Alcohol-attributable and alcohol-preventable mortality in Denmark: an analysis of which intake levels contribute most to alcohol’s harmful and beneficial effects

The aim of the study was to quantify alcohol-attributable and -preventable mortality, totally and stratified on alcohol consumption in Denmark 2010, and to estimate alcohol-related mortality assuming different scenarios of changes in alcohol distribution in the population. We estimated alcohol-attributable and -preventable fractions based on relative risks of conditions causally associated with alcohol from meta-analyses and information on alcohol consumption in Denmark obtained from 14,458 participants in the Danish National Health Survey 2010 and corrected for adult per capita consumption. Cause-specific mortality data were obtained from the Danish Register of Causes of Death. In total, 1,373 deaths among women (5.0 % of all deaths) and 2,522 deaths among men (9.5 % of all deaths) were attributable to alcohol, while an estimated number of 765 (2.8 %) and 583 (2.2 %) deaths were prevented by alcohol. Of the alcohol-attributable deaths, 73 and 81 % occurred within the high alcohol consumption group (>14/21 drinks/week for women/men). A reduction of 50 % in the alcohol consumption was associated with a decrease of 1,406 partly alcohol-attributable deaths (46 %) and 37 alcohol-preventable deaths (3 %). Total compliance with sensible drinking guidelines with a low risk limit (<7/14 drinks/week) and a high risk limit (<14/21 drinks/week) was associated with a reduction of 2,380 and 1,977 alcohol-attributable deaths, respectively. In summary, 5.0 % of deaths among women and 9.5 % of deaths among men were attributable to alcohol in Denmark 2010. The minority of Danish women and men had high alcohol consumption (16 and 26 %). However, the majority of all alcohol-attributable deaths among women and men were caused by high consumption (73 and 81 %).     

Heavy drinking occasions and depression

AIMS: To assess the risk of depression for subjects with or without heavy drinking occasions after adjusting for the average long-term alcohol consumption, age, gender, marital status, employment status, and chronic diseases. METHODS: In a cross-sectional population survey (N = 3124) carried out in Finland in 1997, long-term average alcohol consumption was assessed by a self-administered quantity-frequency questionnaire. A heavy drinking occasion was defined as six or more drinks for men and four or more drinks for women consumed at one session. The self-administered 21-item Beck Depression Inventory score of > or = 10 was classified as clinically significant depression. RESULTS: Ex-drinkers and subjects with heavy drinking occasions had more often clinically significant depression compared with lifelong abstainers and individuals without heavy drinking occasions. In addition to the drinking habit, the risk for clinically significant depression increased also with age. Men aged 45-64 years with heavy drinking occasions had 2.3 times higher risk for depression compared with young men (aged 25-34 years) without heavy drinking occasions. The respective risk for old women was 2.2 times higher. CONCLUSIONS: Drinking pattern with heavy drinking occasions is independently associated with clinically significant depression irrespective of average long-term alcohol consumption.     

At-risk drinking among patients making routine primary care visits

BACKGROUND: Addressing non-alcoholic, at-risk patterns of alcohol consumption that are associated with increased morbidity and mortality is an important health care priority. OBJECTIVE: The objective was to describe the prevalence and characteristics of at-risk drinkers in a population-based sample of adults with routine primary care visits. Methods: Three thousand four hundred thirty-nine patients with advance appointments in 23 primary care practices completed a health survey prior to their visit. At-risk drinking was defined as consuming an average of two or more drinks per day (chronic drinking), or two or more occasions of consuming five or more drinks in the past month (binge drinking), or, in the past month, one or more occasion of driving after consuming three or more drinks (drinking and driving). RESULTS: Prevalence was: 11% at-risk drinking; 63% light to moderate drinking; 26% abstinence. Abstainers differed from alcohol users on demographics (older, fewer Caucasian, lower income, more unemployed), other health behaviors (less exercise, lower rates of smoking, and marijuana and cocaine use), and family history of alcohol problems (lower). Abstainers also reported poorer physical and psychological health. Compared to light to moderate drinkers, at-risk drinkers were more likely to be male, unmarried, and to use other substances (tobacco, marijuana, and cocaine). Among at-risk drinkers, those with two or more risk factors were more likely male, consumed more alcohol per week, had higher AUDIT scores and were more motivated to change their drinking. Among those with only one risk factor, binge drinkers reported high rates of tobacco and marijuana use, relatively poor perceived health, and the highest proportion of negative consequences from drinking. CONCLUSIONS: At least 1 in 10 patients making routine primary care visits have drinking practices that place them at risk for negative consequences from drinking. Three drinking patterns that can be used to define at-risk drinking are relatively distinct.     

Average volume of alcohol consumption, patterns of drinking, and all-cause mortality: results from the US National Alcohol Survey

The objective of this study was to investigate the effects of an average volume of alcohol consumption and drinking patterns on all-cause mortality. The sample (n = 5,072) was drawn from the 1984 National Alcohol Survey, representative of the US population living in households. Follow-up time was until the end of 1995, with 532 people deceased during this period. The authors found a significant influence of drinking alcohol on mortality with a J-shaped association for males and an insignificant relation of the same shape for females. When the largest categories of equivalent average volume of consumption were divided into people with and without heavy drinking occasions, serving as an indicator of drinking pattern, this differentiation proved important in predicting mortality. Light to moderate drinkers had higher mortality risks when they reported heavy drinking occasions (defined by either eight drinks per occasion or getting drunk at least monthly). Similarly, when the category of exdrinkers was divided into people who did or did not report heavy drinking occasions in the past, people with heavy drinking occasions had a higher mortality risk. Finally, indicating alcohol problems in the past was related to higher mortality risk. Results emphasized the importance of routinely including measures of drinking patterns into future epidemiologic studies on alcohol-related mortality.     

How do quantities drunk per drinking day and the frequencies of drinking those quantities contribute to self-reported harm and positive consequences?

AIMS: This article examines how quantities drunk per drinking day (dose) and the frequency of drinking those quantities affect self-reported harm and positive consequences at the individual and population level. METHODS: Participants were drinkers in a general population survey among Finns aged 15-69 years, conducted in 2000 (N = 1760, response rate 78%). Types of harm examined were self-reported worries over drinking control, negative consequences of individual drinking occasions, and external reactions to drinking. RESULTS: Respondents who reported frequent drinking at very high doses (13 drinks and above for men, 8 and above for women) were in a league of their own with respect to the risk of harm. At the population level, the dose of 8-12 drinks accounted for most problems among men, and doses of 5-7 and 3-4 drinks among women. No gain in positive consequences was attached to drinking beyond the dose of 5-7 drinks among men and 3-4 drinks among women. CONCLUSIONS: The dose level at which the population-level risk was the highest was lower than the level at which the individual-level risk was the highest, due to a greater prevalence of drinking the lesser quantities. Future studies should pay more attention to the separate effects of dose as well as the frequency of drinking the particular doses per occasion at the individual level, and also, as to how the prevalence of these drinking patterns contributes to the population-level risk.     

One-year drinking history and mortality

The one-year drinking history of 94 men was recorded by recurrent interviews (mean: 20 per person). The cohort was followed for 18.3 years; during that time, 13 men died. Cox's proportional hazards survival models including age and social class as confounders, indicated that mortality was significantly associated with total annual alcohol consumption, frequency of drinking, and frequency of intoxicating drinking. Estimates of risk of death for various consumption levels are presented: For having 10 drinks (each containing 12 grams of pure ethanol) a week vs one drink a week, the estimated relative risk of death (95% confidence limits in parentheses) was 2.3 (1.6-3.3). For being intoxicated once a week vs no intoxications at all during one year the respective risk was 2.1 (1.3-3.1). The risk estimates for the frequency of intoxication were found to be higher than those in an earlier study using single interview data on drinking. This suggests that more accurate measurement of alcohol consumption may yield higher risk of death estimates than found in studies based on single interview data on alcohol.     

Within-day drinking water consumption patterns: results from a drinking water consumption survey

Data currently available on drinking water intakes do not support dietary exposure estimates for contaminants that have acute effects lasting less than 24 h. Realistic exposure estimates for these types of contaminants in drinking water require detailed information on amounts and time of consumption for each drinking occasion during a day. A nationwide water consumption survey was conducted to address how often, when, and how much water is consumed at specific times during the day. The survey was conducted in two waves, to represent two seasons, and the survey instrument consisted of 7-day water consumption diaries. Data on total daily amounts consumed, number of drinking occasions per day, amounts consumed per drinking occasion, and intervals between drinking occasions show larger between-subjects variation than within-subject variation. Statistically significant associations were also observed between drinking water consumption patterns and participants' ages and sex and geographical regions in which these participants live. The number of drinking occasions on a given day varied from 0 to 19, with the majority of respondents reporting 6 or less drinking occasions per day. The average interval between drinking occasions varied from 1 to 17 h, with 57% of the person-days reporting average intervals at least 3 h apart. The mean amount consumed per drinking occasion showed little association with the number of drinking occasions and fluctuated between 8 and 10 oz. To our knowledge, this survey is the only source of information on within-day patterns (i.e., when and how much) of drinking water consumption for a nationally representative sample of the US population. The detailed water consumption data from this survey can be used to support less than 24-h dietary exposure estimates for contaminants in drinking water.     

Patterns of self-reported drinking and driving in Michigan

We analyzed a statewide telephone survey of Michigan adults to determine patterns of self-reported drinking and driving. The estimated prevalence of drinking and driving was 13.5 percent for men and 2.9 percent for women; the highest prevalence was among 18- to 24-year-old men (32 percent). Based on these estimates, over half a million Michigan adults drank and drove on over one million occasions during the month preceding the survey. Most drinking drivers (93 percent) reported binge drinking, yet 70 percent of them otherwise reported only moderate routine alcohol consumption, that is, they consumed fewer than 14 drinks a week on average. Because we were concerned about the validity of self-reports, we compared the patterns of self-reported alcohol use with the patterns of alcohol-related motor vehicle crashes. The pattern of self-reported drinking and driving (using age-, sex-, and region-specific estimates) was highly correlated with the pattern of injury in alcohol-related crashes (r = .96; p less than .0001). Self-reported patterns of alcohol use may be used to identify persons at highest risk for being injured or dying in a motor vehicle crash.     

Alcohol drinking in Jerusalem

Alcohol use was assessed in a random sample of middle aged Jewish parents (1043 men and 591 women) who were interviewed at Visit 2 of the Lipid Research Clinics Prevalence Study in Jerusalem in 1976-80. A standard questionnaire probed drinking frequency (times per week) and quantity (number of drinks per week). Only 15.7% of men and 3.8% of women drank more than twice weekly, the mean number of drinks being 3.5 and 1.3 for men and women respectively. Teetotalism was rare and most subjects (61.9% of men and 55.1% of women) drank once or twice weekly, reflecting the high proportion of the Jews who use wine for sacramental purposes. Immigrants from North Africa drank more than native born Israelis or immigrants from Asia or Europe. Drinking was most frequent among men in lower status occupations, though the opposite was true of their wives. Season had a marked impact on the quantity and type of drinking, the mean number of drinks per week reaching a maximum in late winter and a minimum in summer. More beer was consumed in summer and more spirits in winter.     

A quasi-randomized group trial of a brief alcohol intervention on risky single occasion drinking among secondary school students

Objectives

To show the effectiveness of a brief group alcohol intervention. Aims of the intervention were to reduce the frequency of heavy drinking occasions, maximum number of drinks on an occasion and overall weekly consumption.

Methods

A cluster quasi-randomized control trial (intervention n?=?338; control n?=?330) among 16- to 18-year-old secondary school students in the Swiss Canton of Zürich. Groups homogeneous for heavy drinking occasions (5+/4+ drinks for men/women) consisted of those having medium risk (3–4) or high risk (5+) occasions in the past 30?days. Groups of 8–10 individuals received two 45-min sessions based on motivational interviewing techniques.

Results

Borderline significant beneficial effects (p?<?0.10) on heavy drinking occasions and alcohol volume were found 6?months later for the medium-risk group only, but not for the high-risk group. None of the effects remained significant after Bonferroni corrections.

Conclusions

Group intervention was ineffective for all at-risk users. The heaviest drinkers may need more intensive treatment. Alternative explanations were iatrogenic effects among the heaviest drinkers, assessment reactivity, or reduction of social desirability bias at follow-up through peer feedback.     

The association of alcohol consumption with outcome of pregnancy

Patterns of alcohol consumption were assessed in 12,440 pregnant women interviewed at the time of delivery. Only 92 women (0.7 per cent) reported drinking 14 or more drinks per week, with most consuming fewer than 21 drinks per week. In the crude data, alcohol intake of 14 or more drinks per week was associated with a variety of adverse pregnancy outcomes, including low birthweight, gestational age under 37 weeks, stillbirth, and placenta abruptio. After use of logistic regression to control for confounding by demographic characteristics, smoking, parity and obstetric history, only the association of placenta abruptio with alcohol consumption of 14 or more drinks per week remained statistically significant. With the exception of placenta abruptio, alcohol intake of fewer than 14 drinks per week was not associated with and increased risk of any adverse outcome. No association was seen with congenital malformations at any level of alcohol intake.     

Trends in alcohol intake by education and marital status in urban population in Russia between the mid 1980s and the mid 1990s

AIMS: We investigated changes in the distribution of alcohol consumption by education and marital status in Russia during the period of societal transformation after 1990. Such changes would indicate the potential role of alcohol in the rising social inequalities in mortality. METHODS: We analysed data from three surveys in random population samples conducted in Novosibirsk as part of the WHO MONICA project in 1985/86 (1533 men, 1292 women), 1988/89 (1700 men, no women) and 1994/95 (1526 men, 1510 women), coinciding with the period of societal transformation. Four measures of drinking were examined in relation to education and marital status: prevalence of drinking at least twice a week; the mean intake in the last week; the mean intake per drinking occasion; and the prevalence of binge drinking (>80 g ethanol for men and >60 g for women) at least once a month. RESULTS: Among men, those with university education had the lowest levels of all measures of drinking. Drinking indices increased over time in all educational groups but most sharply in men with high education, thus leading to a smaller education-related difference in the last survey. With respect to marital status, divorced and widowed men tended to drink most, but the pattern was inconsistent, and the difference between divorced and married men also narrowed over time. Among women, alcohol intake increased between the first and last survey. Differences by education and marital status in women were smaller than in men, and binge drinking was inversely related to education. CONCLUSIONS: All indices of alcohol consumption in men increased between the mid 1980s and the mid 1990s. The increase in alcohol intake among men was proportionally similar across categories of education and marital status but the absolute differences increased. The contribution of alcohol to the increase in social differentials in mortality in the 1990s was probably modest.     

Determinants of adult mortality in Russia: estimates from sibling data

OBJECTIVES: It would be useful to have a quick and cost-effective method to study individual-level determinants of mortality in countries where reliable data are not available. We have modified indirect demographic methods and applied them to a population sample to investigate predictors of mortality in Russia. METHODS: A national sample of the Russian population was interviewed in a cross-sectional survey. The participants were asked about characteristics of their eldest siblings, including their vital status, year of birth, and year of death (if deceased). The association between personal characteristics and mortality risk was estimated for 682 male and 698 female siblings (of whom 122 and 81, respectively, had died). RESULTS: In both sexes, mortality was strongly associated with smoking and low education. After adjustment for smoking and education, mortality was elevated in men and women who drank alcohol at least once a month. Mortality was also higher among in men who had been binge drinking (more than half a bottle of vodka per drinking session) at least once a week (adjusted risk ratio [RR] = 2.5; 95% confidence interval [CI] = 1.2-4.9) and in women who were binging at least once a month (RR = 3.9; CI = 1.1-14.5) compared with nonbinging. SUBJECTS: Similar associations with drinking were seen for cardiovascular deaths in men. Childhood social circumstances were not associated with mortality. CONCLUSIONS: The study of siblings appears to be a cost-effective alternative for estimating risk factors for mortality in literate populations. This study identified smoking, low education, and alcohol consumption (especially binge drinking) as risk factors for mortality in Russia.     

An evaluation of National Alcohol Screening Day

AIMS: Although National Alcohol Screening Day (NASD) became the USA's largest and most visible community-based intervention targeting risky drinking over the past decade, its utility in identifying individuals who are at risk for alcohol problems and in catalyzing behaviour change has not been tested in studies including untreated controls. The purpose of this study was to assess changes in alcohol use three months following NASD participation using a quasi-experimental pretest-posttest control group design. METHODS: Participants (N = 713) were recruited from 5 NASD sites in Florida, Massachusetts, and New York, USA. Intervention subjects (N = 318) were recruited at the NASD event; control subjects (N = 395) were recruited at the same locations approximately 1 week after NASD. All participants completed brief surveys at the time of enrollment, and then again 3 months later. RESULTS: Significant decreases in the typical number of drinks consumed per occasion were observed among at-risk drinkers in the intervention group relative to controls in the 3 months following NASD. At-risk NASD participants averaged approximately 5.6 fewer drinks per week than at-risk controls. CONCLUSIONS: Findings suggest that exposure to a brief screening program with provision of feedback can result in significant reductions in alcohol consumption among risky drinkers.     

Maternal alcohol use in relation to selected birth defects

The hypothesis that maternal alcohol consumption affects the development of structures possibly derived from a common embryonic cell population, the cranial neural crest, was explored using data collected by a case-control surveillance program of birth defects in greater Boston, Philadelphia, and Toronto, Ontario, Canada, and in five counties in Iowa from 1983 through 1987. Maximum and average alcohol consumption during the first four lunar months of pregnancy were compared between the mothers of 1,464 infants with malformations of the ear, face, anterior neck, and upper heart (cranial neural crest cases) and 1,427 infants with other malformations (controls). For maximum number of drinks in a day and average number of drinking days per week, relative risks approximated unity across levels of exposure. For average number of drinks per drinking day, the relative risk (and 95% confidence interval) for heavy intake (5 or more drinks) was 1.8 (0.8-4.4). When the largest defect subgroup of cases, infants with cleft lip with or without cleft palate, was considered separately, the relative risk for an average of 5 or more drinks per drinking day was 3.0 (1.1-8.5). These findings suggest that maternal alcohol use is less related to overall malformations derived from cranial neural crest cell than to one specific defect among them--cleft lip with or without cleft palate. However, the latter association has not been reported previously in humans and remains to be confirmed in other studies.     

Light to Moderate Alcohol Consumption and Disability: Variable Benefits by Health Status

In adults, light to moderate alcohol consumption is associatedwith lower risks for heart disease, diabetes, and mortality.This study examined whether light to moderate alcohol use isalso associated with lower risk of incident physical disabilityover two 5-year periods in 4,276 noninstitutionalized adultsin the United States, aged 50 years or older, by using datafrom 3 waves of the National Health and Nutrition ExaminationSurvey Epidemiologic Follow-up Study surveys from 1982 to 1992.Light/moderate drinking (<15 drinks per week and <5 perdrinking day or 4 per drinking day for women) was associatedwith reduced risk for incident disability or death over 5 years,compared with abstention (adjusted odds ratio = 0.77; P = 0.008).Among survivors, light/moderate drinking was associated withlower risk for incident disability, compared with abstention(adjusted odds ratio = 0.75; P = 0.009). In stratified analyses,disability risk decreased with light/moderate drinking in adose-dependent fashion in men and women with good or betterself-reported health but not in men or women with fair or worseself-reported health. Alcohol consumption in moderation mightreduce the risk of developing physical disability in older adultsin good health but not in those in poor health. activities of daily living; alcohol drinking; longitudinal studies     

A comparison of the alcohol-attributable mortality in four European countries

Background: Deaths due to alcohol consumption are an important component of all-cause mortality, particularly premature mortality. However, there are considerable regional variations, the reasons for which are unclear. Methods: Estimates were made as reliably as possibly using vital statistics and best estimates of risk of the alcohol-attributable mortality, by age, sex and cause for four European countries (England and Wales, Germany, Denmark and Italy). Twenty-seven alcohol-related conditions were considered including the possible cardio-protective effects of alcohol. Results: It was estimated that there are approximately 2% fewer deaths annually in England and Wales than would be expected in a non-drinking population and 0.3% fewer deaths among East German females. In West Germany, Denmark, Italy and among East German males there are more deaths caused by alcohol than are prevented (between 0.7 and 2.6% of all deaths). The highest age-specific proportion of alcohol-attributable deaths is found in East Germany where around 30% of deaths among males aged 25–44 years are due to drinking. Among young men in all four countries the largest contributor to alcohol-related deaths is road traffic accidents involving alcohol. Conclusions: Possible explanations for the variation in alcohol-attributable deaths between countries include different underlying heart disease rates, different patterns of alcohol consumption and beverage preferences, and different use of mortality classification. Differences in the reported alcohol consumption levels explain little of the variation in alcohol-attributable deaths. Estimating alcohol-attributable mortality by age and sex across countries may be a useful indicator for developing alcohol strategies and exploring ways of preventing premature mortality.     

Cigarettes, alcohol and marijuana: varying associations with birthweight

The relations of cigarette smoking, alcohol drinking and marijuana use during pregnancy to birthweight were examined in two prospectively studied pregnancy cohorts (Phases I and II). After analytic adjustment in ordinary least squares regressions for other factors that influence birthweight, cigarette smoking during at least half the pregnancy was associated with a significant decrease in mean birthweight (159 grams in Phase I, 202 grams in Phase II). In Phase II only, beer drinking was associated with a significant decrement of 8.4 grams in estimated birthweight per ounce of absolute alcohol per month. Neither wine nor liquor drinking in the Phase II data nor any of the three beverages in the Phase I data was associated with significant decrements in predicted birthweight. Furthermore, with one exception (drinking once a week in Phase II only), alcohol drinking, defined as the number of occasions per month on which any alcoholic beverage was consumed, was not associated with a change in birthweight. Regarding marijuana use, the data are not consistent between the two phases. In the Phase I data, no coherent trend in association with birthweight was observed. In the Phase II data, marijuana use 2-3 times per week, 4-6 times per week and daily was associated with increasing decrements in estimated birthweight: 127 g, 143 g and 230 g respectively. The inconsistent findings for alcohol drinking and marijuana use between phases stand in marked contrast to the consistent findings for cigarette smoking.     

Racial and ethnic differences in all-cause mortality risk according to alcohol consumption patterns in the national alcohol surveys

Previous studies have found J-shaped relations between volume of alcohol consumed and mortality risk in white Americans but not in African Americans, suggesting the need for studies in which race/ethnicity-defined subgroups are analyzed in separate comparable models. In the present study, the authors utilized mortality follow-up data (through 2006) on respondents from the 1984 and 1995 National Alcohol Surveys, including similar numbers of black, white, and Hispanic respondents by oversampling the minority groups. Cox proportional hazards models controlling for demographic, socioeconomic, mental health, and drug- and tobacco-use measures were used to estimate mortality risk from all causes. Findings indicated a protective effect of moderate alcohol drinking (2-30 drinks/month for women and 2-60 drinks/month for men) with no monthly ≥5-drink days) relative to lifetime abstention for whites only. Elevated mortality risk relative to moderate drinking was found in former drinkers with lifetime alcohol problems. Moderate drinkers who consumed ≥5 drinks in 1 day at least monthly were also found to have increased risk, suggesting the importance of identifying heavy-occasion drinking for mortality analyses. These differential results regarding lifetime abstainers may suggest bias from differential unmeasured confounding or unmeasured aspects of alcohol consumption pattern or may be due to genetic differences in the health impact of alcohol metabolism.     

Alcohol drinking, consumption patterns and breast cancer among Danish nurses: a cohort study

BACKGROUND: The aim of this study was to analyse the impact of alcohol intake and drinking pattern on the risk of breast cancer. METHODS: A total of 17 647 nurses were followed from 1993 until the end of 2001. At baseline participants completed a questionnaire on alcohol intake and other lifestyle-related factors. Data were analysed using Cox's proportional hazard model. RESULTS: During follow-up 457 women were diagnosed with breast cancer. The relative risk of breast cancer was 2.30 [Confidence interval (CI): 1.56-3.39] for alcohol intake of 22-27 drinks per week, compared to 1-3 drinks per week. Among alcohol consumers, weekly alcohol intake increased the risk of breast cancer with 2% for each additional drink consumed. Weekend consumption increased the risk with 4% for each additional drink consumed friday through sunday. Binge drinking of 4-5 drinks the latest weekday increased risk with 55%, compared with consumption of one drink. A possible threshold in risk estimates was found for consumption above 27 drinks per week. CONCLUSIONS: For alcohol consumption above the intake most frequently reported, the risk of breast cancer is increased. The risk is minor for moderate levels but increases for each additional drink consumed during the week. Weekend consumption and binge drinking imply an additional increase in breast cancer risk.