Bassett Julie K, Peng Yang, MacInnis Robert J, Hodge Allison M, Lynch Brigid M, Room Robin, Giles Graham G, Milne Roger L, Jayasekara Harindra
Cancer Epidemiology Division, Cancer Council Victoria, East Melbourne, VIC, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
Int J Epidemiol. 2025 Feb 16;54(2). doi: 10.1093/ije/dyaf022.
Published studies rarely assess associations between trajectories of drinking and mortality.
We aimed to assess associations between long-term sex-specific drinking trajectories and all-cause and disease-specific mortality for 39 588 participants (23 527 women; 16 061 men) enrolled in the Melbourne Collaborative Cohort Study in 1990-94 aged 40-69 years. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause, cardiovascular disease- and cancer-specific mortality in relation to group-based alcohol intake trajectories.
There were 7664 deaths (1117 cardiovascular; 2251 cancer) in women over 595 456 person-years, and 7132 deaths (1283 cardiovascular; 2340 cancer) in men over 377 314 person-years. We identified three distinct group-based alcohol intake trajectories for women: 'lifetime abstention', 'stable light', and 'increasing moderate'; and six for men: 'lifetime abstention', 'stable light', 'stable moderate', 'increasing heavy', 'early decreasing heavy', and 'late decreasing heavy'. We observed 9%-12% lower all-cause mortality, driven by associations with cardiovascular disease-specific deaths, for 'stable light' (women: HR 0.91; 95% CI 0.87-0.96; men: HR 0.88; 95% CI 0.82-0.94) and 'stable moderate' (HR 0.88; 95% CI 0.81-0.96) drinking, compared with 'lifetime abstention'. In contrast, all-cause mortality was 18%-21% higher for 'early decreasing heavy' (HR 1.18; 95% CI 1.05-1.32) and 'late decreasing heavy' (HR 1.21; 95% CI 1.04-1.40) drinking, and cancer-specific mortality 19%-37% higher for 'increasing moderate' (HR 1.19; 95% CI 1.00-1.43), 'early decreasing heavy' (HR 1.34; 95% CI 1.10-1.64), and 'late decreasing heavy' (HR 1.37; 95% CI 1.06-1.77) drinking.
Our findings highlight the importance of avoiding higher levels of alcohol intake during the life course to reduce all-cause and cancer-specific mortality.
已发表的研究很少评估饮酒轨迹与死亡率之间的关联。
我们旨在评估1990 - 1994年参加墨尔本协作队列研究的39588名参与者（23527名女性；16061名男性），年龄在40 - 69岁，其长期按性别划分的饮酒轨迹与全因死亡率和特定疾病死亡率之间的关联。采用Cox回归来估计基于组的酒精摄入量轨迹与全因、心血管疾病和癌症特异性死亡率相关的风险比（HR）和95%置信区间（CI）。
在595456人年的随访中，女性中有7664人死亡（1117例心血管疾病；2251例癌症），在377314人年的随访中，男性中有7132人死亡（1283例心血管疾病；2340例癌症）。我们确定了女性基于组的三种不同酒精摄入量轨迹：“终生戒酒”、“稳定少量”和“逐渐增加中度”；男性有六种：“终生戒酒”、“稳定少量”、“稳定中度”、“逐渐增加重度”、“早期减少重度”和“晚期减少重度”。与“终生戒酒”相比，我们观察到“稳定少量”（女性：HR 0.91；95% CI 0.87 - 0.96；男性：HR 0.88；95% CI 0.82 - 0.94）和“稳定中度”（HR 0.88；95% CI 0.81 - 0.96）饮酒者的全因死亡率降低了9% - 12%，这主要是由于与心血管疾病特异性死亡的关联。相比之下，“早期减少重度”（HR 1.18；95% CI 1.05 - 1.32）和“晚期减少重度”（HR 1.21；95% CI 1.04 - 1.40）饮酒者的全因死亡率高18% - 21%，“逐渐增加中度”（HR 1.19；95% CI 1.00 - 1.43）、“早期减少重度”（HR 1.34；95% CI 1.10 - 1.64）和“晚期减少重度”（HR 1.37；95% CI 1.06 - 1.77）饮酒者的癌症特异性死亡率高19% - 37%。
我们的研究结果强调了在生命过程中避免较高酒精摄入量对于降低全因死亡率和癌症特异性死亡率的重要性。
