title: General and cancer mortality in a large cohort of Italian alcoholics.
abstract: BACKGROUND
  The consumption of alcohol is an underappreciated risk factor for a wide range of conditions. Overall, it is associated with high mortality rates and causes approximately 4% of all deaths worldwide. This study aimed to evaluate the general and cancer mortality in a cohort of subjects with alcohol addiction residing in Tuscany (Central Italy).
  
  
  METHODS
  Overall, 2,272 alcoholics (1,467 men and 805 women; mean age at first examination 43.8 years ± 13.0), treated at the Alcohol Centre of Florence in the period April 1985 to September 2001, were followed until the end of the study period (median follow-up: 9.6 years). A total of 21,855 person-years were available for analyses. Expected deaths were estimated by using age, sex, and calendar-specific regional mortality rates. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) were calculated.
  
  
  RESULTS
  Six hundred and thirty-six of the 2,272 patients (28.0%) died, yielding an SMR of 5.0 (95% CI: 4.6 to 5.4). The alcoholics had significantly elevated mortality risk from all malignant cancers (SMR = 3.8, 95% CI: 3.3 to 4.4) and a series of specific diseases (infections: SMR = 10.1, 95% CI: 4.8 to 21.1; diabetes: SMR = 3.6, 95% CI: 1.9 to 6.7; immunological system, including AIDS: SMR = 8.1, 95% CI: 4.1 to 16.2; nervous system: SMR = 3.5, 95% CI: 1.9 to 6.4; cardiovascular system: SMR = 2.4, 95% CI: 2.0 to 2.9; respiratory system: SMR = 5.8, 95% CI: 4.2 to 8.0; digestive system: SMR = 26.4, 95% CI: 22.6 to 30.8, including liver cirrhosis (SMR = 40.0, 95% CI: 33.9 to 47.1); violent causes: SMR = 6.6, 95% CI: 5.0 to 8.6). Among malignant cancers, the highest SMRs were found for cancers of the pharynx (SMR = 22.8, 95% CI: 9.5 to 54.8), oral cavity (SMR = 22.2, 95% CI: 13.2 to 37.6), liver (SMR = 13.5, 95% CI: 9.2 to 19.8), and larynx (SMR = 10.7, 95% CI: 5.8 to 19.9). Although women showed higher SMR in comparison with the general population of the area, their overall survival estimates during the follow-up were higher than those for male alcoholics.
  
  
  CONCLUSIONS
  This large series of Italian alcoholics showed a significant increase in total and cancer mortality in comparison with the general population, with female alcoholics reporting higher survival rates.
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.forename: Gabriele
authors.initials: G
authors.lastname: Bardazzi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.forename: Andrea
authors.initials: A
authors.lastname: Quartini
authors.forename: Marco
authors.initials: M
authors.lastname: Ceroti
authors.forename: Adriana
authors.initials: A
authors.lastname: Iozzi
authors.forename: Elena
authors.initials: E
authors.lastname: Gelain
authors.forename: Andrea
authors.initials: A
authors.lastname: Querci
authors.forename: Allaman
authors.initials: A
authors.lastname: Allamani
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications* / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality*; D018570:Risk Assessment; D012737:Sex Factors; D013534:Survival; D055815:Young Adult