Alcohol consumption, drinking patterns and cause-specific mortality in an Australian cohort of 181,607 participants aged 45 years and over

Objectives: Despite relatively high alcohol consumption in Australia, local evidence regarding drinking and causespecific mortality is limited. We aimed to quantify the risk of alcohol-related causes of death and to calculate contemporary estimates of absolute risk and population attributable fractions for deaths caused by alcohol consumption in Australia. Study design: Prospective cohort study. Methods: Cox proportional hazards regressions were used to calculate hazard ratios (HR) for cause-specific mortality in relation to overall alcohol consumption and pattern of drinking among 181,607 of 267,357 participants aged >= 45 years (2005-2009) in the New South Wales 45 and Up Study, with linkage to death records to December 24, 2019. Cumulative absolute risks and population attributable fractions were estimated. Results: Over a median 11.4 years, there were 18,193 deaths. Every additional seven drinks/week increased risk of death from: alcohol-related cancers combined by 12 % (HR = 1.12; 95%CI = 1.05-1.18); digestive system disease by 32 % (1.33; 1.22-1.44); falls by 23 % (1.23; 1.03-1.46); cardiovascular disease by 7 % (1.07; 1.03-1.11); alcohol-related causes combined by 10 % (1.10; 1.07-1.12); and from all-cause mortality by 6 % (1.06; 1.04-1.08). By age 85 years, men and women who consumed >10 drinks/week were estimated to have 8.5 % and 4.1 % higher cumulative absolute risk of mortality from alcohol-related causes, respectively, compared to those consuming 0 to <1 drink/week. An estimated 9029 deaths (5.3 % of all deaths) were attributable to alcohol consumption in Australia in 2021. Conclusions: Excess risk of death from alcohol consumption in Australia is substantial. Given relatively high alcohol intake, interventions aimed at reducing consumption may translate into significant public health gains.