Montes17,18,
  17. Carmen Navarro Sanchez18,19,20,
  18. Larraitz Arriola16,21,
  19. Peter Wallström22,
  20. Anne Tjønneland23,
  21. Anja Olsen23,
  22. Antonia Trichopoulou24,25,
  23. Vasiliki Benetou24,
  24. Dimitrios Trichopoulos25,26,27,
  25. Rosario Tumino28,
  26. Claudia Agnoli29,
  27. Carlotta Sacerdote30,31,
  28. Domenico Palli32,
  29. Kuanrong Li33,
  30. Rudolf Kaaks33,
  31. Petra Peeters34,
  32. Joline WJ Beulens34,
  33. Luciana Nunes1,35,
  34. Marc Gunter36,
  35. Teresa Norat36,
  36. Kim Overvad37,38,
  37. Paul Brennan1,
  38. Elio Riboli36,
  39. Isabelle Romieu1
  1. 1International Agency for Research on Cancer, Lyon, France
  2. 2Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
  3. 3Potsdam-Rehbrücke Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
  4. 4Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromsø, Norway
  5. 5Department of Research, Cancer Registry of Norway, Oslo, Norway
  6. 6Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  7. 7Samfundet Folkhälsan, Helsinki, Finland
  8. 8Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, France
  9. 9Université Paris Sud, UMRS 1018, Villejuif, France
  10. 10IGR, Villejuif, France
  11. 11Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  12. 12Department of Public Health and Primary Care, University of Cambridge Addenbrooke's Hospital, Cambridge, UK
  13. 13Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
  14. 14Unit of Nutrition, Cancer Epidemiology Research Program, Environment and Cancer, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology (ICO), Barcelona, Spain
  15. 15Navarre Public Health Institute, Pamplona, Spain
  16. 16Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Murcia, Spain
  17. 17Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada, Granada, Spain
  18. 18CIBER Epidemiología y Salud Pública (CIBERESP), Spain
  19. 19Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
  20. 20Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
  21. 21Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Spain
  22. 22Nutrition Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden
  23. 23Danish Cancer Society Research Center, Copenhagen, Denmark
  24. 24Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, Greece
  25. 25Hellenic Health Foundation, Athens, Greece
  26. 26Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  27. 27Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
  28. 28Cancer Registry and Histopathology Unit, “Civic-MP Arezzo” Hospital, ASP Ragusa, Italy
  29. 29Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  30. 30Unit of Cancer Epidemiology, AO Citta’ della Salute e della Scienza-University of Turin and Center for Cancer Prevention (CPO-Piemonte), Turin, Italy
  31. 31Human Genetics Foundation (HuGeF), Turin, Italy
  32. 32Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Florence, Italy
  33. 33Department of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
  34. 34Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
  35. 35Department of Statistics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
  36. 36Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
  37. 37Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
  38. 38Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
  1. Correspondence to Dr Pietro Ferrari; ferrarip{at}


Objectives To investigate the role of factors that modulate the association between alcohol and mortality, and to provide estimates of absolute risk of death.

Design The European Prospective Investigation into Cancer and nutrition (EPIC).

Setting 23 centres in 10 countries.

Participants 380 395 men and women, free of cancer, diabetes, heart attack or stroke at enrolment, followed up for 12.6 years on average.

Main outcome measures 20 453 fatal events, of which 2053 alcohol-related cancers (ARC, including cancers of upper aerodigestive tract, liver, colorectal and female breast), 4187 cardiovascular diseases/coronary heart disease (CVD/CHD), 856 violent deaths and injuries. Lifetime alcohol use was assessed at recruitment.

Results HRs comparing extreme drinkers (≥30 g/day in women and ≥60 g/day in men) to moderate drinkers (0.1–4.9 g/day) were 1.27 (95% CI 1.13 to 1.43) in women and 1.53 (1.39 to 1.68) in men. Strong associations were observed for ARC mortality, in men particularly, and for violent deaths and injuries, in men only. No associations were observed for CVD/CHD mortality among drinkers, whereby HRs were higher in never compared to moderate drinkers. Overall mortality seemed to be more strongly related to beer than wine use, particularly in men. The 10-year risks of overall death for women aged 60 years, drinking more than 30 g/day was 5% and 7%, for never and current smokers, respectively. Corresponding figures in men consuming more than 60 g/day were 11% and 18%, in never and current smokers, respectively. In competing risks analyses, mortality due to CVD/CHD was more pronounced than ARC in men, while CVD/CHD and ARC mortality were of similar magnitude in women.

Conclusions In this large European cohort, alcohol use was positively associated with overall mortality, ARC and violent death and injuries, but marginally to CVD/CHD. Absolute risks of death observed in EPIC suggest that alcohol is an important determinant of total mortality.

  • Nutrition & Dietetics
  • Cardiology

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