Alcohol consumption: context and association with mortality in Switzerland
Non-communicable diseases (NCDs), such as cardiovascular diseases, diabetes, and cancers are the leading causes of death. Moreover, NCDs cause most avoidable deaths often related to well-known risk factors, such as alcohol, tobacco, and unhealthy diets. This study investigates the association between amount and context of alcohol consumption and mortality from major non-communicable diseases in Switzerland.
The data used for this study were combined from three different sources: the menuCH study, the Swiss population census data, and the Swiss mortality data . The three data sources were combined at the district level.
The menuCH study is a cross-sectional population-based study conducted between January 2014 and February 2015 in ten centers across Switzerland. The study included two 24-hour dietary recalls (asking people what they had eaten the previous 24 hours) and one questionnaire about sociodemographic, dietary, and lifestyle factors.
Each menuCH participant was categorized into one of six alcohol consumption groups considering the participant’s pure alcohol intake from alcoholic beverages in the 24 HDR as well as information on general alcohol avoidance from the self-administered questionnaire. Participants, who did not consume alcoholic beverages in the 24 HDR and reported alcohol avoidance were categorized as ‘abstainer’, whereas participants who did not report alcohol consumption in the 24 HDR but did not report alcohol avoidance were categorized as ‘safe_no’.
Participants, who did consume alcoholic beverages in the 24 HDR were categorized into four groups. On the one hand, the categorization was based on whether the participants consumed more pure alcohol during or outside mealtime (‘during’ and ‘outside’ alcohol users, respectively). If the participants used alcohol on average more than recommended (women: 12 g pure alcohol per day; men: 24 g pure alcohol), they were categorized as heavy alcohol users (‘heavy’) and otherwise categorized as safe alcohol users (‘safe’). Therefore, the resulting six alcohol consumption groups were: ‘abstainer’, ‘safe_no’, ‘safe_during’, ‘safe_outside’, ‘heavy_during’, or ‘heavy_outside’.
In general, the consumption of alcoholic beverages tended to increase mortality rates, especially for all-cancer and upper aero-digestive tract cancer mortality.
- Heavy, during mealtime alcohol users had a higher risk of all-cancer (relative risk 1.05), breast cancer (RR = 1.10) and upper aero-digestive tract cancer (RR = 1.19) mortality.
- Heavy, outside mealtime alcohol users had an increased upper aero-digestive tract cancer (RR = 1.20) and diabetes mortality (RR = 1.35).
- Even for “safe” alcohol users (this is the category researchers used for those who use less alcohol than the official Swiss recommendations) there was evidence for an increased risk of all-cancer that was just as high as for heavy, during mealtime alcohol users (safe_during: RR = 1.07), liver cancer (safe_outside: RR = 1.27), and upper aero-digestive tract cancer (safe_during: RR = 1.15) mortality.
In conclusion, significant associations of alcohol consumption with all-cancer and upper aero-digestive tract cancer mortality were detected, indicating an increased mortality rate with increasing alcohol intake.
For the other investigated causes of death, the results pointed in the same direction, but were statistically not significant.
Non-communicable diseases generate the largest number of avoidable deaths often caused by risk factors such as alcohol, smoking, and unhealthy diets. The study investigates the association between amount and context of alcohol consumption and mortality from major NCDs in Switzerland.
Generalized linear regression models were fitted on data of the cross-sectional population-based National Nutrition Survey menuCH (2014–2015, n = 2057). Mortality rates based on the Swiss mortality data (2015–2018) were modeled by the alcohol consumption group considering the amount and context (i.e., during or outside mealtime) of alcohol consumption and potential confounders. The models were checked for spatial autocorrelation using Moran’s I statistic. Integrated nested Laplace approximation (INLA) models were fitted when evidence for missing spatial information was found.
Higher mortality rates were detected among alcohol users compared to non-alcohol users for all-cancer (rate ratio (RR) ranging from 1.01 to 1.07) and upper aero-digestive tract cancer (RR ranging from 1.15 to 1.20) mortality. Global Moran’s I statistic revealed spatial autocorrelation at the Swiss district level for all-cancer mortality. An INLA model led to the identification of three districts with a significant decrease and four districts with a significant increase in all-cancer mortality.
Significant associations of alcohol consumption with all-cancer and upper aero-digestive tract cancer mortality were detected. The study results indicate the need for further studies to improve the next alcohol-prevention scheme and to lower the number of avoidable deaths in Switzerland.