What Does Research Show Regarding Alcohol and Lifespan?
High-Quality Studies on Alcoholic Beverages and Longevity
While the potential harms of alcohol are well-known, media stories sometimes associate low alcohol intakes with greater longevity.
Is there any truth to this?
To examine this issue, we will review several recent, large studies involving thousands of participants. These studies are all systematic reviews focusing on alcohol’s impact on all-cause mortality and lifespan.
Study 1: Alcohol Consumption and All-Cause Mortality (USDA Nutrition Evidence Systematic Review)
Title: Alcohol Consumption and All-Cause Mortality: A Systematic Review
Authors: Elizabeth Mayer-Davis et al. USDA Nutrition Evidence Systematic Review.
This review examined the findings from 60 studies on alcohol consumption and all-cause mortality.
Key findings:
There was consistent evidence linking frequent binge-drinking (more than five drinks per occasion) to higher all-cause mortality.
All-cause mortality risk was higher in individuals with greater aaverage alcohol consumption. Among those who drank alcohol, the lowest risk was observed at less than two drinks per day for men and fewer than one drink for women.
Among 25 studies comparing light drinkers to never drinkers, approximately half found that “low average consumption” of alcohol was associated with a lower risk of mortality compared to abstainers. Most of the other half found no significant relationship, although two studies noted a higher risk of mortality in light drinkers compared to never drinkers.
Study 2: Alcohol Use Disorder and Mortality
Title: The Risk Relationships Between Alcohol Consumption, Alcohol Use Disorder, and Alcohol Use Disorder Mortality: A Systematic Review and Meta-Analysis
This systematic review examined 10 studies investigating the impact of alcohol intake, alcohol use disorder, and mortality.
Key findings:
Consuming four standard drinks per day (10g of alcohol per drink) increased the risk of developing an alcohol use disorder by 610%.
This level of intake was associated with 4x higher mortality risk compared to non-drinkers.
Patients with alcohol use disorders faced a 213% higher mortality risk per 1000 person-years.
Study 3: Low-Volume Alcohol Use, Bias, and Mortality Risk
Title: Why Do Only Some Cohort Studies Find Health Benefits From Low-Volume Alcohol Use? A Systematic Review and Meta-Analysis of Study Characteristics That May Bias Mortality Risk Estimates
This systematic review investigated potential biases in observational studies that reported benefits from low-volume alcohol consumption.
Key findings:
When former/occasional drinkers were separated from non-drinkers, low-volume drinkers had the same mortality risk as non-drinkers.
However, when studies accounted for smoking and socioeconomic status, low-volume drinkers had a 16% higher mortality risk compared to abstainers.
Study 4: Alcohol Consumption and All-Cause Mortality
Title: The Association Between Alcohol Consumption and All-Cause Mortality: An Umbrella Review of Systematic Reviews Using Lifetime Abstainers or Low-Volume Drinkers as a Reference Group
This umbrella review of systematic reviews identified 25 relevant studies on alcohol intake and all-cause mortality.
Key findings:
Only five of the 25 systematic reviews excluded former drinkers from the reference group, raising concerns about “sick-quitter” bias.
Among the five systematic reviews that excluded former drinkers, higher alcohol intake correlated with a significant 28% to 270% increase in mortality risk.
Study 5: Alcohol Consumption, Lifestyle Factors, and Mortality
Title: The Independent and Joint Risks of Alcohol Consumption, Smoking, and Excess Weight on Mortality: A Systematic Review and Meta-Analysis Exploring Synergistic Associations
This systematic review and meta-analysis included 107 studies on alcohol use and all-cause mortality published between 1980 and 2021.
Key findings included:
Occasional (<1.3 grams of alcohol per day) and low-volume (1.3-2.4 grams per day) drinkers had no statistically significant mortality risk differences compared to non-drinkers.
Drinking 45-64 grams of alcohol per day was associated with a 19% higher mortality risk.
Consuming over 65 grams per day increased the risk to 35% higher.
Study 8: Alcohol Dose and Mortality Risk
Title: Dose-Response Relationships Between Levels of Alcohol Use and Risks of Mortality or Disease, for All People, by Age, Sex, and Specific Risk Factors
Authors: Jürgen Rehm, Pol Rovira, Laura Llamosas-Falcon, Kevin D Shield
This systematic review investigated the dose-response relationship between alcohol consumption and all-cause mortality.
Key findings included:
All-cause mortality increased with rising alcohol intake when compared to lifetime abstainers.
Dose-response curves were exponential, with heavier drinkers seeing the greatest risk reduction by reducing intake.
Study 9: Alcohol and Mortality In Patients With Cardiovascular Disease
Title: Association of Alcohol Consumption With Morbidity and Mortality in Patients With Cardiovascular Disease: Original Data and Meta-Analysis of 48,424 Men and Women
This systematic review and meta-analysis assessed data on 48,423 patients with a previous cardiovascular event. The goal was to determine how alcohol consumption is associated with all-cause mortality and cardiovascular mortality in patients with cardiovascular disease.
Key findings included:
Low to moderate alcohol consumption reduced mortality risk in doses up to 62 grams per day.
A dose of 7 grams per day offering the most significant risk reduction.
However, in studies that excluded former drinkers from the ‘non drinkers’ reference group, these benefits were no longer observed, indicating bias.
There is No Recognized Safe Dose of Alcohol
The evidence is more straightforward regarding alcohol’s links to an increased risk of cancer.
The World Health Organization states: “no level of alcohol consumption is safe for our health” (1).
Why alcohol increases cancer risk:
Alcohol is classified as a Group 1 carcinogen (like tobacco) by the International Agency for Research on Cancer (IARC)
This classification has been given “due to sufficient evidence of alcohol having a causal relationship with numerous types of cancer” (2).
Alcohol consumption significantly increases the risk of developing breast, colorectal, esophageal, head and neck, and liver cancers (3).
How Does Alcohol Impact Lifespan?
Some studies link light drinking to a potentially lower risk of cardiovascular and all-cause mortality.
However, this could be due to “sick-quitter” bias, where former drinkers are grouped as “non-drinkers.”
The majority of studies include former drinkers in “non-drinker” reference groups.
Excluding former drinkers often reveals that mortality risks increase with alcohol intake.
For instance, current drinkers with low alcohol intake may have better health outcomes than those who formerly quit alcohol due to ill health.
Where the studies examined in this article agree is that heavy drinking significantly increases the risk of cause-specific and all-cause mortality.
It is also important to note that alcohol can be addictive, and alcohol use disorders can significantly decrease life expectancy. In a large observational study, life expectancy ranged from only 47 to 58 years in people hospitalized due to alcohol use disorder. This is more than two decades below the average life expectancy (4).
In regard to lifespan, based on the data and recommendations from public health organizations, the best option for non-drinkers would be to continue abstaining from alcohol consumption.
For individuals who continue to consume alcohol, low intakes are associated with the smallest risk. The Dietary Guidelines for Americans 2020-2025 classify “low alcohol intake” as one drink or less for women and two drinks or less for men per day (5, 6).
That said, remember that no level of alcohol consumption is entirely safe, particularly concerning cancer risk.
Michael works as a nutritionist in a community setting and holds a Master's Degree in Clinical Nutrition. He is a Registered Associate Nutritionist with the Association for Nutrition.
