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Impact of alcohol intake on total mortality and mortality from major causes in Japan: a pooled analysis of six large-scale cohort studies
  1. Manami Inoue1,
  2. Chisato Nagata2,
  3. Ichiro Tsuji3,
  4. Yumi Sugawara3,
  5. Kenji Wakai4,
  6. Akiko Tamakoshi5,
  7. Keitaro Matsuo6,
  8. Tetsuya Mizoue7,
  9. Keitaro Tanaka8,
  10. Shizuka Sasazuki1,
  11. Shoichiro Tsugane1,
  12. for the Research Group for the Development and Evaluation of Cancer Prevention Strategies in Japan
  1. 1Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
  2. 2Department of Epidemiology & Preventive Medicine, Gifu University School of Medicine, Gifu, Japan
  3. 3Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
  4. 4Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
  5. 5Department of Public Health, Aichi Medical University School of Medicine, Aichi, Japan
  6. 6Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
  7. 7Department of Epidemiology and International Health, Research Institute National Center for Global Health and Medicine, Tokyo, Japan
  8. 8Department of Preventive Medicine, Saga Medical School, Faculty of Medicine, Saga University, Saga, Japan
  1. Correspondence to Manami Inoue, Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan; mnminoue{at}


Objectives Using common alcohol consumption categories, to conduct a pooled analysis of six ongoing large-scale cohort studies in Japan in order to produce concrete estimates of the quantitative contribution of alcohol consumption to all-cause and major causes of mortality in the Japanese population.

Methods Of the 309 082 subjects, there were 35 801 deaths during 3 832 285 person-years of follow-up. Using a random-effect model, we conducted a meta-analysis of the HRs of each alcohol consumption category in each study, thereby obtaining pooled estimates for the risk of total and major causes of mortality due to alcohol consumption.

Results There was a J- or U-shaped association for the risk of total and major causes of mortality in men, and the risk of total and heart disease mortality in women. Compared with non-drinkers, there was a significantly lower risk for total mortality at an alcohol consumption level of <69 g/day, cancer mortality at <46 g/day, heart disease mortality at <69 g/day and cerebrovascular disease mortality at <46 g/day in men, and for total mortality at <23 g/day in women. In addition, mortality risk increased linearly with rising alcohol dose among drinkers. It was estimated that 5% of total mortality, 3% of cancer mortality, 2% of heart disease mortality and 9% of cerebrovascular disease mortality in men, but only 0–1% of these risks in women, could be prevented by reducing alcohol consumption to <46 g/day in men and <23 g/day in women.

Conclusion Maintaining alcohol consumption below 46 g/day in men and 23 g/day in women appears to minimise the risks of mortality in the Japanese population.

  • Pooled analysis
  • cohort study
  • alcohol consumption
  • mortality
  • Japanese
  • alcohol & health

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  • Research group members: Shoichiro Tsugane (principal investigator), Manami Inoue, Shizuka Sasazuki, Motoki Iwasaki, Tetsuya Otani (until 2006), Norie Sawada (since 2007), Taichi Shimazu, Taichi Yamaji (since 2007; National Cancer Center, Tokyo), Ichiro Tsuji (since 2004), Yoshitaka Tsubono (in 2003; Tohoku University, Sendai), Yoshikazu Nishino (Miyagi Cancer Research Institute, Natori, Miyagi), Kenji Wakai (Nagoya University, Nagoya), Keitaro Matsuo (since 2006; Aichi Cancer Center, Nagoya), Chisato Nagata (Gifu University, Gifu), Tetsuya Mizoue (National Center for Global Health and Medicine, Tokyo), Keitaro Tanaka (Saga University, Saga) and Akiko Tamakoshi (Aichi Medical University, Nagakute, Aichi).

  • Funding This study was supported by a grant for the Third Term Comprehensive Control Research for Cancer from the Ministry of Health, Labour and Welfare of Japan.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the National Cancer Center, Aichi Medical University, Tohoku University Graduate School of Medicine and Gifu University Graduate School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.