Association of coincident self-reported mental health problems and alcohol intake with all-cause and cardiovascular disease mortality: A Norwegian pooled population analysis release_epozqn6kg5e43d45i7ounevk5i

by Eirik Degerud, Gudrun Høiseth, Jørg Mørland, Inger Ariansen, Sidsel Graff-Iversen, Eivind Ystrom, Luisa Zuccolo, Øyvind Næss


The disease burden attributable to mental health problems and to excess or harmful alcohol use is considerable. Despite a strong relationship between these 2 important factors in population health, there are few studies quantifying the mortality risk associated with their co-occurrence in the general population. The aim of this study was therefore to investigate cardiovascular disease (CVD) and all-cause mortality according to self-reported mental health problems and alcohol intake in the general population. We followed 243,372 participants in Norwegian health surveys (1994-2002) through 2014 for all-cause and CVD mortality by data linkage to national registries. The mean (SD) age at the time of participation in the survey was 43.9 (10.6) years, and 47.8% were men. During a mean (SD) follow-up period of 16.7 (3.2) years, 6,587 participants died from CVD, and 21,376 died from all causes. Cox models estimated hazard ratios (HRs) with 95% CIs according to a mental health index (low, 1.00-1.50; high, 2.01-4.00; low score is favourable) based on the General Health Questionnaire and the Hopkins Symptom Checklist, and according to self-reported alcohol intake (low, <2; light, 2-11.99; moderate, 12-23.99; high, ≥24 grams/day). HRs were adjusted for age, sex, educational level, marital status, and CVD risk factors. Compared to a reference group with low mental health index score and low alcohol intake, HRs (95% CIs) for all-cause mortality were 0.93 (0.89, 0.97; p = 0.001), 1.00 (0.92, 1.09; p = 0.926), and 1.14 (0.96, 1.35; p = 0.119) for low index score combined with light, moderate, and high alcohol intake, respectively. HRs (95% CIs) were 1.22 (1.14, 1.31; p < 0.001), 1.24 (1.15, 1.33; p < 0.001), 1.43 (1.23, 1.66; p < 0.001), and 2.29 (1.87, 2.80; p < 0.001) for high index score combined with low, light, moderate, and high alcohol intake, respectively. For CVD mortality, HRs (95% CIs) were 0.93 (0.86, 1.00; p = 0.058), 0.90 (0.76, 1.07; p = 0.225), and 0.95 (0.67, 1.33; p = 0.760) for a low index score combined with light, moderate, and high alcohol intake, respectively, and 1.11 (0.98, 1.25; p = 0.102), 0.97 (0.83, 1.13; p = 0.689), 1.01 (0.71, 1.44; p = 0.956), and 1.78 (1.14, 2.78; p = 0.011) for high index score combined with low, light, moderate, and high alcohol intake, respectively. HRs for the combination of a high index score and high alcohol intake (HRs: 2.29 for all-cause and 1.78 for CVD mortality) were 64% (95% CI 53%, 74%; p < 0.001) and 69% (95% CI 42%, 97%; p < 0.001) higher than expected for all-cause mortality and CVD mortality, respectively, under the assumption of a multiplicative interaction structure. A limitation of our study is that the findings were based on average reported intake of alcohol without accounting for the drinking pattern. In the general population, the mortality rates associated with more mental health problems and a high alcohol intake were increased when the risk factors occurred together.
In text/plain format

Published in PLoS Medicine by Public Library of Science (PLoS)
ISSN-L 1549-1277
Volume 17
Issue 2
Page(s) e1003030
Release Date 2020-02-03
Container Type journal
Publisher Public Library of Science (PLoS)
Primary Language en (lookup)

Known Files and URLs

application/pdf  1.4 MB
sha1:6e715ab22aaa8b94affe... (webarchive) (web)
application/pdf  1.5 MB
sha1:01a76d2f7bab13a9931a... (webarchive) (web)
application/pdf  1.5 MB
sha1:ade2cf2992701a8784bc... (webarchive) (web)
application/pdf  1.5 MB
sha1:71ce26f180e7ca33418e... (webarchive) (publisher)
Read Full Text
Type  article-journal
Stage   published
Date   2020-02-03
Container Metadata
Open Access Publication
In Keepers Registery
ISSN-L:  1549-1277
Fatcat Entry
Work Entity
grouping other versions (eg, pre-print) and variants of this release
Cite This Release
Fatcat Bits

State is "active". Revision:
As JSON object via API