Alcohol and all-cause mortality: an overview

The relationship between alcohol consumption and all-cause mortality is J-shaped in most industrialized countries. The J-shape is the result of the combination of adverse and beneficial effects of alcohol consumption. Adverse effects include several types of cancer (oropharyngeal, oesophageal, liver, laryngeal and breast cancer), other diseases of the aerodigestive tract, diseases of the heart (alcoholic cardiomyopathy, haemorrhagic stroke, arrhythmia, hypertension), addiction-related mental disorders, and accidents and injuries. Beneficial effects are for ischaemic heart disease and ischaemic stroke. The exact shape of the all-cause mortality curve in a given region depends upon the proportion of the population consuming alcohol at different levels, especially heavy consumption, and on the prevalence of the disorders named above. Thus regions with a relatively low prevalence of ischaemic cardiovascular disease show almost no benefits of consumption, and an all-cause mortality curve which is almost exponential. Females experience a minimum mortality risk at a level of alcohol intake which is lower than that associated with the minimum risk for men. Similarly, an upturn in mortality risk occurs at lower intake levels for women than for men. At present, there is no satisfactory explanation for the observation that the shape of the mortality curve varies with the consumption level of the cohort under study. Heavier-drinking cohorts tend to display their minimum risk at relatively higher levels of alcohol intake than cohorts with lower alcohol consumption.