DLM: Alcohol (2001)
Citation:
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
To examine the association between intake of different types of alcoholic beverages and mortality.
Inclusion Criteria:
Subjects were a subsample of the Copenhagen city heart study, aged 20 or more, living in the Osterbro-area of Copenhagen in 1976.
Exclusion Criteria:
- Subjects who reported having more than five drinks per day of beer, wine or spirits
- Subjects who abstained from drinking due to medical treatment or dipsomania.
Description of Study Protocol:
- 6,051 women and 7,234 women, 30 to 70 years of age taken from a random, age-stratified sample of 19,698 from 87,172 living in Copenhagen, Denmark
- Subjects completed self-administered questionnaires related to health characteristics including: Alcohol intake, smoking, education and household income
- Alcohol consumption divided into categories of beer, wine and spirits with frequency of each
- Population sample followed until January 1988 and outcomes analyzed.
Data Collection Summary:
- Self-administered questionnaire on health, education, income, alcohol use and smoking collected 1976 to 1978
- Coded follow-up on medical outcomes of subsample population through January 1988 including death certificates from the National Board of Health
- Height and weight used to calculate BMI
- Alcohol intake determined by asking if beer, wine or spirits was taken hardly ever/never, monthly, weekly or daily
- Smoking amounts measured as non-smoker, former smoker (number of years) and amount of tobacco per day
- Outcome measures: Number and time of cause-specific deaths from 1976 to 1988.
Description of Actual Data Sample:
- Alcohol consumption:
- 5,858 drank both wine and beer
- 5,408 drank both wine and spirit
- 4,629 drank spirit and beer
- 77 drank wine, beer and spirit daily
- 2,745 (2,120 females, 625 males) never drank alcohol
- Mortality:
- 2,229 total deaths (831 females, 1,398 males)
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1,119 deaths (354 females, 765 males) from cardiovascular and cerebrovascular disease.
Summary of Results:
- Relative risk (RR) of alcohol consumption on mortality compared to non drinkers:
- Wine (three to five glasses per day) 0.51 (95% CI, 0.32 to 0.81)
- Spirits (three to five per day) 1.34 (95% CI, 1.05 to 1.71)
- Beer (three to five per day) 0.72 (95% CI, 0.61 to 0.88)
- Wine drinking showed the same relation to risk of death from cardiovascular and cerebrovascular disease as to risk of death from all causes
- Low to moderate intake of wine is associated with lower mortality from cardiovascular and cerebrovascular disease and other causes
- Similar intake of spirits implied an increased risk, while beer drinking did not affect mortality.
Author Conclusion:
Light and moderate wine drinking, in contrast with beer and spirits drinking, is associated with a strong dose-dependent decrease in all cause mortality. This is attributable to a decrease in mortality from cardiovascular and cerebrovascular disease, as well as from other causes.
Funding Source:
Government: | Danish National Board of Health |
Reviewer Comments:
- Very large sample, but no dietary intake information
- Unclear if height and weight reported or measured and if BMI changed over time.
Quality Criteria Checklist: Primary Research
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Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | Yes | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | Yes | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | Yes | |
2. | Was the selection of study subjects/patients free from bias? | Yes | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | Yes | |
2.2. | Were criteria applied equally to all study groups? | Yes | |
2.3. | Were health, demographics, and other characteristics of subjects described? | No | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | Yes | |
3. | Were study groups comparable? | Yes | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | Yes | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | Yes | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | N/A | |
3.4. | If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? | Yes | |
3.5. | If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) | N/A | |
3.6. | If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? | N/A | |
4. | Was method of handling withdrawals described? | Yes | |
4.1. | Were follow-up methods described and the same for all groups? | Yes | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | Yes | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | Yes | |
4.4. | Were reasons for withdrawals similar across groups? | N/A | |
4.5. | If diagnostic test, was decision to perform reference test not dependent on results of test under study? | N/A | |
5. | Was blinding used to prevent introduction of bias? | N/A | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | N/A | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | N/A | |
5.3. | In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? | N/A | |
5.4. | In case control study, was case definition explicit and case ascertainment not influenced by exposure status? | N/A | |
5.5. | In diagnostic study, were test results blinded to patient history and other test results? | N/A | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | Yes | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | N/A | |
6.2. | In observational study, were interventions, study settings, and clinicians/provider described? | N/A | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | Yes | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | No | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | No | |
6.6. | Were extra or unplanned treatments described? | No | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | Yes | |
6.8. | In diagnostic study, were details of test administration and replication sufficient? | N/A | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | Yes | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | Yes | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | N/A | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | Yes | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | Yes | |
7.5. | Was the measurement of effect at an appropriate level of precision? | Yes | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | Yes | |
7.7. | Were the measurements conducted consistently across groups? | Yes | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | Yes | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | Yes | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | Yes | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | Yes | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | N/A | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | Yes | |
8.6. | Was clinical significance as well as statistical significance reported? | Yes | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | N/A | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | Yes | |
9.1. | Is there a discussion of findings? | Yes | |
9.2. | Are biases and study limitations identified and discussed? | Yes | |
10. | Is bias due to study's funding or sponsorship unlikely? | Yes | |
10.1. | Were sources of funding and investigators' affiliations described? | Yes | |
10.2. | Was the study free from apparent conflict of interest? | Yes | |