European Journal of Epidemiology

, Volume 32, Issue 7, pp 627–629 | Cite as

The combined association of alcohol consumption with dementia risk is likely biased due to lacking account of death cases

  • Nadine BinderEmail author
  • Lisa Manderscheid
  • Martin Schumacher

Xu et al. [1] perform a meta-analysis to investigate the potential dose–response association between alcohol consumption and risk of dementia. Despite the thoroughly conducted dose–response analysis, an often disregarded statistical flaw shown to affect dementia studies challenges the overall findings:

Dementia study data has an underlying illness-death structure, as illustrated in Fig.  1: Study participants may not only suffer from dementia, but they may also die during follow-up and this may be with or without prior dementia. Collecting information on the dementia status at follow-up visits only, may, however, result in missing dementia status in individuals who died between two visits. Correspondingly, dementia incidence may be underestimated and relative risk estimates might be substantially biased if naive analyses are performed, e.g. by censoring at the last observed dementia-free time [ 2]. Leffondré et al. recommend that whenever the dementia status is collected at visits only...


Dementia Alcohol Consumption Relative Risk Estimate Death Case Moderate Alcohol Consumption 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Nadine Binder is supported by the German Research Foundation (DFG), Grant Number SCHU 756/12-2.


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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Institute for Prevention and Cancer EpidemiologyFaculty of Medicine and Medical Center - University of FreiburgFreiburgGermany
  2. 2.Institute for Medical Biostatistics, Epidemiology and InformaticsUniversity Medical Center MainzMainzGermany
  3. 3.Institute for Medical Biometry and StatisticsFaculty of Medicine and Medical Center - University of FreiburgFreiburgGermany

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