Drinking alcohol in moderation is associated with lower rate of all-cause mortality in individuals with higher rather than lower educational level

Drinking alcohol in moderation has been a topic of interest in relation to its impact on all-cause mortality, and its association with socioeconomic status has been extensively explored. However, the potential modification of this association by educational level remains relatively unexplored. To address this gap, a recent study was conducted using data from the MORGAM Project, comprising 16 cohorts and a total of 142,066 participants.
The aim of this study was to assess the association between alcohol consumption patterns and the hazard of all-cause mortality across different educational levels. Educational level was categorized into three groups: lower (primary school), middle (secondary school), and higher (university/college degree).
Over a median follow-up period of 11.8 years, a total of 16,695 deaths occurred. The analyses revealed intriguing associations between alcohol intake and mortality rates based on educational level. Compared to lifelong abstainers, individuals who consumed 0.1-10 g/d of ethanol exhibited a 13% lower rate of death among those with higher educational level (HR=0.86; 95%CI: 0.74-1.02), an 11% lower rate among those with middle educational level (HR=0.89; 0.84-0.95), but only a 5% lower rate among those with lower educational level (HR=0.95; 0.89-1.02).
In contrast, while participants who consumed more than 20 g/d of ethanol had a 1% higher rate of death only if among those with higher educational level (HR=1.01; 0.82-1.25), a 10% higher rate was observed among those with middle educational level (HR=1.10; 1.02-1.19), and a 17% higher rate among those with lower educational level (HR=1.17; 1.09-1.26).
Moreover, the analysis revealed a nonlinear association between alcohol consumption and all-cause mortality, with a distinct J-shaped curve that varied across different educational levels. This relationship remained consistent across both sexes and different approaches to measuring alcohol consumption, including quantity, frequency, and beverage preference, with wine showing a more pronounced effect.
In conclusion, this large international study suggests that the well-known different impact of both moderate and high alcohol consumption on mortality rates also differs based on educational level. Moderate drinking (≤10 g/d) was associated with a lower mortality rate, particularly among individuals with higher educational level, while heavy drinking was associated with a higher mortality rate, especially among those with lower educational level. These findings, besides confirming a distinct J shaped relationship between moderate alcohol intake and mortality, highlight the importance of targeted interventions and advice to reduce excessive alcohol intake, particularly among individuals with lower educational level.
Source: Di Castelnuovo A, Bonaccio M, Costanzo S, McElduff P, Linneberg A, Salomaa V, Männistö S, Ferrières J, Dallongeville J, Thorand B, Brenner H, Ferrario M, Veronesi G, Tamosiunas A, Grimsgaard S, Drygas W, Malyutina S, Söderberg S, Nordendahl M, Kee F, Grassi G, Dabboura S, Borchini R, Westermann D, Schrage B, Zeller T, Kuulasmaa K, Blankenberg S, Donati MB, Iacoviello L; MORGAM Study Investigators; de Gaetano G. 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. 2023 Jun 30.