Self-reported alcohol consumption and all-cause mortality during 20 years of follow-up in a Swedish population

Abstract Background While excessive alcohol consumption increases mortality, the threshold remains uncertain.This study aimed to investigate the association between self-reported alcohol consumption and all-cause mortality in a representative Swedish population. Methods In 2002–2005, a random sample of 2,816 participants aged 30–75 years (mean 48 years) from two Swedish communities was recruited (participation rate 76%) focusing on cardiometabolic risk factors, lifestyle, and social determinants of health. Self-reported exposure to alcohol was categorised based on mean weekly ethanol intake: abstainers, occasional drinkers (<20 g/week), low (20 to <60 g/week), moderate (60 to <120 g/week), high (120 to <240 g/week), and highest consumption (≥240 g/week). Mortality follow-up data were available through 31 December 2022. Hazard ratios (HR) for all-cause mortality were estimated using multivariable Cox regression with occasional drinkers as the reference group. Analyses were adjusted for demographic, lifestyle, socioeconomic and cardiometabolic risk factors. Results During a mean follow-up of 19.2 years, 301 deaths occurred. In the final model, the highest consumers had a HR of 2.0 for mortality (95% CI 1.07-3.75). There was no evidence that low or moderate consumption influenced mortality risk (HR=0.84; 95% CI 0.59-1.19 and HR= 1.17; 95% CI 0.76-1.81, respectively). Abstainers had an increased mortality after adjustments for age and sex (HR=1.38; 95% CI 1.02-1.86), but it was attenuated and non-significant after further adjustments. Conclusion These findings are consistent with current recommendations limiting alcohol consumption to no more than 10 standard drinks per week and provide no evidence for a protective effect of moderate drinking on mortality.