Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy.
Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
Addiction. 2019 Apr;114(4):636-650. doi: 10.1111/add.14490. Epub 2018 Dec 14.
Epidemiological evidence on the impact of different alcohol drinking patterns on health-care systems or hospitalizations is sparse. We investigated how the different average volumes of alcohol consumed relate to all-cause and cause-specific hospitalizations.
Prospective cohort study (baseline 2005-10) linked to a registry of hospital discharge records to identify hospitalizations at follow-up (December 2013).
Molise region, Italy.
A total of 20 682 individuals (48% men, age ≥ 35 years) who participated in the Moli-sani Study and were free from cardiovascular disease or cancer at baseline.
The alcohol volume consumed in the year before enrolment was classified as: life-time abstainers, former drinkers, occasional drinkers and current drinkers who drank 1-12 (referent), 12.1-24, 24.1-48 and > 48 g/day of alcohol. Cause-specific hospitalizations were assigned by Italian Diagnosis Related Groups classification or by ICD-9 code of main admission diagnoses. Incidence rate ratios (IRR) of hospitalization were estimated by Poisson regression, taking into account the total number of admissions that occurred during the follow-up per person.
During a median follow-up of 6.3 years, 12 996 multiple hospital admissions occurred. In multivariable analyses, life-time abstainers and former drinkers had higher rates of all-cause [IRR = 1.11, 95% confidence interval (CI) = 1.05-1.17 and IRR = 1.19, 95% CI = 1.02-1.31, respectively] and vascular (IRR = 1.14, 95% CI = 1.02-1.27 and IRR = 1.48, 95% CI = 1.24-1.76, respectively) hospitalizations compared with light alcohol consumers. Alcohol consumption > 48 g/day was associated with a higher rate of hospitalization for both alcohol-related diseases (IRR = 1.74, 95% CI = 1.32-2.29) and cancer (IRR = 1.36, 95% CI = 1.12-1.65). The magnitude of the association between heavier alcohol intake and hospitalization tended to be greater in smokers than non-smokers. No associations were observed with hospitalization for trauma or neurodegenerative diseases.
Moderate alcohol consumption appears to have a modest but complex impact on global hospitalization burden. Heavier drinkers have a higher rate of hospitalization for all causes, including alcohol-related diseases and cancer, a risk that appears to be further magnified by concurrent smoking.
关于不同饮酒模式对医疗保健系统或住院的影响的流行病学证据很少。我们研究了不同的平均饮酒量与全因和病因特异性住院之间的关系。
前瞻性队列研究（基线 2005-10 年）与医院出院记录登记处相联系，以确定随访期间（2013 年 12 月）的住院情况。
意大利莫利塞地区。
共有 20682 名（48%为男性，年龄≥35 岁）参加了莫利萨尼研究，且在基线时无心血管疾病或癌症。
在入组前一年中摄入的酒精量分为：终身戒酒者、前饮酒者、偶尔饮酒者和当前饮酒者，饮酒量分别为 1-12（参考）、12.1-24、24.1-48 和>48 g/天。病因特异性住院由意大利诊断相关组分类或主要入院诊断的 ICD-9 代码确定。通过泊松回归估计住院的发病率比（IRR），考虑到每个随访期间发生的总入院次数。
在中位随访 6.3 年期间，发生了 12996 多次住院。在多变量分析中，终身戒酒者和前饮酒者的全因住院率较高[IRR=1.11，95%置信区间（CI）=1.05-1.17 和 IRR=1.19，95% CI=1.02-1.31，分别]和血管性（IRR=1.14，95% CI=1.02-1.27 和 IRR=1.48，95% CI=1.24-1.76，分别）住院率高于轻度饮酒者。饮酒量>48 g/天与酒精相关疾病（IRR=1.74，95% CI=1.32-2.29）和癌症（IRR=1.36，95% CI=1.12-1.65）的住院率较高有关。与较重的酒精摄入与住院之间的关联程度在吸烟者中比非吸烟者中更大。与创伤或神经退行性疾病的住院无关。
适量饮酒似乎对全球住院负担产生了适度但复杂的影响。饮酒量较大者的全因住院率较高，包括与酒精相关的疾病和癌症，而这种风险似乎因同时吸烟而进一步放大。
