title: The association of pattern of lifetime alcohol use and cause of death in the European prospective investigation into cancer and nutrition (EPIC) study.
abstract: BACKGROUND
  There is limited evidence for an association between the pattern of lifetime alcohol use and cause-specific risk of death.
  
  
  METHODS
  Multivariable hazard ratios were estimated for different causes of death according to patterns of lifetime alcohol consumption using a competing risks approach: 111 953 men and 268 442 women from eight countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included. Self-reported alcohol consumption at ages 20, 30, 40 or 50 years and at enrollment were used for the analysis; 26 411 deaths were observed during an average of 12.6 years of follow-up.
  
  
  RESULTS
  The association between lifetime alcohol use and death from cardiovascular diseases was different from the association seen for alcohol-related cancers, digestive, respiratory, external and other causes. Heavy users (>5 drinks/day for men and >2.5 drinks/day for women), regardless of time of cessation, had a 2- to 5-times higher risk of dying due to alcohol-related cancers, compared with subjects with lifetime light use (≤1 and ≤0.5 drink/week for men and women, respectively). Compared with lifetime light users, men who used <5 drinks/day throughout their lifetime had a 24% lower cardiovascular disease mortality (95% confidence interval 2-41). The risk of death from coronary heart disease was also found to be 34-46% lower among women who were moderate to occasionally heavy alcohol users compared with light users. However, this relationship was only evident among men and women who had no chronic disease at enrollment.
  
  
  CONCLUSIONS
  Limiting alcohol use throughout life is associated with a lower risk of death, largely due to cardiovascular disease but also other causes. However, the potential health benefits of alcohol use are difficult to establish due to the possibility of selection bias and competing risks related to diseases occurring later in life.
authors.affiliation: German Institute of Human Nutrition Potsdam-Rehbrücke, Division of Epidemiology, Nuthetal, Germany, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht, The Netherlands, Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark, Danish Cancer Society Research Center, Copenhagen, Denmark, Nutrition, Hormones and Women's Health, CESP Centre for Research in Epidemiology and Public Health, and Paris South University, Villejuif, France, Department of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany, WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece, Hellenic Health Foundation, Athens, Greece, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece, Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy, Nutritional Epidemiology Unit Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy, Cancer Registry and Histopathology Unit, Civile-M.P. Arezzo Hospital, Ragusa, Italy, MRC/HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK, HuGeF Foundation, Torino, Italy, Public Health Directorate, Asturias, Spain, Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute, Catalan Institute of Oncology, Barcelona, Spain, Andalusian School of Public Health and CIBER de Epidemiología y Salud Pública, Granada, Spain, Departmen
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mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: EPIC; Prospective study; cause-specific mortality; lifetime alcohol use