BACKGROUND: The associations of cause-specific mortality with alcohol consumption have been studied mainly in higher-income countries. We relate alcohol consumption to mortality in Cuba. METHODS: In 1996-2002, 146 556 adults were recruited into a prospective study from the general population in five areas of Cuba. Participants were interviewed, measured and followed up by electronic linkage to national death registries until January 1, 2017. After excluding all with missing data or chronic disease at recruitment, Cox regression (adjusted for age, sex, province, education, and smoking) was used to relate mortality rate ratios (RRs) at ages 35-79 years to alcohol consumption. RRs were corrected for long-term variability in alcohol consumption using repeat measures among 20 593 participants resurveyed in 2006-08. FINDINGS: After exclusions, there were 120 623 participants aged 35-79 years (mean age 52 [SD 12]; 67 694 [56%] women). At recruitment, 22 670 (43%) men and 9490 (14%) women were current alcohol drinkers, with 15 433 (29%) men and 3054 (5%) women drinking at least weekly; most alcohol consumption was from rum. All-cause mortality was positively and continuously associated with weekly alcohol consumption: each additional 35cl bottle of rum per week (110g of pure alcohol) was associated with ∼10% higher risk of all-cause mortality (RR 1.08 [95%CI 1.05-1.11]). The major causes of excess mortality in weekly drinkers were cancer, vascular disease, and external causes. Non-drinkers had ∼10% higher risk (RR 1.11 [1.09-1.14]) of all-cause mortality than those in the lowest category of weekly alcohol consumption (<1 bottle/week), but this association was almost completely attenuated on exclusion of early follow-up. INTERPRETATION: In this large prospective study in Cuba, weekly alcohol consumption was continuously related to premature mortality. Reverse causality is likely to account for much of the apparent excess risk among non-drinkers. The findings support limits to alcohol consumption that are lower than present recommendations in Cuba. FUNDING: Medical Research Council, British Heart Foundation, Cancer Research UK, CDC Foundation (with support from Amgen).
BACKGROUND: The associations of cause-specific mortality with alcohol consumption have been studied mainly in higher-income countries. We relate alcohol consumption to mortality in Cuba. METHODS: In 1996-2002, 146 556 adults were recruited into a prospective study from the general population in five areas of Cuba. Participants were interviewed, measured and followed up by electronic linkage to national death registries until January 1, 2017. After excluding all with missing data or chronic disease at recruitment, Cox regression (adjusted for age, sex, province, education, and smoking) was used to relate mortality rate ratios (RRs) at ages 35-79 years to alcohol consumption. RRs were corrected for long-term variability in alcohol consumption using repeat measures among 20 593 participants resurveyed in 2006-08. FINDINGS: After exclusions, there were 120 623 participants aged 35-79 years (mean age 52 [SD 12]; 67 694 [56%] women). At recruitment, 22 670 (43%) men and 9490 (14%) women were current alcohol drinkers, with 15 433 (29%) men and 3054 (5%) women drinking at least weekly; most alcohol consumption was from rum. All-cause mortality was positively and continuously associated with weekly alcohol consumption: each additional 35cl bottle of rum per week (110g of pure alcohol) was associated with ∼10% higher risk of all-cause mortality (RR 1.08 [95%CI 1.05-1.11]). The major causes of excess mortality in weekly drinkers were cancer, vascular disease, and external causes. Non-drinkers had ∼10% higher risk (RR 1.11 [1.09-1.14]) of all-cause mortality than those in the lowest category of weekly alcohol consumption (<1 bottle/week), but this association was almost completely attenuated on exclusion of early follow-up. INTERPRETATION: In this large prospective study in Cuba, weekly alcohol consumption was continuously related to premature mortality. Reverse causality is likely to account for much of the apparent excess risk among non-drinkers. The findings support limits to alcohol consumption that are lower than present recommendations in Cuba. FUNDING: Medical Research Council, British Heart Foundation, Cancer Research UK, CDC Foundation (with support from Amgen).
Authors: Kaye Middleton Fillmore; Tim Stockwell; Tanya Chikritzhs; Alan Bostrom; William Kerr Journal: Ann Epidemiol Date: 2007-05 Impact factor: 3.797
Authors: Naomi E Allen; Valerie Beral; Delphine Casabonne; Sau Wan Kan; Gillian K Reeves; Anna Brown; Jane Green Journal: J Natl Cancer Inst Date: 2009-02-24 Impact factor: 13.506
Authors: Michael V Holmes; Caroline E Dale; Luisa Zuccolo; Richard J Silverwood; Yiran Guo; Zheng Ye; David Prieto-Merino; Abbas Dehghan; Stella Trompet; Andrew Wong; Alana Cavadino; Dagmar Drogan; Sandosh Padmanabhan; Shanshan Li; Ajay Yesupriya; Maarten Leusink; Johan Sundstrom; Jaroslav A Hubacek; Hynek Pikhart; Daniel I Swerdlow; Andrie G Panayiotou; Svetlana A Borinskaya; Chris Finan; Sonia Shah; Karoline B Kuchenbaecker; Tina Shah; Jorgen Engmann; Lasse Folkersen; Per Eriksson; Fulvio Ricceri; Olle Melander; Carlotta Sacerdote; Dale M Gamble; Sruti Rayaprolu; Owen A Ross; Stela McLachlan; Olga Vikhireva; Ivonne Sluijs; Robert A Scott; Vera Adamkova; Leon Flicker; Frank M van Bockxmeer; Christine Power; Pedro Marques-Vidal; Tom Meade; Michael G Marmot; Jose M Ferro; Sofia Paulos-Pinheiro; Steve E Humphries; Philippa J Talmud; Irene Mateo Leach; Niek Verweij; Allan Linneberg; Tea Skaaby; Pieter A Doevendans; Maarten J Cramer; Pim van der Harst; Olaf H Klungel; Nicole F Dowling; Anna F Dominiczak; Meena Kumari; Andrew N Nicolaides; Cornelia Weikert; Heiner Boeing; Shah Ebrahim; Tom R Gaunt; Jackie F Price; Lars Lannfelt; Anne Peasey; Ruzena Kubinova; Andrzej Pajak; Sofia Malyutina; Mikhail I Voevoda; Abdonas Tamosiunas; Anke H Maitland-van der Zee; Paul E Norman; Graeme J Hankey; Manuela M Bergmann; Albert Hofman; Oscar H Franco; Jackie Cooper; Jutta Palmen; Wilko Spiering; Pim A de Jong; Diana Kuh; Rebecca Hardy; Andre G Uitterlinden; M Arfan Ikram; Ian Ford; Elina Hyppönen; Osvaldo P Almeida; Nicholas J Wareham; Kay-Tee Khaw; Anders Hamsten; Lise Lotte N Husemoen; Anne Tjønneland; Janne S Tolstrup; Eric Rimm; Joline W J Beulens; W M Monique Verschuren; N Charlotte Onland-Moret; Marten H Hofker; S Goya Wannamethee; Peter H Whincup; Richard Morris; Astrid M Vicente; Hugh Watkins; Martin Farrall; J Wouter Jukema; James Meschia; L Adrienne Cupples; Stephen J Sharp; Myriam Fornage; Charles Kooperberg; Andrea Z LaCroix; James Y Dai; Matthew B Lanktree; David S Siscovick; Eric Jorgenson; Bonnie Spring; Josef Coresh; Yun R Li; Sarah G Buxbaum; Pamela J Schreiner; R Curtis Ellison; Michael Y Tsai; Sanjay R Patel; Susan Redline; Andrew D Johnson; Ron C Hoogeveen; Hakon Hakonarson; Jerome I Rotter; Eric Boerwinkle; Paul I W de Bakker; Mika Kivimaki; Folkert W Asselbergs; Naveed Sattar; Debbie A Lawlor; John Whittaker; George Davey Smith; Kenneth Mukamal; Bruce M Psaty; James G Wilson; Leslie A Lange; Ajna Hamidovic; Aroon D Hingorani; Børge G Nordestgaard; Martin Bobak; David A Leon; Claudia Langenberg; Tom M Palmer; Alex P Reiner; Brendan J Keating; Frank Dudbridge; Juan P Casas Journal: BMJ Date: 2014-07-10