Summary
Background
Alcohol
consumption is proposed to be the third most important modifiable risk
factor for death and disability. However, alcohol consumption has been
associated with both benefits and harms, and previous studies were
mostly done in high-income countries. We investigated associations
between alcohol consumption and outcomes in a prospective cohort of
countries at different economic levels in five continents.
Methods
We
included information from 12 countries participating in the Prospective
Urban Rural Epidemiological (PURE) study, a prospective cohort study of
individuals aged 35–70 years. We used Cox proportional hazards
regression to study associations with mortality (n=2723), cardiovascular
disease (n=2742), myocardial infarction (n=979), stroke (n=817),
alcohol-related cancer (n=764), injury (n=824), admission to hospital
(n=8786), and for a composite of these outcomes (n=11 963).
Findings
We
included 114 970 adults, of whom 12 904 (11%) were from high-income
countries (HICs), 24 408 (21%) were from upper-middle-income countries
(UMICs), 48 845 (43%) were from lower-middle-income countries (LMICs),
and 28 813 (25%) were from low-income countries (LICs). Median follow-up
was 4·3 years (IQR 3·0–6·0). Current drinking was reported by 36 030
(31%) individuals, and was associated with reduced myocardial infarction
(hazard ratio [HR] 0·76 [95% CI 0·63–0·93]), but increased
alcohol-related cancers (HR 1·51 [1·22–1·89]) and injury (HR 1·29
[1·04–1·61]). High intake was associated with increased mortality (HR
1·31 [1·04–1·66]). Compared with never drinkers, we identified
significantly reduced hazards for the composite outcome for current
drinkers in HICs and UMICs (HR 0·84 [0·77–0·92]), but not in LMICs and
LICs, for which we identified no reductions in this outcome (HR 1·07
[0·95–1·21]; pinteraction<0·0001).
Interpretation
Current
alcohol consumption had differing associations by clinical outcome, and
differing associations by income region. However, we identified
sufficient commonalities to support global health strategies and
national initiatives to reduce harmful alcohol use.
Funding
Population
Health Research Institute, the Canadian Institutes of Health Research,
Heart and Stroke Foundation of Ontario, AstraZeneca (Canada),
Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and
Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national
or local organisations in participating countries.
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