MainReportLibrary

Alcohol

Alcohol Intake Patterns and All-Cause Mortality: Scientific Observations

Introduction

Alcohol consumption is a major public health concern worldwide, with complex relationships to mortality outcomes. This report synthesizes current scientific evidence on the relationship between alcohol intake patterns and all-cause mortality, drawing on multiple large-scale studies and meta-analyses. Understanding these relationships is crucial for developing effective public health policies and providing evidence-based guidance for individuals.

Dose-Response Relationships

General Patterns

The relationship between alcohol consumption and mortality has been extensively studied, with evolving understanding of the dose-response pattern. While earlier research suggested a J-shaped relationship (with moderate drinkers having lower mortality than abstainers), more recent and methodologically rigorous studies have challenged this view1.

A systematic review and meta-analysis of 107 cohort studies involving more than 4.8 million participants found no significant reductions in risk of all-cause mortality for drinkers consuming less than 25 g of ethanol per day compared with lifetime nondrinkers after adjustment for key study characteristics1. This contradicts the long-held belief that moderate alcohol consumption offers protective health benefits.

The relationship between increasing alcohol consumption and mortality risk appears to be largely monotonic for most health outcomes, with risk increasing as consumption increases2. However, for specific conditions like diabetes type 2 and some ischemic diseases, some studies still indicate a curvilinear relationship2.

Threshold Effects

Research indicates clear thresholds where mortality risk begins to increase significantly:

  • No significant reduction in all-cause mortality risk was found among occasional (>0 to <1.3 g of ethanol per day) or low-volume drinkers (1.3-24.0 g per day)1
  • A nonsignificant increased risk was observed for those consuming 25 to 44 g per day1
  • Significantly increased risk was found for consumption of 45 to 64 g and 65+ g per day1

In the United States, both males and females face a 1 in 1000 risk of dying from alcohol use when consuming more than 7 drinks per week, with this risk increasing to 1 in 100 at consumption levels above 9 drinks per week3.

Sex Differences in Mortality Risk

Scientific evidence consistently shows that women face higher mortality risks at lower consumption levels compared to men:

  • Female drinkers show significantly larger mortality risks compared to female lifetime nondrinkers at lower consumption thresholds than men1
  • Women drinking ≥20 g/day (approximately 2% of women in studies) had an adjusted hazard ratio (HR) of 1.92 for all-cause mortality, compared to an HR of 1.23 for men drinking ≥60 g/day (3% of men)4
  • Women generally experience a greater increase in relative risk per gram of alcohol consumed than men2

This sex difference is quantified in mortality risk estimates: for males, the risk ranges from 0.07 per 1000 at 1 drink per week to 1.76 per 1000 at 21 drinks per week; for females, the corresponding risks are 0.03 per 1000 and 0.75 per 10003.

Age-Related Factors

The relationship between alcohol consumption and mortality varies by age:

  • The relative risk per gram of alcohol consumed appears lower for people of older ages2
  • However, alcohol consumption remains a leading cause of morbidity and mortality in older adults, particularly those with socioeconomic or health-related risk factors56

Drinking Patterns Beyond Volume

While much research focuses on average consumption volume, drinking pattern also significantly impacts mortality:

  • Binge drinking specifically increased alcohol-related disease mortality in men4
  • Overall, mortality was more strongly associated with high average alcohol intake than with binge drinking patterns, except for alcohol-related diseases in men4

Socioeconomic and Health-Related Risk Modifiers

Recent research has highlighted how underlying risk factors modify the relationship between alcohol and mortality:

  • Even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors67
  • Low-risk drinking was associated with higher cancer mortality (HR, 1.15) among those with health-related risk factors6
  • Among those with socioeconomic risk factors, low-risk and moderate-risk drinking patterns were associated with higher mortality from all causes (low risk: HR, 1.14; moderate risk: HR, 1.17) and cancer (low risk: HR, 1.25; moderate risk: HR, 1.36)6
  • Alcohol appears to interact synergistically with other risk factors, including socioeconomic status, smoking, obesity, and physical inactivity2

Specific Drinking Patterns and Mortality

Certain drinking patterns show differential relationships with mortality:

  • Wine preference (>80% of alcohol from wine) and drinking with meals showed small protective associations with mortality, especially from cancer, but only in drinkers with socioeconomic or health-related risk factors6
  • These patterns were associated with attenuating excess mortality from high-, moderate-, and even low-risk drinking6
  • However, these protective associations may reflect the effect of healthier lifestyles, slower alcohol absorption, or non-alcoholic components of beverages rather than the alcohol itself7

Recent Trends in Alcohol-Related Mortality

The public health impact of alcohol consumption has been increasing in recent years:

  • The average annual number of deaths from excessive alcohol use in the United States increased 29.3%, from approximately 138,000 during 2016–2017 to 178,000 during 2020–20218
  • Deaths increased approximately 27% among males (from 94,362 to 119,606 per year) and approximately 35% among females (from 43,565 to 58,701 per year) during this period8

Conclusion

Scientific observations on alcohol intake patterns and all-cause mortality indicate that the relationship is complex but generally shows increasing risk with increasing consumption. The protective effects of moderate drinking suggested by earlier research appear largely absent when methodological issues are addressed in more recent studies. Women face higher mortality risks at lower consumption levels than men, and both socioeconomic and health-related factors modify the relationship between alcohol and mortality. These findings have important implications for public health policies and guidelines regarding alcohol consumption.

Footnotes

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC10066463/ ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC8401096/ ↩ ↩2 ↩3 ↩4 ↩5

  3. https://www.stopalcoholabuse.gov/media/pdf/Report-on-Alcohol-Intake-and-Health.pdf ↩ ↩2

  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC4756032/ ↩ ↩2 ↩3

  5. https://www.alkoholundkrebs.ch/files/uploads/2024/09/Alcohol-Consumption-Patterns-and-Mortality-Among-Older-Adults-With-Health-Related-or-Socioeconomic-Risk-Factors.pdf ↩

  6. https://pmc.ncbi.nlm.nih.gov/articles/PMC11320169/ ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  7. https://pubmed.ncbi.nlm.nih.gov/39133491/ ↩ ↩2

  8. https://www.cdc.gov/mmwr/volumes/73/wr/mm7308a1.htm ↩ ↩2