古巴的酒精消费与特定病因死亡率：对120623名成年人的前瞻性研究。
Alcohol consumption and cause-specific mortality in Cuba: prospective study of 120 623 adults.
作者信息
Armas Rojas Nurys B, Lacey Ben, Simadibrata Daniel Martin, Ross Stephanie, Varona-Pérez Patricia, Burrett Julie Ann, Calderón Martínez Marcy, Lorenzo-Vázquez Elba, Bess Constantén Sonia, Thomson Blake, Sherliker Paul, Morales Rigau José Manuel, Carter Jennifer, Massa M Sofia, Hernández López Osvaldo Jesús, Islam Nazrul, Martínez Morales Miguel Ángel, Alonso Alomá Ismell, Achiong Estupiñan Fernando, Díaz González Mayda, Rosquete Muñoz Noel, Cendra Asencio Marelis, Emberson Jonathan, Peto Richard, Lewington Sarah
机构信息
National Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba.
Nuffield Department of Population Health (NDPH), University of Oxford, UK.
出版信息
EClinicalMedicine. 2021 Mar 17;33:100692. doi: 10.1016/j.eclinm.2020.100692. eCollection 2021 Mar.
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).
背景
特定病因死亡率与酒精消费之间的关联主要在高收入国家进行了研究。我们研究了古巴的酒精消费与死亡率之间的关系。
方法
1996年至2002年，从古巴五个地区的普通人群中招募了146556名成年人参与一项前瞻性研究。对参与者进行访谈、测量，并通过与国家死亡登记处的电子链接进行随访，直至2017年1月1日。在排除所有招募时存在缺失数据或患有慢性病的人后，使用Cox回归（根据年龄、性别、省份、教育程度和吸烟情况进行调整）来关联35至79岁人群的死亡率比值（RRs）与酒精消费。利用2006年至2008年重新调查的20593名参与者的重复测量数据，对酒精消费的长期变异性进行校正后得到RRs。
结果
排除后，有120623名年龄在35至79岁的参与者（平均年龄52岁[标准差12]；67694名[56%]为女性）。招募时，22670名（43%）男性和9490名（14%）女性为当前饮酒者，其中15433名（29%）男性和3054名（5%）女性至少每周饮酒一次；大多数酒精消费来自朗姆酒。全因死亡率与每周酒精消费呈正相关且持续相关：每周每增加35厘升朗姆酒（110克纯酒精），全因死亡风险约增加10%（RR 1.08[95%置信区间1.05 - 1.11]）。每周饮酒者额外死亡的主要原因是癌症、血管疾病和外部原因。不饮酒者的全因死亡风险比每周酒精消费最低类别（<1瓶/周）的人高约10%（RR 1.11[1.09 - 1.14]），但在排除早期随访数据后，这种关联几乎完全减弱。
解读
在古巴的这项大型前瞻性研究中，每周酒精消费与过早死亡持续相关。反向因果关系可能是不饮酒者中明显额外风险的主要原因。研究结果支持低于古巴目前建议的酒精消费限制。
资金来源
医学研究理事会、英国心脏基金会、英国癌症研究中心、美国疾病控制与预防中心基金会（由安进公司提供支持）。
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