Corrao G, Bagnardi V, Zambon A, Arico S
Department of Statistics, University of Milan, Italy.
Addiction. 1999 Oct;94(10):1551-73. doi: 10.1046/j.1360-0443.1999.9410155111.x.
To compare the strength of the evidence provided by the epidemiological literature on the association between alcohol consumption and the risk of six cancers (oral cavity, oesophagus, colorectum, liver, larynx, breast), hypertension, cerebrovascular diseases, gastric and duodenal ulcer, liver cirrhosis and other chronic liver diseases, pancreatitis and injures and adverse effects.
A search of the epidemiological literature from 1966 to 1998 was performed by several bibliographic databases. Meta-regression models were fitted considering fixed and random models and linear and non-linear effects of alcohol intake on the risk of each condition. The effects of some characteristics of the studies including an index of their quality were considered as putative sources of heterogeneity of the estimates. Publication bias was also investigated by asymmetry of funnel plots.
Of the 397 initially reviewed studies, 200 were selected for meta-analysis. Since qualitative characteristics of the studies were often significant sources of heterogeneity among them, the estimates of the pooled dose-response slopes were based only on the 123 studies with higher quality score and/or reporting adjusted estimates of relative risks. Higher alcohol-related risks were found for liver cirrhosis, neoplasms of the upper respiratory and digestive tracts, haemorrhagic stroke and injuries and adverse effects. Weaker but significant associations were found for colorectum, liver and breast cancers, essential hypertension and chronic pancreatitis. For all these conditions, low intakes, corresponding to daily consumption of two drinks or two glasses of wine (25 g/day), have shown significant risks. Ischaemic stroke and gastric and duodenal ulcer seem independent of alcohol intake. The area in which the study was performed, the study's design and the outcome variable differently affected the slopes.
The small number of sufficiently reliable studies, the strong indications of heterogeneity across them and the suspicion of publication bias suggest that there is a great need for well-conducted epidemiological studies performed in several countries, to examine the dose-response relationship between alcohol intake and the risk of several alcohol-related conditions, as well as the role of drinking pattern in determining the risk.
比较流行病学文献中关于饮酒与六种癌症（口腔癌、食管癌、结直肠癌、肝癌、喉癌、乳腺癌）、高血压、脑血管疾病、胃及十二指肠溃疡、肝硬化和其他慢性肝病、胰腺炎以及损伤和不良反应风险之间关联所提供证据的强度。
通过多个文献数据库检索1966年至1998年的流行病学文献。考虑固定模型和随机模型以及酒精摄入量对每种疾病风险的线性和非线性影响，拟合元回归模型。研究的一些特征（包括质量指数）的影响被视为估计异质性的潜在来源。还通过漏斗图的不对称性研究发表偏倚。
在最初审查的397项研究中，选择了200项进行荟萃分析。由于研究的定性特征往往是它们之间异质性的重要来源，汇总剂量反应斜率的估计仅基于123项质量评分较高和/或报告相对风险调整估计的研究。发现肝硬化、上呼吸道和消化道肿瘤、出血性中风以及损伤和不良反应与酒精相关的风险较高。在结直肠癌、肝癌和乳腺癌、原发性高血压和慢性胰腺炎方面发现了较弱但显著的关联。对于所有这些疾病，低摄入量（相当于每天饮用两杯饮料或两杯葡萄酒，25克/天）已显示出显著风险。缺血性中风以及胃和十二指肠溃疡似乎与酒精摄入量无关。研究进行的地区、研究设计和结局变量对斜率有不同影响。
足够可靠的研究数量较少、它们之间存在强烈的异质性迹象以及对发表偏倚的怀疑表明，非常需要在多个国家进行精心设计的流行病学研究，以检查酒精摄入量与几种与酒精相关疾病风险之间的剂量反应关系，以及饮酒模式在确定风险中的作用。
