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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

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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.

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Data availability

The data are not available in a public repository. Access to the data is restricted by the ethical approvals and the legislation of the European Union and the countries of each study. Approval by the Principal Investigator of each cohort study and the MORGAM/ BiomarCaRE Steering Group will be required for release of the data. The MORGAM Manual at https://www.thl.fi/publications/morgam/manual/contents.htm gives more information on access to the data.

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Funding

The MORGAM Project has received funding from EU projects MORGAM (Biomed, BMH4-CT98-3183), GenomEUtwin (FP5, QLG2-CT-2002–01254), ENGAGE (FP7, HEALTH-F4-2007–201413), CHANCES (FP7, HEALTH-F3-2010–242244), BiomarCaRE (FP7, HEALTH-F2-2011–278913), euCanSHare (Horizon 2020, No. 825903) and AFFECT-EU (Horizon 2020, No. 847770); and Medical Research Council, London (G0601463, No. 80983: Biomarkers in the MORGAM Populations). This has supported central coordination, workshops and part of the activities of the MORGAM Data Centre, the MORGAM Laboratories and the MORGAM Participating Centres. The present analysis was partially supported by the Ministero della Salute, Italy. Bando Ricerca Finalizzata 2018 RF-2018–12,367,074. VS was supported by the Finnish Foundation for Cardiovascular Research and Juho Vainio Foundation. SS was supported by the County Council of Västerbotten (ALF, RV-967561), and Umeå University. BS is funded by the German Research Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Author information

Authors and Affiliations

  1. Mediterranea Cardiocentro, Naples, Italy

    Augusto Di Castelnuovo

  2. Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077, Pozzilli, IS, Italy

    Marialaura Bonaccio, Simona Costanzo, Maria Benedetta Donati, Licia Iacoviello & Giovanni de Gaetano

  3. Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia

    Patrick McElduff

  4. Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark

    Allen Linneberg

  5. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Allen Linneberg

  6. Finnish Institute for Health and Welfare, Helsinki, Finland

    Veikko Salomaa, Satu Männistö & Kari Kuulasmaa

  7. Department of Cardiology and INSERM UMR 1295, Toulouse University Hospital, Toulouse, France

    Jean Ferrières

  8. Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE, 59000, Lille, France

    Jean Dallongeville

  9. Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

    Barbara Thorand

  10. Division of Clinical Epidemiology and Aging Research and Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany

    Hermann Brenner

  11. Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy

    Marco Ferrario, Giovanni Veronesi & Licia Iacoviello

  12. Lithuanian University of Health Sciences, Kaunas, Lithuania

    Abdonas Tamosiunas

  13. Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway

    Sameline Grimsgaard

  14. Department of Epidemiology CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland

    Wojciech Drygas

  15. Calisia University, 62-800, Kalisz, Poland

    Wojciech Drygas

  16. The Institute of Internal and Preventive Medicine -Branch of the “FRC Institute of Cytology and Genetics SB RAS”, Novosibirsk, Russia

    Sofia Malyutina

  17. Department of Public Health and Clinical Medicine and Heart Centre, Umeå University, Umeå, Sweden

    Stefan Söderberg & Maria Nordendahl

  18. Centre for Public Health, Queens University of Belfast, Belfast, Northern Ireland

    Frank Kee

  19. Clinica Medica, Università Milano-Bicocca, Milan, Italy

    Guido Grassi

  20. Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany

    Salim Dabboura, Benedikt Schrage, Tanja Zeller & Stefan Blankenberg

  21. Occupational and Preventive Medicine, ASST Lariana, Como, Italy

    Rossana Borchini

  22. Department for Cardiology and Angiology, Medical Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg, Germany

    Dirk Westermann

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  1. Augusto Di Castelnuovo
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  2. Marialaura Bonaccio
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  9. Jean Dallongeville
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  14. Abdonas Tamosiunas
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  15. Sameline Grimsgaard
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  16. Wojciech Drygas
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  28. Stefan Blankenberg
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  29. Maria Benedetta Donati
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  30. Licia Iacoviello
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Consortia

the MORGAM Study Investigators

Contributions

ADC: Conceptualization, Formal analysis, Writing-original draft; MB: Conceptualization, Writing-original draft; SC: Data curation, Formal analysis; PMcE: Data curation, Resources, Writing-review & editing; AL: Data curation, Resources, Writing-review & editing; VS: Data curation, Resources, Writing-review & editing; SM: Data curation; JF: Data curation, Resources, Writing-review & editing; JD: Data curation, Writing-review & editing; BT: Writing-review & editing; HB: Data curation, Writing-review & editing; MF: Data curation, Writing-review & editing; GV: Formal analysis, Methodology; AT: Data curation, Writing-review & editing; SG: Data curation, Writing-review & editing; WD: Data curation; SM: Data curation; SS: Data curation, Writing-review & editing; MN: Data curation; FK: Data curation, Supervision, Writing-review & editing; GG: Data curation; SD: Data curation; RB: Data curation; DW: Data curation; BS: Data curation;; TZ: Data curation, Writing-review & editing; KK: Data curation, Supervision, Writing-review & editing; SB: Project administration, Supervision, Writing-review & editing; MBD: Conceptualization, Supervision, Writing-review & editing; LI: Conceptualization, Project administration, Supervision, Writing-review & editing; GdG: Conceptualization, Supervision, Writing-review & editing.

Corresponding author

Correspondence to Licia Iacoviello.

Ethics declarations

Conflict of interest

ADC reports personal fees as member of the Organizing Committee for the 7th European Beer and Health Symposium (2014), Beer and Health Initiative (The Dutch Beer Institute foundation—The Brewers of Europe), outside the submitted work. SC reports personal fees as member of the Organizing Committee and speaker for the 9th European Beer and Health Symposium (Bruxelles 2019) and for given lecture at the 13th European Nutrition Conference FENS 2019 (Dublin), sponsored by the Beer and Health Initiative (The Dutch Beer Institute foundation—The Brewers of Europe) outside the submitted work. GdG is a member of the International Scientific Forum on Alcohol Research (http://alcoholresearchforum.org), an independent organization of scientists that prepares critiques of emerging research reports on alcohol and health. The members of the Forum donate their time and effort to the review of papers and receive no financial support for their contributions to critiques. The Forum itself receives no support from any organization or company in the alcoholic beverage industry. However, whether the support for individual members is from governmental agencies, universities, private foundations, or other groups, none of these organizations has any input into the conclusions presented in the critiques published on the forum web-site. A detailed disclosure statement signed by each member of the forum is available at: http://alcoholresearchforum.org/disclosure-statement. GdG is a corresponding member of the non-profit Accademia Italiana della Vite e del Vino. VS has received a honorarium from Sanofi for consulting. He also has had research collaboration with Bayer Ltd (all unrelated to the present study). SS reports speakers’ honoraria from Actelion Pharmaceuticals Ltd (unrelated to the present study). JF reports lectures fees from Amgen, MSD, Sanofi and Servier. SM is supported by RAS, #22031700094–5.

Ethical approval

This research was done without any patient involvement. Patients were not invited to comment on the study design and were not consulted to develop patient relevant outcomes or interpret the results. Patients were not invited to contribute to the writing or editing of this document for readability or accuracy.

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Di Castelnuovo, A., Bonaccio, M., Costanzo, S. et al. 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. Eur J Epidemiol 38, 869–881 (2023). https://doi.org/10.1007/s10654-023-01022-3

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