Alcohol use, other traits, and risk of unnatural death: a prospective study

This study prospectively explores relations of usual alcohol intake in a Northern California population of 128,934 persons to risk of subsequent unnatural death. Of 385 such deaths during the 8-year study period, 88 were due to motor vehicle accidents (MVAs), 106 to suicide, 52 to homicide, and 139 to miscellaneous other unnatural causes. Comparisons of ex-drinkers and 5 levels of current drinkers to lifelong abstainers were studied by Cox proportional hazards models with 9 covariates. In adjusted analyses, persons reporting intake of 6 or more drinks daily were at greatly increased risk of death from suicide (6 times) and homicide (7 times), and at moderately increased risk of death from MVAs (2 times). Lighter and ex-drinkers were not at significantly increased risk for all unnatural deaths or any of its subsets. Among persons reporting 6 or more drinks/day, women and persons below 50 years of age were at especially high risk, but Blacks and Whites were at similar risk. Persons who usually drank liquor or wine were at greater risk for MVAs than those who usually drank beer; beverage choice was unrelated to the other causes of death. Among other covariates, men and not married persons were at higher risk and college graduates at lower risk, for each cause of death. The only major racial difference was a lower risk of suicide for Blacks (versus Whites). These data provide considerable detail about usual alcohol use and risk of unnatural death. They point to special need for preventive efforts among younger persons and women, with particular attention to suicide and homicide.