Alcohol Consumption and Age-Specific Risk of Esophageal Cancer: Prospective Cohort Study

China accounts for more than 40% of new global cases and deaths from esophageal cancer, and has a relatively high rate of past-year alcohol use, reaching up to 27%. The incidence and risk factors of esophageal cancer exhibit marked age-related variation; however, the impact of alcohol consumption on the risk of esophageal cancer across different age groups remains poorly understood.

This study aimed to investigate the age-specific associations between alcohol consumption and the risk of esophageal cancer.

Data were obtained from the China Kadoorie Biobank, a large-scale, nationwide prospective cohort study. The final analysis included 489,664 adult participants aged 30 to 79 years enrolled at baseline between 2004 and 2008. Age-specific incidence rates per 100,000 person-years of esophageal cancer were calculated. Cox proportional hazards models were used to assess the associations between alcohol consumption and the risk of esophageal cancer, stratified by age group.

In the study cohort, incidence rates of esophageal cancer consistently increased with higher frequency of alcohol consumption among all age groups younger than 70 years. The association exhibited an age-specific pattern: within each age group, the rate ratio for weekly versus never drinkers was highest in the youngest group (8.31 for the 30-49 year age group) and declined with age; across age groups, among weekly drinkers, the incidence rate increased sharply from the 30-49 year to the 50-54 year age group (rate ratio 2.81). Within each age group, compared with never drinkers, the adjusted hazard ratios for weekly drinkers decreased progressively with age group, from 4.06 (95% CI 2.73-6.02) in adults aged 30-49 years to 3.17 (95% CI 2.34-4.30), 2.88 (95% CI 2.20-3.77), 2.36 (95% CI 1.78-3.14), 2.25 (95% CI 1.69-3.00), and 1.61 (95% CI 1.15-2.25) in those aged 50-54, 55-59, 60-64, 65-69, and 70-74 years, respectively.

Our findings highlight a potential age-modifying effect of alcohol consumption on the risk of esophageal cancer, with a strong relative risk observed in young adults and a marked acceleration during the transition to midlife. This underscores the need to develop age-specific public health strategies to reduce alcohol use and to strengthen screening and intervention efforts to reduce the burden of esophageal cancer.