Association of alcohol, alcohol and tobacco with mortality: findings from a prospective cohort study in Mumbai (Bombay), India

The aim of the present study was to examine the association between alcohol, alcohol and tobacco, and mortality in a large adult population in the city of Mumbai. A total of 35,102 men aged 45 years and older were surveyed about their alcohol drinking as part of a cohort study. These respondents were followed up over time, and all deaths were recorded. Compared with those who never drank alcohol, alcohol drinkers had 1.22 times higher risk of mortality, with the highest risk observed for liver disease (hazard ratio [HR] = 3.19). Among ever drinkers, risk of mortality varied according to types (country/desi), frequency (four or less times a week, HR = 1.39), and quantity of alcohol consumed (>100 mL) per day. In addition, country/desi drinkers (HR = 1.34) had the highest mortality risk compared with all other types of alcohol (HR = 0.97). Alcohol drinkers had increased risk of mortality for tuberculosis (HR = 2.53), cerebrovascular disease (HR = 1.83), and liver disease (HR = 3.19). Synergistic joint effect of tobacco and alcohol on mortality was also observed, with lowest risk in never tobacco user drinkers (HR = 1.02) and highest in mixed tobacco user drinkers (HR = 1.79). The results of this study show a direct association between greater consumption of alcohol and increased risk of mortality from alcohol-specific causes. In addition to individual effect, this study demonstrates the synergistic interaction between alcohol and tobacco use in various forms on mortality.