Alcohol use disorders and mortality: a systematic review and meta-analysis

Aims To conduct a systematic review and meta-analysis on all-cause mortality in people with alcohol use disorders. Methods Using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, studies were identified through MEDLINE, EMBASE, and Web of Science up to August, 2012. Prospective and historical cohort studies including a comparison of alcohol use disorder with a control group investigating all-cause mortality risk were included. Results This meta-analysis included 81 observational studies with 221 683 observed deaths among 853 722 people with alcohol use disorder. In men, the relative risk (RR) among clinical samples was 3.38 (95% confidence interval [CI]: 2.98-3.84); in women it was 4.57 (95% CI: 3.86-5.42). Alcohol use disorders identified in general population surveys showed a twofold higher risk compared with no alcohol use disorder in men; no data were available for women. RRs were markedly higher for those <= 40 years old (ninefold in men, 13-fold in women) while still being at least twofold among those aged 60 years or older. Conclusions Mortality in people with alcohol use disorders is markedly higher than thought previously. Women have generally higher mortality risks than men. Among all people with alcohol use disorders, people in younger age groups and people in treatment show substantially higher mortality risk than others in that group.