Mortality in relation to alcohol consumption: a prospective study among male British doctors.
BACKGROUND
To relate alcohol consumption patterns to mortality in an elderly population.


METHODS
We undertook a 23-year prospective study of 12 000 male British doctors aged 48-78 years in 1978, involving 7000 deaths. Questionnaires about drinking and smoking were completed in 1978 and once again in 1989-91. Mortality analyses are standardized for age, follow-up duration, and smoking, and (during the last decade of the study, 1991-2001) subdivide non-drinkers into never-drinkers and ex-drinkers.


RESULTS
In this elderly population, with mean alcohol consumption per drinker of 2 to 3 units per day, the causes of death that are already known to be augmentable by alcohol accounted for only 5% of the deaths (1% liver disease, 2% cancer of the mouth, pharynx, larynx, or oesophagus, and 2% external causes of death) and were significantly elevated only among men consuming >2 units/day. Vascular disease and respiratory disease accounted for more than half of all the deaths and were both significantly less common among current than among non-drinkers; hence, overall mortality was also significantly lower (relative risk, RR 0.81, CI 0.76-0.87, P = 0.001). The non-drinkers, however, include the ex-drinkers, some of whom may have stopped recently because of illness, and during the last decade of the study (1991-2001) overall mortality was significantly higher in the few ex-drinkers who had been current drinkers in 1978 than in the never-drinkers or current drinkers. To avoid bias, these 239 ex-drinkers were considered together with the 6271 current drinkers and compared with the 750 men who had been non-drinkers in both questionnaires. Even so, ischaemic heart disease (RR 0.72, CI 0.58-0.88, P = 0.002), respiratory disease (RR 0.69, CI 0.52-0.92, P = 0.01), and all-cause (RR 0.88, CI 0.79-0.98, P = 0.02) mortality were significantly lower than in the non-drinkers.


CONCLUSIONS
Although some of the apparently protective effect of alcohol against disease is artefactual, some of it is real.
Doll
Richard
R
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Radcliffe Infirmary, Oxford OX2 6HE, UK. secretary@ctsu.ox.ac.uk
Peto
Richard
R
Boreham
Jillian
J
Sutherland
Isabelle
I
D000368:Aged; D000428:Alcohol Drinking / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D010820:Physicians / Q000706:statistics & numerical data; D012120:Respiration Disorders / Q000401:mortality; D013695:Temperance; D006113:United Kingdom / Q000453:epidemiology