Alcohol Consumption and Mortality among Middle-aged and Elderly Japanese Men and Women

doi:10.1016/j.annepidem.2004.10.010

Annals of Epidemiology

Volume 15, Issue 8, September 2005, Pages 590-597

https://doi.org/10.1016/j.annepidem.2004.10.010 Get rights and content

Purpose

We conducted a prospective cohort study to examine the association between alcohol intake and the risk of all-cause mortality among middle-aged and elderly Japanese men and women.

Methods

At baseline (1988–1990), a total of 110,792 Japanese men and women aged 40 to 79 years were asked to complete a questionnaire that included information on alcohol intake, and were followed up for all-cause mortality through December 31, 1999. Relative risks (95% confidence interval) were calculated using Cox proportional-hazards models.

Results

The risk of all-cause mortality was lowest among current drinkers with an alcohol intake of 0.1 to 22.9 g/d (RR, 0.80; 95% CI, 0.72–0.88 for men; and RR, 0.88; 95% CI, 0.77–1.00 for women). Excessive mortality associated with heavy drinking (≥ 69 g/d) was observed for cancer, cardiovascular disease and injuries and other external causes in men, while significantly reduced mortality with light drinking was seen for cancer in men and CVD in women. For men, the benefit associated with light alcohol consumption (< 23 g/d) was more apparent among nonsmokers than among smokers.

Conclusion

Our prospective data show a 12% to 20% decreased risk of all-cause mortality in both Japanese men and women who consumed less than 23 g/d of alcohol (approximately 2 drinks), although heavy drinking increased that risk.

Introduction

Epidemiological studies in Western industrialized countries have found that light-to-moderate alcohol consumption is associated with decreased total mortality, most of which were due to a reduction in cardiovascular deaths 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. In Japan, the health effects of alcohol consumption have not been clearly defined. Although several prospective studies have been conducted to examine the relation between alcohol consumption and all-cause mortality 12, 13, 14, 15, 16, the findings on the protective effect of light-to-moderate alcohol consumption have been controversial, and only one study has reported the corresponding relation for Japanese women (16).

A large cohort study involving 490,000 US men and women indicated that the benefit from moderate alcohol consumption depends in part on age and background cardiovascular risk (2). Given the differences in baseline characteristics among subjects, types of alcohol beverages usually consumed, or subjects' drinking patterns, the balance of risks and benefits of alcohol consumption is likely to differ among age groups and populations. Few studies, however, have addressed this issue in Japanese populations.

The main purpose of our study is to examine prospectively the relation between alcohol intake and risk of death from all causes (CVD, cancer, and injuries and other external causes) in a large cohort of Japanese men and women. In addition, we also aim to determine how age and cigarette smoking modify the relation of alcohol consumption to total mortality in our cohort.

Section snippets

Study Cohort

The Japan Collaborative Cohort Study for Evaluation of Cancer Risk (the JACC study) is a large prospective cohort study sponsored by the Japanese Ministry of Education, Culture, Sports, Science and Technology (Monbukagakusho). The details of the JACC study have been described elsewhere (17). Briefly, it was initiated between 1988 and 1990, when 127,500 apparently healthy inhabitants from 45 areas throughout Japan were enrolled as a baseline cohort. Among this cohort population, 46,465 men and

Results

Among the 110,792 cohort participants, we excluded the 8168 (7.4%) subjects who had missing information on their drinking status, and 5192 (4.7%) subjects who reported a history of cancer, stroke, or myocardial infarction. This left 97,432 (42,072 men and 55,360 women) subjects for the present analysis. During a mean follow-up of 10 years, a total of 9589 subjects (5902 men and 3687 women) died from all causes. Among 5902 deaths in men, 2418 (41.0%) died from cancer, 1584 (26.8%) from CVD, and

Discussion

In this large prospective study, we found that current drinkers who consumed less than 23.0 g/d of alcohol (approximately 2 drinks) had a 12% to 20% significantly decreased risk of all-cause mortality in men and women, while heavier drinking (≥ 69.0 g/d) was associated with a 30% increased risk in men, in relation to nondrinkers. Our findings were consistent with studies in Western industrialized countries and another cohort study in Japan (12), although the definition of “moderate drinking”

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: The JACC Study has been supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan (Nos. 61010076, 62010074, 63010074, 1010068, 2151065, 3151064, 4151063, 5151069, 6279102 and 11181101).

^∗: Japan Collaborative Cohort Study for Evaluation of Cancer Risk sponsored by Monbukagakusho. See acknowledgments for members of the JACC Study.

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Alcohol Consumption and Mortality among Middle-aged and Elderly Japanese Men and Women

Purpose

Methods

Results

Conclusion

Introduction

Section snippets

Study Cohort

Results

Discussion

Lancet

Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men

N Engl J Med

Alcohol consumption and mortality among middle-aged and elderly US adults

N Engl J Med

Average volume of alcohol consumption, patterns of drinking, and all-cause mortality: Results from the US National Alcohol Survey

Am J Epidemiol

Wine, liquor, beer, and mortality

Am J Epidemiol

Alcohol consumption and mortality from all causes, coronary heart diseases, and stroke: Results from a prospective cohort study of Scottish men with 21 years of follow up

BMJ

Alcohol volume, drinking pattern, and cardiovascular disease morbidity and mortality: Is there a U-shaped function?

Am J Epidemiol

Alcohol intake and mortality: Findings from the National Health Interview Surveys (1988 and 1990)

Am J Epidemiol

Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus

JAMA

Light-to-moderate alcohol consumption and the risk of stroke among US male physicians

N Engl J Med

Alcohol consumption and mortality in men with preexisting cerebrovascular disease

Arch Intern Med

Alcohol consumption and mortality among women

N Engl J Med

Alcohol consumption and all-cause and cancer mortality among middle-aged Japanese men: Seven-year follow-up of the JPHC Study Cohort I

Am J Epidemiol

Japanese alcoholic beverage and all cause mortality in Japanese adult men

J Epidemiol

Choice of comparison group in assessing the health effects of moderate alcohol consumption

JAMA

Alcohol and mortality: A cohort study of male Japanese physicians

Int J Epidemiol