25 January 2019 In Cardiovascular System

BACKGROUND AND AIMS: Epidemiological evidence on the impact of different alcohol drinking patterns on health-care systems or hospitalizations is sparse. We investigated how the different average volumes of alcohol consumed relate to all-cause and cause-specific hospitalizations.

DESIGN: Prospective cohort study (baseline 2005-10) linked to a registry of hospital discharge records to identify hospitalizations at follow-up (December 2013).

SETTING: Molise region, Italy.

PARTICIPANTS: A total of 20 682 individuals (48% men, age >/= 35 years) who participated in the Moli-sani Study and were free from cardiovascular disease or cancer at baseline.

MEASUREMENTS: The alcohol volume consumed in the year before enrolment was classified as: life-time abstainers, former drinkers, occasional drinkers and current drinkers who drank 1-12 (referent), 12.1-24, 24.1-48 and > 48 g/day of alcohol. Cause-specific hospitalizations were assigned by Italian Diagnosis Related Groups classification or by ICD-9 code of main admission diagnoses. Incidence rate ratios (IRR) of hospitalization were estimated by Poisson regression, taking into account the total number of admissions that occurred during the follow-up per person.

FINDINGS: During a median follow-up of 6.3 years, 12 996 multiple hospital admissions occurred. In multivariable analyses, life-time abstainers and former drinkers had higher rates of all-cause [IRR = 1.11, 95% confidence interval (CI) = 1.05-1.17 and IRR = 1.19, 95% CI = 1.02-1.31, respectively] and vascular (IRR = 1.14, 95% CI = 1.02-1.27 and IRR = 1.48, 95% CI = 1.24-1.76, respectively) hospitalizations compared with light alcohol consumers. Alcohol consumption > 48 g/day was associated with a higher rate of hospitalization for both alcohol-related diseases (IRR = 1.74, 95% CI = 1.32-2.29) and cancer (IRR = 1.36, 95% CI = 1.12-1.65). The magnitude of the association between heavier alcohol intake and hospitalization tended to be greater in smokers than non-smokers. No associations were observed with hospitalization for trauma or neurodegenerative diseases.

CONCLUSIONS: Moderate alcohol consumption appears to have a modest but complex impact on global hospitalization burden. Heavier drinkers have a higher rate of hospitalization for all causes, including alcohol-related diseases and cancer, a risk that appears to be further magnified by concurrent smoking.

15 December 2016 In General Health

BACKGROUND AND AIMS: Data regarding smoking and alcohol consumption and risk of gastrointestinal bleeding (GIB) are sparse and conflicting. We assessed the risk of major GIB associated with smoking and alcohol consumption in a large, prospective cohort.

METHODS: We prospectively studied 48,000 men in the Health Professional follow-up Study (HPFS) who were aged 40-75 years at baseline in 1986. We identified men with major GIB requiring hospitalization and/or blood transfusion via biennial questionnaires and chart review.

RESULTS: We documented 305 episodes of major GIB during 26 years of follow-up. Men who consumed >30 g/day of alcohol had a multivariable relative risk (RR) of 1.43 (95% confidence interval (CI), 0.88-2.35; P for trend 0.006) for major GIB when compared with nondrinkers. Alcohol consumption appeared to be primarily related to upper GIB (multivariable RR for >30 g/day vs. nondrinkers was 1.35; 95% CI, 0.66-2.77; P for trend 0.02). Men who consumed >/= 5 drinks/week vs. < 1 drink/month of liquor had a multivariable RR of 1.72 (95% CI, 1.26-2.35, P for trend <0.001). Wine and beer were not significantly associated with major GIB. The risk of GIB associated with NSAIDs/aspirin use increased with greater alcohol consumption (multivariable RR 1.37; 95% CI, 0.85-2.19 for 1-14g/day of alcohol, RR 1.75; 95% CI, 1.07-2.88 for >/= 15g/day compared to nondrinkers). Smoking was not significantly associated with GIB.

CONCLUSIONS: Alcohol consumption, but not smoking, was associated with an increased risk of major GIB. Associations were most notable for upper GIB associated with liquor intake. Alcohol appeared to potentiate the risk of NSAID-associated GIB.

22 March 2016 In Cardiovascular System

BACKGROUND: Habitual moderate alcohol consumption is associated with a lower risk of acute myocardial infarction (MI), whereas heavy (binge) drinking is associated with higher cardiovascular risk. However, less is known about the immediate effects of alcohol consumption on the risk of acute MI and whether any association differs by beverage type or usual drinking patterns.

METHODS: We conducted a case-crossover analysis of 3869 participants from the Determinants of Myocardial Infarction Onset Study who were interviewed during hospitalization for acute MI in one of the 64 medical centers across the United States in 1989-1996. We compared the observed number of times that each participant consumed wine, beer, or liquor in the hour preceding MI symptom onset with the expected frequency based on each participant's control information, defined as the number of times the participant consumed alcohol in the past year.

RESULTS: Among 3869 participants, 2119 (55%) reported alcohol consumption in the past year, including 76 within 1 hour before acute MI onset. The incidence rate of acute MI onset was elevated 1.72-fold (95% confidence interval [CI] = 1.37-2.16) within 1 hour after alcohol consumption. The association was stronger for liquor than for beer or wine. The higher rate was not apparent for daily drinkers. For the 24 hours after consumption, there was a 14% lower rate (relative risk = 0.86 [95% CI = 0.79-0.95]) of MI compared with periods with no alcohol consumption.

CONCLUSIONS: Alcohol consumption is associated with an acutely higher risk of MI in the subsequent hour among people who do not typically drink alcohol daily.

16 September 2015 In General Health

BACKGROUND: To justify alcohol-related health promotion programs and target them at the correct workplaces, it is important to identify occupations with increased risk of severe health outcomes caused by alcohol.

METHODS: Data on hospital admissions (854 555 men and 801 653 women) from the Finnish health care register and data on deaths from Statistics Finland from 1 January 2001 to 31 December 2004 were merged with information from the 2000 population census. We assessed the age- and education-adjusted relationship between occupation and the sum of hospitalizations and death primarily caused by alcohol, using Cox proportional hazards regression. We also estimated the fraction of incidence of severe alcohol-induced health outcomes that are attributable to factors related to one's occupation (population attributable fraction).

RESULTS: Most of the cases were men (80%), middle-aged and usually had no more than a secondary level of education. When the reference was professionals, who were at the lowest risk, those at increased risk were mostly manual workers in craft work, construction and service. However, we also found several non-manual occupations at a high risk. According to population attributable fraction, the proportion of severe alcohol-induced health outcomes would have been 31% lower among men and 20% lower among women if all occupational groups had been at the same risk as professionals.

CONCLUSIONS: We detected considerable occupational differences in alcohol-induced morbidity and mortality among a nationally representative working population. This indicates a need for alcohol-focused health promotion programs in these high-risk occupations.

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