European Journal of Epidemiology

, Volume 18, Issue 7, pp 631–642 | Cite as

How stable is the risk curve between alcohol and all-cause mortality and what factors influence the shape? A precision-weighted hierarchical meta-analysis

  • Gerhard Gmel
  • Elisabeth Gutjahr
  • Jürgen Rehm


Objective: To determine the influence of six determining variables on the shape of the risk curve between alcohol and all-cause mortality. Methods: Data: Based on a systematic search with clear inclusion criteria, all articles on alcohol and all-cause mortality until 2000 were included. Statistical methods: Precision-weighted pooling of relative risks (RRs); precision-weighted hierarchical analysis. Variables: For pooling: RRs for different categories of average volume of drinking, lifetime abstainers and ex-drinkers. For hierarchical analysis: on first level: consumption in grams of pure alcohol per day; on second level: length of follow-up time in months; per capita consumption; average age, proportion of abstainers, average volume of drinking, and variability of average volume of drinking at baseline. Outcomes measures: RR of former and current drinkers for all-cause mortality compared to abstainers. Results: The main hypotheses could be confirmed for males: Ex-drinkers had a higher mortality risk than lifetime abstainers; the higher and the more diverse the average volume of alcohol consumption, the wider the dip of the curve; the older the persons at baseline, the more pronounced the protective effect; and the longer the follow-up time, the less pronounced the protective effect. Except for average volume of drinking effects for females went in the same direction but with one exception did not reach significance. Conclusions: There are systematic influences on the shape of the risk curve between alcohol and all-cause mortality. The overall beneficial effect of light to moderate drinking remained under all scenarios, indicating a high validity of the overall shape despite the heterogeneity between studies.

Alcohol All-cause mortality Average consumption Ex-drinker Gender Heavy drinking occasions Hierarchical meta-analysis Pooled analysis 


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Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Gerhard Gmel
    • 1
  • Elisabeth Gutjahr
    • 2
  • Jürgen Rehm
    • 3
  1. 1.Swiss Institute for the Prevention of Alcohol and Drug ProblemsLausanneSwitzerland
  2. 2.Addiction Research InstituteZurichSwitzerland
  3. 3.Centre for Addiction and Mental Health, Toronto; Department of Public Health SciencesUniversity of TorontoTorontoCanada

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