Doll R, Peto R, Hall E, Wheatley K, Gray R
Imperial Cancer Research Fund Cancer Studies Unit, Nuffield Department of Clinical Medicine, Radcliffe Infirmary, Oxford.
BMJ. 1994 Oct 8;309(6959):911-8. doi: 10.1136/bmj.309.6959.911.
To assess the risk of death associated with various patterns of alcohol consumption.
Prospective study of mortality in relation to alcohol drinking habits in 1978, with causes of death sought over the next 13 years (to 1991).
12,321 British male doctors born between 1900 and 1930 (mean 1916) who replied to a postal questionnaire in 1978. Those written to in 1978 were the survivors of a long running prospective study of the effects of smoking that had begun in 1951 and was still continuing.
Men were divided on the basis of their response to the 1978 questionnaire into two groups according to whether or not they had ever had any type of vascular disease, diabetes, or "life threatening disease" and into seven groups according to the amount of alcohol they drank. By 1991 almost a third had died. All statistical analyses of mortality were standardised for age, calendar year, and smoking habit. There was a U shaped relation between all cause mortality and the average amount of alcohol reportedly drunk; those who reported drinking 8-14 units of alcohol a week (corresponding to an average of one to two units a day) had the lowest risks. The causes of death were grouped into three main categories: "alcohol augmented" causes (6% of all deaths: cirrhosis, liver cancer, upper aerodigestive (mouth, oesophagus, larynx, and pharynx) cancer, alcoholism, poisoning, or injury), ischaemic heart disease (33% of all deaths), and other causes. The few deaths from alcohol augmented causes showed, at least among regular drinkers, a progressive trend, with the risk increasing with dose. In contrast, the many deaths from ischaemic heart disease showed no significant trend among regular drinkers, but there were significantly lower rates in regular drinkers than in non-drinkers. The aggregate of all other causes showed a U shaped dose-response relation similar to that for all cause mortality. Similar differences persisted irrespective of a history of previous disease, age (under 75 or 75 and older), and period of follow up (first five and last eight years). Some, but apparently not much, of the excess mortality in non-drinkers could be attributed to the inclusion among them of a small proportion of former drinkers.
The consumption of alcohol appeared to reduce the risk of ischaemic heart disease, largely irrespective of amount. Among regular drinkers mortality from all causes combined increased progressively with amount drunk above 21 units a week. Among British men in middle or older age the consumption of an average of one or two units of alcohol a day is associated with significantly lower all cause mortality than is the consumption of no alcohol, or the consumption of substantial amounts. Above about three units (two American units) of alcohol a day, progressively greater levels of consumption are associated with progressively higher all cause mortality.
评估与各种饮酒模式相关的死亡风险。
1978年对饮酒习惯与死亡率进行的前瞻性研究，并在接下来的13年（至1991年）中探寻死亡原因。
12321名出生于1900年至1930年（平均1916年）的英国男性医生，他们在1978年回复了一份邮寄问卷。1978年被写信询问的对象是一项始于1951年且仍在继续的长期吸烟影响前瞻性研究的幸存者。
根据男性对1978年问卷的回答，依据他们是否曾患任何类型的血管疾病、糖尿病或“危及生命的疾病”分为两组，并根据饮酒量分为七组。到1991年，近三分之一的人已死亡。所有死亡率的统计分析均按年龄、历年和吸烟习惯进行了标准化处理。全因死亡率与据报的平均饮酒量之间呈U形关系；那些报告每周饮用8 - 14个酒精单位（相当于平均每天1 - 2个单位）的人风险最低。死亡原因分为三大类：“酒精增加性”原因（占所有死亡的6%：肝硬化、肝癌、上消化道（口腔、食管、喉和咽）癌、酒精中毒、中毒或损伤）、缺血性心脏病（占所有死亡的33%）和其他原因。由酒精增加性原因导致的少数死亡病例，至少在经常饮酒者中呈现出一种渐进趋势，风险随饮酒量增加而上升。相比之下，缺血性心脏病导致的众多死亡病例在经常饮酒者中未显示出显著趋势，但经常饮酒者的死亡率明显低于不饮酒者。所有其他原因的总和呈现出与全因死亡率相似的U形剂量反应关系。无论既往疾病史、年龄（75岁以下或75岁及以上）以及随访时间（前五年和后八年）如何，类似的差异都持续存在。不饮酒者中部分（但显然不多）额外的死亡率可归因于其中包含一小部分既往饮酒者。
饮酒似乎可降低缺血性心脏病风险，在很大程度上与饮酒量无关。在经常饮酒者中，每周饮酒量超过21个单位时，全因死亡率随饮酒量增加而逐渐上升。在英国中年或老年男性中，平均每天饮用1或2个酒精单位与全因死亡率显著低于不饮酒或大量饮酒的情况相关。每天饮酒量超过约3个（两个美国单位）酒精单位时，饮酒量越高，全因死亡率越高。
