Total and beverage-specific alcohol use at mid-life and all-cause and cause-specific mortality: a prospective cohort study

While detrimental health impacts of excessive alcohol use are well-established, potential effects of low-to-moderate drinking remain controversial. We examined the associations between total and beverage-specific alcohol intake and mortality, including cardiovascular disease (CVD), cancer (e.g., 20 site-specific cancers), and other mortality. We included 340,924 participants from UK Biobank (2006–2022). Alcohol use was categorized as: never or occasional alcohol consumption (≤ 20 g/week), low consumption (> 20 g/week to ≤ 20 g/d for men, > 20 g/week to ≤ 10 g/d for women), moderate consumption (> 20 to ≤ 40 g/d for men, > 10 to ≤ 20 g/d for women), and high consumption (> 40 g/d for men and > 20 g/d for women). We used Cox proportional hazard models to examine the associations of alcohol intake and mortality. During a mean follow-up of 13.4 years, we documented 22,381 deaths. Compared with never or occasional alcohol intake, high total alcohol intake was associated with higher mortality from all-causes (HR and 95%CI: 1.24 (1.17, 1.31)), CVD (1.14 (1.01, 1.28)), cancer (1.36 (1.26, 1.47)), and other causes (1.12 (1.02, 1.22)), whereas moderate alcohol use was associated with higher cancer mortality (1.11 (1.03, 1.20)) only. Alcohol consumption from spirits and beer/cider, even at low to moderate levels, was associated with higher mortality from all-causes, CVD, cancer, and other diseases (HRs ranging from 1.07 to 1.83). Yet, low and moderate alcohol intake from wine was associated with lower all-cause, CVD, cancer, or other mortality. Importantly, moderate to high intake of total alcohol and alcohol from beer/cider and spirits, and high wine use were particularly associated with higher mortality from multiple site-specific cancers, including mortality from head/neck, respiratory system, gastrointestinal, liver/gallbladder, hematological, female breast, and female/male genital cancers. The results suggested that low to moderate alcohol intake from spirits and beer/cider was associated with higher all-cause, CVD, cancer, and other mortality, whereas low to moderate alcohol use from wine was associated with lower all-cause, CVD, cancer, and other mortality. However, high alcohol use, regardless of beverage-type, mortality from various site-specific cancers was elevated.