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How stable is the risk curve between alcohol and all-cause mortality and what factors influence the shape? A precision-weighted hierarchical meta-analysis

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Abstract

Objective: To determine the influence of six determining variables on the shape of the risk curve between alcohol and all-cause mortality. Methods: Data: Based on a systematic search with clear inclusion criteria, all articles on alcohol and all-cause mortality until 2000 were included. Statistical methods: Precision-weighted pooling of relative risks (RRs); precision-weighted hierarchical analysis. Variables: For pooling: RRs for different categories of average volume of drinking, lifetime abstainers and ex-drinkers. For hierarchical analysis: on first level: consumption in grams of pure alcohol per day; on second level: length of follow-up time in months; per capita consumption; average age, proportion of abstainers, average volume of drinking, and variability of average volume of drinking at baseline. Outcomes measures: RR of former and current drinkers for all-cause mortality compared to abstainers. Results: The main hypotheses could be confirmed for males: Ex-drinkers had a higher mortality risk than lifetime abstainers; the higher and the more diverse the average volume of alcohol consumption, the wider the dip of the curve; the older the persons at baseline, the more pronounced the protective effect; and the longer the follow-up time, the less pronounced the protective effect. Except for average volume of drinking effects for females went in the same direction but with one exception did not reach significance. Conclusions: There are systematic influences on the shape of the risk curve between alcohol and all-cause mortality. The overall beneficial effect of light to moderate drinking remained under all scenarios, indicating a high validity of the overall shape despite the heterogeneity between studies.

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Authors and Affiliations

  1. Swiss Institute for the Prevention of Alcohol and Drug Problems, Lausanne, Switzerland

    Gerhard Gmel

  2. Addiction Research Institute, Zurich, Switzerland

    Elisabeth Gutjahr

  3. Centre for Addiction and Mental Health, Toronto; Department of Public Health Sciences, University of Toronto, Toronto, Canada

    Jürgen Rehm

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  1. Gerhard Gmel
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Gmel, G., Gutjahr, E. & Rehm, J. How stable is the risk curve between alcohol and all-cause mortality and what factors influence the shape? A precision-weighted hierarchical meta-analysis. Eur J Epidemiol 18, 631–642 (2003). https://doi.org/10.1023/A:1024805021504

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