Prospective study of alcohol consumption in the United States: quantity, frequency, and cause-specific mortality

Alcohol average volume (quantity multiplied by frequency) has been associated with mortality in drinkers. However, average volume may mask associations due to quantity or frequency alone.

We prospectively assessed relationships between alcohol quantity and frequency, and mortality from all-causes, cardiovascular disease, cancer, and other-causes in a cohort created by linking the 1988 National Health Interview Survey (response rate 87%) to the National Death Index through 2002. Participants were 20,765 current drinkers age > or = 18 years. At 14-year follow-up 2,547 had died.

For quantity, among men who consumed > or =5 drinks (compared to 1 drink) on drinking days, adjusted relative risks (RR) of mortality were: for cardiovascular disease, 1.30 [95% confidence interval (CI) 0.96-1.75; p for linear trend (p-trend) = 0.0295], for cancer, 1.53 (95% CI 1.11-2.09; p-trend = 0.0026), and for other-causes, 1.42 (95% CI 1.08-1.87; p-trend = 0.0029); among women for other-causes, 2.88 (95% CI 1.61-5.12; p-trend = 0.0010). For frequency, among men in the highest frequency quartile (compared to the lowest), RR were: for cardiovascular disease, 0.79 (95% CI 0.63-0.99; p-trend = 0.0330), for cancer, 1.23 (95% CI 0.95-1.59; p-trend = 0.0461), and for other-causes, 1.30 (95% CI 1.01-1.67; p-trend = 0.0070); among women, for cancer, 1.65 (95% CI 1.12-2.45, p-trend = 0.0031). Average volume obscured effects of quantity alone and frequency alone, particularly for cardiovascular disease in men where quantity and frequency trended in opposite directions.

Alcohol quantity and frequency were independently associated with cause-specific mortality. Accumulating evidence of their differential effects may, in the future, be useful for clinical and public health recommendations.