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Alcohol and the risk of pneumonia: a systematic review and meta-analysis
  1. Evangelia Simou,
  2. John Britton,
  3. Jo Leonardi-Bee
  1. Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
  1. Correspondence to Miss Evangelia Simou; evangelia.simou{at}


Objective A systematic review and meta-analysis to estimate the magnitude of the association between alcohol consumption and the risk of community-acquired pneumonia (CAP) in adults was undertaken.

Design Systematic review and meta-analysis.

Methods Comprehensive searches of Medline, Embase and Web of Science were carried out to identify comparative studies of the association between alcohol intake and CAP between 1985 and 2017. Reference lists were also screened. A random-effects meta-analysis was used to estimate pooled effect sizes. A dose–response meta-analysis was also performed.

Results We found 17 papers eligible for inclusion in the review, of which 14 provided results which could be pooled. Meta-analysis of these 14 studies identified an 83% increased risk of CAP among people who consumed alcohol or in higher amounts, relative to those who consumed no or lower amounts of alcohol, respectively (relative risk=1.83, 95% CI 1.30 to 2.57). There was substantial between-study heterogeneity, which was attributable in part to differences in study continent, adjustment for confounders and pneumonia diagnosis (clinical vs death). Dose–response analysis found that for every 10–20 g higher alcohol intake per day, there was an 8% increase in the risk of CAP.

Conclusions The findings suggest that alcohol consumption increases the risk of CAP. Therefore, strengthening policies to reduce alcohol intake would be likely to reduce the incidence of CAP.

  • respiratory infections
  • epidemiology
  • infectious disease/hiv

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  • Contributors ES, JB and JL-B designed the study and wrote the protocol. ES wrote the search strategy and undertook the literature searches, and wrote the draft of the manuscript. ES and JL-B undertook study screening, data extraction and quality assessment. ES undertook all data analyses, supervised by JL-B. All authors contributed to the interpretation of the findings. JB and JL-B provided critical revisions to the article, and all authors approved the final version of the article to be published. ES acts as guarantor of the manuscript.

  • Funding This work was supported by the Medical Research Council (grant number MR/K023195/1). The UK Centre for Tobacco and Alcohol Studies (, and the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, and the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration, are gratefully acknowledged.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics approval was not required for this work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data sharing available.