Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis

Philippe Laramée, Saoirse Leonard, Amy Buchanan-Hughes, Samantha Warnakula, Jean-Bernard Daeppen, Jürgen Rehm, Philippe Laramée, Saoirse Leonard, Amy Buchanan-Hughes, Samantha Warnakula, Jean-Bernard Daeppen, Jürgen Rehm

Abstract

Background: Alcohol dependence (AD) carries a high mortality burden, which may be mitigated by reduced alcohol consumption. We conducted a systematic literature review and meta-analysis investigating the risk of all-cause mortality in alcohol-dependent subjects.

Methods: MEDLINE, MEDLINE In-Process, Embase and PsycINFO were searched from database conception through 26th June 2014. Eligible studies reported all-cause mortality in both alcohol-dependent subjects and a comparator population of interest. Two individuals independently reviewed studies. Of 4540 records identified, 39 observational studies were included in meta-analyses.

Findings: We identified a significant increase in mortality for alcohol-dependent subjects compared with the general population (27 studies; relative risk [RR] = 3.45; 95% CI [2.96, 4.02]; p < 0.0001). The mortality increase was also significant compared to subjects qualifying for a diagnosis of alcohol abuse or subjects without alcohol use disorders (AUDs). Alcohol-dependent subjects continuing to drink heavily had significantly greater mortality than alcohol-dependent subjects who reduced alcohol intake, even if abstainers were excluded (p < 0.05).

Interpretation: AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption.

Keywords: Abstinence; Alcohol dependence; Alcoholism; Meta-analysis; Mortality; Systematic review.

Figures

Fig. 1
Fig. 1
PRISMA flowchart.
Fig. 2
Fig. 2
Random-effects and fixed-effect meta-analyses of mortality risk in a) alcohol-dependent subjects vs the general population, b) alcohol-dependent subjects vs subjects without AUDs, and c) alcohol-dependent subjects vs subjects qualifying for a diagnosis of alcohol abuse. aHR, OR, RR or SMR (depending on study); bHR, OR or RR (depending on study); cCollege cohort; dCore city cohort.
Fig. 3
Fig. 3
Random-effects and fixed-effect meta-analyses of mortality risk in alcohol-dependent subjects with continued heavy drinking vs a) alcohol-dependent subjects who reduced their alcohol intake (excluding abstainers), b) alcohol-dependent subjects who reduced their alcohol intake (including abstainers), and c) abstinent alcohol-dependent subjects. aHR, OR or RR (depending on study).

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