International Journal of Epidemiology, Vol 26, 85-91, Copyright © 1997 by International Epidemiological Association
H Brenner, V Arndt, D Rothenbacher, S Schuberth, E Fraisse and TM Fliedner
BACKGROUND: Many epidemiological studies have shown a J- or U-shaped
association between alcohol consumption and total mortality. It has been
argued that the higher mortality among abstainers than among moderate
drinkers might result from misreporting of alcohol consumption, confounding
or inclusion of a high proportion of ex- drinkers or individuals with
pre-existing diseases among abstainers. METHODS: These concerns were
addressed in a cohort study among 8043 construction workers aged 25-64
years who underwent occupational health examinations at six centres in
South West Germany during 1986 to 1988. Abstainers were compared with
alcohol users with respect to biological markers of alcohol consumption,
prevalence of pre-existing diseases and other covariates. Study
participants were followed for all-cause mortality until 1994. RESULTS:
There was a clear monotonic dose- response relationship of biological
markers with self-reported alcohol consumption. Prevalence of pre-existing
diseases was highest among heavy drinkers, while no major differences were
observed between abstainers and men who consumed 1-49 g of alcohol per day.
Overall, 172 men died during the follow-up period. There was a strong
U-shaped relationship between alcohol consumption and total mortality.
Mortality was 2.8 times higher (95% confidence interval [CI]: 1.5-5.4)
among non- drinkers than among men who consumed 1-49 g of alcohol per day
after control for potential confounders in multivariable analyses. Strongly
increased mortality was also found among heavy drinkers. Exclusion of
non-drinkers with pre-existing diseases did not change the U-shaped
association. CONCLUSIONS: We found a strong U-shaped association between
alcohol consumption and all-cause mortality which is unlikely to be
explained by misreporting, confounding or pre-existing disease.
ARTICLES
The association between alcohol consumption and all-cause mortality in a cohort of male employees in the German construction industry
Department of Epidemiology, University of Ulm, Germany.
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