Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-analyses.
Level 3 - non-randomized controlled study
Systematic review of non-randomized cohort studies
PubMed 37000449 · doi:10.1001/jamanetworkopen.2023.6185
What was done
A systematic review and meta-analysis was performed using PubMed and Web of Science for cohort studies published between January 1980 and July 2021. Mixed linear regression models were applied to 724 risk estimates from 107 cohort studies comprising 4,838,825 participants and 425,564 deaths to evaluate relative risks of all-cause mortality associated with daily alcohol intake. The analyses adjusted for study-level quality criteria, sampling variation, and reference group biases such as the misclassification of former drinkers as abstainers, and stratified by sex and median cohort age (<56 versus ≥56 years).
What was found
In fully adjusted models accounting for former drinker bias and study quality markers, there was no statistically significant reduction in all-cause mortality among occasional drinkers (>0 to <1.3 g of ethanol per day; RR, 0.96; 95% CI, 0.86-1.06; P = .41) or low-volume drinkers (1.3-24.0 g per day; RR, 0.93; P = .07) compared with lifetime nondrinkers. Mortality risk was nonsignificantly increased among drinkers consuming 25 to 44 g per day (RR, 1.05; P = .28) and significantly increased for those consuming 45 to 64 g per day (RR, 1.19; P < .001) and 65 or more grams per day (RR, 1.35; P < .001). Risk of mortality was significantly higher among female drinkers compared with female lifetime nondrinkers (RR, 1.22; P = .03), emerging at lower consumption levels than in men.
Why it matters
This review shows that the widely cited protective effect of low-dose alcohol intake on all-cause mortality is largely an artifact of methodological bias in control groups. When biases are controlled, moderate drinking offers no survival advantage, and higher consumption clearly increases risk.
Limits
The analysis is restricted to observational cohort studies and relies on self-reported alcohol consumption. The abstract does not provide cause-specific mortality breakdowns, lifetime pattern variations such as binge drinking, or control for residual lifestyle and dietary confounders across cohorts.
Cited by
- supports Consuming two alcoholic drinks per week carries only a very small increase in health risk.
- supports Studies establishing a J-shaped curve showing lower mortality in low-drinking groups compared to non-drinkers were confounded by including former problem drinkers with pre-existing health damage in the non-drinking reference groups.