Current issues of ACP Journal Club are published in Annals of Internal Medicine


Etiology

Binge beer drinking was associated with mortality in middle-aged men

ACP J Club. 1998 Mar-April; 128:51. doi:10.7326/ACPJC-1998-128-2-051


Source Citation

Kauhanen J, Kaplan GA, Goldberg DE, Salonen JT. Beer binging and mortality: results from the Kuopio ischaemic heart disease risk factor study, a prospective population based study. BMJ. 1997 Oct 4;315:846-51.


Abstract

Objective

To determine whether an association exists between heavy episodic beer drinking and mortality in middle-aged men.

Design

A population-based cohort study (Kuopio Ischaemic Heart Disease Risk Factor Study) with mean follow-up for death of 7.7 years.

Setting

Kuopio, Finland, and surrounding rural communities.

Participants

1641 men (mean age 52 y) who were 42, 48, 54, or 60 years of age at baseline (1984 to 1989); had regularly consumed beer; had abstained from drinking beer for 3 days before baseline examination; and had complete follow-up data.

Assessment of risk factors

Alcohol consumption was self-reported as usual frequency and dose (bottles or glasses) for each type: beer, wine, strong wine, and spirits. Beer consumption was categorized as < 3, 3 to 5, and ≥ 6 bottles of beer/usual session, with < 3 bottles/session as the reference standard (relative risk 1.0). Other baseline variables used in adjusted analyses were age, estimated alcohol consumption/wk, smoking, physical activity, occupational and marital status, social contact, depression, coronary heart disease, stroke, other cardiovascular disease, diabetes, and other cardiovascular risk factors.

Main outcome measures

All-cause mortality, cardiovascular mortality, external deaths (violence, suicide, injuries, and poisonings), and deaths from myocardial infarction (MI).

Main results

136 deaths occurred during follow-up: 59 from cardiovascular causes (28 fatal MIs) and 25 from external causes. Drinking ≥ 6 bottles of beer/session, but not 3 to 5 bottles/session, was associated with increased all-cause mortality, external mortality, and deaths from MI but not cardiovascular mortality (Table).

Conclusions

Drinking ≥ 6 bottles of beer/session was associated with increased all-cause mortality, external deaths, and deaths from myocardial infarction but not cardiovascular mortality in middle-aged men. The association remained after controlling for multiple risk factors.

Sources of funding: Alcoholic Beverage Medical Research Foundation; National Heart, Lung; and Blood Institute; Academy of Finland, Yrjö Jahnsson Foundation, Finland.

For article reprint: Dr. J. Kauhanen, Department of Public Health and General Practice, University of Kuopio, Box 1627, FIN-70211 Kuopio, Finland. FAX 358-17-162937.


Table. Mortality in middle-aged men who usually consume ≥ 6 beers/session

Mortality Adjusted relative risk 95% CI
All-cause 2.05 1.01 to 4.14
External causes 5.78 1.40 to 23.9
Myocardial infarction 7.05 1.93 to 25.7
Cardiovascular disease 2.08 0.69 to 6.27*

*Not significant.


Commentary

The study by Kauhanen and colleagues adds to a growing body of literature showing an association between heavy alcohol consumption and increased mortality. For Kaiser Permanente patients, mortality was increased when usual daily consumption was reported to be ≥ 6 drinks for men and 3 to 5 drinks for women (1). A meta-analysis (2) suggested that consumption of even fewer drinks per day increased mortality, again with sex differences.

Kauhanen and colleagues sought to answer a more specific question in their study of Finnish men who primarily drank beer: Does heavy drinking only intermittently increase mortality, independent of average consumption? This study does not unequivocally show that drinking intensity per occasion independently increases mortality. Because ≥ 9 drinks was the highest response option for drinks/d, average weekly consumption was probably underestimated for many persons who drank heavily (3).

Nevertheless, other reasons exist to ask and advise persons about the number of alcoholic drinks they have per occasion. The frequency of drinking ≥ 5 drinks, independent of average alcohol consumption, was associated with past-year alcohol dependence in a U.S. population-based survey (4). Episodic heavy drinking has also been associated with adverse consequences among college students (5). A useful question for detecting episodic heavy drinking is "How often did you drink 6 or more drinks per session in the past year?" Educating and advising heavy-drinking persons about alcohol use results in decreased average consumption, lower frequency of episodic heavy drinking, and (for men) fewer hospital days (6).

Katharine Bradley, MD, MPH
Veterans Affairs Puget Sound Health Care System, Seattle Division Seattle, Washington, USA


References

1. Klatsky AL, Armstrong MA,Friedman GD. Alcohol and mortality. Ann Intern Med. 1992;117:646-54.

2. Holman CD, English DR, Milne E, Winter MG. Meta-analysis of alcohol and all-cause mortality: a validation of NHMRC recommendations.Med J Aust. 1996;164:141-5.

3. Seppa K, Sillanaukee P, Koivula T. The efficiency of a questionnaire in detecting heavy drinkers. Br J Addict. 1990;85:1639-45.

4. Dawson DA, Archer LD. Relative frequency of heavy drinking and the risk of alcohol dependence. Addiction. 1993; 88:1509-18.

5. Wechsler H, Davenport A, Dowdall G, Moeykens B, Castillo S. Health and behavioral consequences of binge drinking in college. A national survey of students at 140 campuses. JAMA. 1994; 272:1672-7.

6. Fleming MF, Barry KL, Manwell LB, Johnson K, London R. Another indication for screening and early intervention: problem drinking. JAMA. 1997; 277:1079-80.