Drinking alcohol in moderation is associated with lower rate of all-cause mortality in individuals with higher rather than lower educational level: findings from the MORGAM project

Augusto Di Castelnuovo, Marialaura Bonaccio, Simona Costanzo, Patrick McElduff, Allen Linneberg, Veikko Salomaa, Satu Männistö, Jean Ferrières, Jean Dallongeville, Barbara Thorand, Hermann Brenner, Marco Ferrario, Giovanni Veronesi, Abdonas Tamosiunas, Sameline Grimsgaard, Wojciech Drygas, Sofia Malyutina, Stefan Söderberg, Maria Nordendahl, Frank KeeGuido Grassi, Salim Dabboura, Rossana Borchini, Dirk Westermann, Benedikt Schrage, Tanja Zeller, Kari Kuulasmaa, Stefan Blankenberg, Maria Benedetta Donati, Licia Iacoviello, Giovanni de Gaetano, MORGAM Study Investigators

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

The association between socioeconomic status (SES) and alcohol-related diseases has been widely explored. Less is known, however, on whether the association of moderate drinking with all-cause mortality is modified by educational level (EL). Using harmonized data from 16 cohorts in the MORGAM Project (N = 142,066) the association of pattern of alcohol intake with hazard of all-cause mortality across EL (lower = primary-school; middle = secondary-school; higher = university/college degree) was assessed using multivariable Cox-regression and spline curves. A total of 16,695 deaths occurred in 11.8 years (median). In comparison with life-long abstainers, participants drinking 0.1-10 g/d of ethanol had 13% (HR = 0.87; 95%CI: 0.74-1.02), 11% (HR = 0.89; 0.84-0.95) and 5% (HR = 0.95; 0.89-1.02) lower rate of death in higher, middle and lower EL, respectively. Conversely, drinkers > 20 g/d had 1% (HR = 1.01; 0.82-1.25), 10% (HR = 1.10; 1.02-1.19) and 17% (HR = 1.17; 1.09-1.26) higher rate of death. The association of alcohol consumption with all-cause mortality was nonlinear, with a different J-shape by EL levels. It was consistent across both sexes and in various approaches of measuring alcohol consumption, including combining quantity and frequency and it was more evident when the beverage of preference was wine. We observed that drinking in moderation (≤ 10 g/d) is associated with lower mortality rate more evidently in individuals with higher EL than in people with lower EL, while heavy drinking is associated with higher mortality rate more evidently in individuals with lower EL than in people with higher EL, suggesting that advice on reducing alcohol intake should especially target individuals of low EL.
Original languageEnglish
Pages (from-to)869–881
JournalEuropean Journal of Epidemiology
Volume38
Early online date30 Jun 2023
DOIs
Publication statusEarly online date - 30 Jun 2023

Keywords

  • Social status
  • Alcohol
  • Educational levels
  • All-cause mortality

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