Dose–Response Relationships Between Levels of Alcohol Use and Risks of Mortality or Disease, for All People, by Age, Sex and Specific Risk Factors
Alcohol use has been causally linked to more than 200 disease and injury conditions, as defined by three-digit ICD-10 codes. The understanding of how alcohol use is related to these conditions is essential to public health and policy research. Accordingly, this study presents a narrative review of different dose–response relationships for alcohol use.
Relative-risk (RR) functions were obtained from various comparative risk assessments. Two main dimensions of alcohol consumption are used to assess disease and injury risk: (1) volume of consumption, and (2) patterns of alcohol use, operationalized via frequency of heavy alcohol use occasions. Lifetime abstention was used as the reference group.
- Most dose–response relationships between alcohol and outcomes are monotonic, but for diabetes type 2 and ischemic diseases, there are indications of a curvilinear relationship, where light to moderate alcohol use is associated with lower risk compared with not using alcohol (i.e., RR < 1).
- In general, women experience a greater increase in RR per gram of alcohol consumed than men. The RR per gram of alcohol consumed was lower for people of older ages.
- RRs indicated that alcohol use may interact synergistically with other risk factors, in particular with socioeconomic status and other behavioral risk factors, such as smoking, obesity, or physical inactivity.
- The literature on the impact of genetic constitution on dose–response curves is underdeveloped, but certain genetic variants are linked to an increased RR per gram of alcohol consumed for some diseases.
When developing alcohol policy measures, including low-risk alcohol use guidelines, dose–response relationships must be taken into consideration.