Rising alcohol consumption in China linked to increased risk of 61 diseases

By Tarun Sai LomteReviewed by Benedette Cuffari, M.Sc.Jun 12 2023

A recent study published in Nature Medicine evaluates the associations between alcohol consumption and the risk of diseases in Chinese adults.

Study: Alcohol consumption and risks of more than 200 diseases in Chinese men. Image Credit: ENZELEN / Shutterstock.com

Rising alcohol use throughout the world

Alcohol consumption is a risk factor for poor health and globally accounts for over three million deaths each year. Notably, alcohol consumption rates have increased in low- and middle-income countries since the 1990s. Likewise, the proportion of Chinese adult males reporting alcohol consumption in the past year increased from 59% in 1990 to 85% in 2017.

Epidemiologic studies involving Western populations have reported the hazards of consuming alcohol for numerous diseases, including cancers, cirrhosis, cardiovascular disease (CVD), and infectious diseases. However, studies conducted in Western populations may not apply to the Chinese population due to marked heterogeneity in disease patterns and alcohol consumption.

About the study

Over 512,000 adults between 30 and 79 years of age were recruited between 2004 and 2008 from 10 regions throughout China. At baseline, participants were asked to indicate their alcohol consumption frequency in the past year.

Accordingly, the study participants were classified as non-, ex-, occasional, and current drinkers. Participants’ vital status was periodically assessed from local death registries and additional records.

Morbidity data were obtained from disease registries and the health insurance system. All recorded injuries and diseases were reviewed. The major diseases likely to be causally linked with alcohol consumption, according to the World Health Organization (WHO), were also analyzed for associations with consumption.

The researchers genotyped the East Asian genetic variants of alcohol dehydrogenase 1 B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2), namely ADH1B-rs1229984 and ALDH2-rs671, and derived a genetic instrument for alcohol consumption. Nine genotypic combinations were studied, and the alcohol intake for each genotype was calculated.

Study findings

At baseline, the average age of participants was 52, 56% of whom were from rural areas, and 41% were male. Among males, 33% were current drinkers, with an average consumption rate of 286 g/week.

Ex- and non-drinkers were more often older with poor self-rated health as compared to current or occasional drinkers. Heavy drinkers were primarily rural residents with lower education, unhealthier lifestyle, and higher average blood pressure than moderate drinkers, the latter of whom consumed less than 140 g/week.

About 62% of current male drinkers reported daily consumption, and 37% engaged in heavy episodic drinking. Only 2% of females reported drinking at least weekly.

More than 134,000 males and 198,400 females had at least one hospitalization during a median follow-up duration of 12.1 years. Over 1.1 million hospitalizations were reported throughout the study period, including 333,541 from 207 diseases among males and 476,986 from 48 diseases among females.

Alcohol consumption in males was significantly associated with elevated risks for 61 disease outcomes. Only 28 of these 61 diseases were considered by the WHO as alcohol-related, of which included six cancers, tuberculosis, diabetes, hypertensive disorders, cerebrovascular diseases, pneumonia, pancreatitis, cirrhosis, alcoholic liver disease, myopathy, chronic ischemic heart disease (IHD), and external causes of harm.

The remaining 33 new alcohol-associated diseases included stomach or lung cancer, six digestive diseases, three musculoskeletal conditions, circulatory diseases, as well as behavioral and psychiatric conditions. Overall, 44 diseases exhibited dose-response associations with alcohol intake. Notably, inguinal hernia, non-toxic goiter, and prostate hyperplasia showed significant inverse associations with alcohol consumption after adjusting for false-rate discovery.  

Daily or heavy episodic consumption and drinking spirits were associated with increased risks for alcohol-related diseases among current drinkers in males. Due to the lower proportion of current drinkers among females and, as a result, the lack of statistical power, the associations between alcohol consumption and disease risks could not be evaluated.

ALDH2-rs671 and ADH1B-rs1229984 showed a strong association in males with alcohol consumption. The genetic instrument predicted a 60-fold difference in the average alcohol consumption across genetic categories in males. The predicted average alcohol consumption was positively associated with established and new alcohol-associated diseases among males.

In males, the genetic associations were stronger for stroke, cirrhosis, and gout. No dose-response genotypic associations were significant for IHD, prostate hyperplasia, and inguinal hernia.

Hospitalizations for any cause were higher among male ever-regular drinkers than occasional drinkers, especially for cancer. These differences increased with age, except for CVD hospitalizations.

Conclusions

The researchers of the current study comprehensively assessed the impact of alcohol intake on disease outcomes among Chinese adults. To this end, alcohol consumption in males was significantly associated with increased risks of 61 diseases and hospitalizations, with 33 diseases identified as new alcohol-associated diseases.

Taken together, these observations emphasize the importance of reducing alcohol intake in China as a public health priority.