A risk factor approach to the alcohol-related diseases

Alcohol-related disorders belong to the spectrum of major non-infectious diseases in Western societies which are capable of prevention by means that have not yet been fully implemented. The mortality in a population of 10,353 middle-aged males invited to a preventive medical population program in Malmö was assessed for 1.5-6.5 years (mean 4.5 years) after the time of invitation and analysed in relation to participation or non-participation. The characteristics at entry of the 7948 males who participated in screening were compared in order to evaluate risk factor patterns for the major categories of premature death during the follow-up period. Among the non-participants for screening the mortality rate was twice as high, and the death rate due to alcohol-related diseases was five times higher than among the participants. There were no significant differences between participants and non-participants in the other death causes. The autopsy rate was high, at 87.8%. Even in the males participating in the screening, alcohol-related deaths constituted a major mortality category, comprising 55 of 218 cases, whereas cancer comprised 61 and coronary heart disease 50 of the premature deaths in this group. In these three main categories of male premature mortality, significant and distinctly differential risk factor patterns were found. Risk factors for coronary heart disease involved smoking, serum cholesterol, triglycerides and systolic blood pressure, and for alcohol-related deaths involved gamma-glutamyltransferase, an alcoholism screening questionnaire and, inversely, serum cholesterol and serum creatinine. In both groups of diseases, these risk factors could be combined into a highly predictive multiple logistic risk factor function. The discriminative power of this instrument was higher for the alcohol-related deaths than for the coronary heart disease deaths. Malignant and alcohol-related diseases constituted at least equally prominent categories as the cardiovascular disorders among the deaths that occurred within middle age in these cohorts. All of these conditions are potentially avoidable and are associated with significant and distinctive risk factor patterns. Risk factors may be applied to the alcohol-related disorders as signals for preventive measures in analogy with tested methods for the regulation of blood pressure and serum lipids.