Journal of Preventive Medicine and Public Health

Original Articles

Age-period-cohort Analysis of Healthy Lifestyle Behaviors Using the National Health and Nutrition Survey in Japan: Tasuku Okui; J Prev Med Public Health. 2020;53(6):409-418. Published online August 13, 2020; DOI: https://doi.org/10.3961/jpmph.20.159

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Objectives
This study conducted an age-period-cohort (APC) analysis of trends in healthy lifestyle behaviors in Japan.
Methods
We used National Health and Nutrition Survey data on salt intake and prevalence of smoking, drinking, and physical activity between 1995 and 2018 in Japan. Age groups were defined from 20 years to 69 years old in 10-year increments. Cohorts were defined for each age group of each year with a 1-year shift, and cohorts born in 1926-1935 (first cohort) until 1989-1998 (last cohort) were examined. We conducted a Bayesian APC analysis, calculating estimated values for each behavior by age group, period, and cohort.
Results
Estimated salt intake decreased from cohorts born in the 1930s to the 1960s, but increased thereafter in both genders, and the magnitude of increase was larger for men. Estimated smoking prevalence increased in the cohorts starting from the 1930s for men and the 1940s for women, and then decreased starting in the cohorts born in the 1970s for both genders. Although estimated drinking prevalence decreased starting in the cohorts born in approximately 1960 for men, for women it increased until the cohorts born in approximately 1970. Estimated physical activity prevalence decreased starting in the cohorts born in the 1940s in both genders, but the magnitude of decrease was larger for women.
Conclusions
Trends in cohort effects differed by gender, which might be related to changes in the social environment for women. Improvements in dietary and exercise habits are required in more recently born cohorts of both genders.

Summary

Citations

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Estimation of the Effect of Salt-Intake Reduction on Cardiovascular Mortality Decline between 1950 and 2017 in Japan: A Retrospective Simulation Study
Takehiro Sugiyama, Nayu Ikeda, Kazuko Minowa, Nobuo Nishi
Nutrients.2022; 14(18): 3747. CrossRef
An analysis of predictors for heavy alcohol drinking using nationally representative survey data in Japan
Tasuku Okui
BMC Public Health.2021;[Epub] CrossRef
An Age-Period-Cohort Analysis of Prevalence and Consultation Rate for Dyslipidemia in Japan
Tasuku Okui
Asia Pacific Journal of Public Health.2021; 33(1): 46. CrossRef
An Age-Period-Cohort Analysis of Biomarkers of Lifestyle-Related Diseases Using the National Health and Nutrition Survey in Japan, 1973–2018
Tasuku Okui
International Journal of Environmental Research and Public Health.2020; 17(21): 8159. CrossRef
Socioeconomic Disparities in All-Cause and Cause-Specific Mortality Rates among Municipalities in Japan, 1999–2019
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Interactions of Behavioral Changes in Smoking, High-risk Drinking, and Weight Gain in a Population of 7.2 Million in Korea: Yeon-Yong Kim, Hee-Jin Kang, Seongjun Ha, Jong Heon Park; J Prev Med Public Health. 2019;52(4):234-241. Published online July 3, 2019; DOI: https://doi.org/10.3961/jpmph.18.290

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Abstract Summary PDF

Objectives
To identify simultaneous behavioral changes in alcohol consumption, smoking, and weight using a fixed-effect model and to characterize their associations with disease status.
Methods
This study included 7 000 529 individuals who participated in the national biennial health-screening program every 2 years from 2009 to 2016 and were aged 40 or more. We reconstructed the data into an individual-level panel dataset with 4 waves. We used a fixed-effect model for smoking, heavy alcohol drinking, and overweight. The independent variables were sex, age, lifestyle factors, insurance contribution, employment status, and disease status.
Results
Becoming a high-risk drinker and losing weight were associated with initiation or resumption of smoking. Initiation or resumption of smoking and weight gain were associated with non-high-risk drinkers becoming high-risk drinkers. Smoking cessation and becoming a high-risk drinker were associated with normal-weight participants becoming overweight. Participants with newly acquired diabetes mellitus, ischemic heart disease, stroke, and cancer tended to stop smoking, discontinue high-risk drinking, and return to a normal weight.
Conclusions
These results obtained using a large-scale population-based database documented interactions among lifestyle factors over time.

Summary

Korean summary
이 분석은 흡연, 음주, 체중의 동시적 변화에 대해 패널분석방법론인 고정효과 모형을 이용하여 분석하였으며, 2009년부터 2016년까지 2년 주기로 4차례 모두 건강검진을 수검받은 720만 명을 대상으로 하였다. 흡연, 음주, 체중의 동시적 변화에 대한 방향성을 탐색하여 생활습관 관련 행태가 독자적이 아닌 유기적으로 변화하는 양상을 확인하였다, 또한 당뇨병, 뇌졸중, 암이 신규로 진단되었을 때 행태 변화가 나타나는 것을 확인하였다.

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Association between Body Mass Index and Risk of Gastric Cancer by Anatomic and Histologic Subtypes in Over 500,000 East and Southeast Asian Cohort Participants
Jieun Jang, Sangjun Lee, Kwang-Pil Ko, Sarah K. Abe, Md. Shafiur Rahman, Eiko Saito, Md. Rashedul Islam, Norie Sawada, Xiao-Ou Shu, Woon-Puay Koh, Atsuko Sadakane, Ichiro Tsuji, Jeongseon Kim, Isao Oze, Chisato Nagata, Shoichiro Tsugane, Hui Cai, Jian-Min
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Perceptions About Alcohol Harm and Alcohol-control Strategies Among People With High Risk of Alcohol Consumption in Alberta, Canada and Queensland, Australia: Diana C. Sanchez-Ramirez, Richard C. Franklin, Donald Voaklander; J Prev Med Public Health. 2018;51(1):41-50. Published online December 30, 2017; DOI: https://doi.org/10.3961/jpmph.17.112

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Abstract PDF

Objectives
To explore alcohol perceptions and their association hazardous alcohol use in the populations of Alberta, Canada and Queensland, Australia.
Methods
Data from 2500 participants of the 2013 Alberta Survey and the 2013 Queensland Social Survey was analyzed. Regression analyses were used to explore the association between alcohol perceptions and its association with hazardous alcohol use.
Results
Greater hazardous alcohol use was found in Queenslanders than Albertans (p<0.001). Overall, people with hazardous alcohol were less likely to believe that alcohol use contributes to health problems (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.27 to 0.78; p<0.01) and to a higher risk of injuries (OR, 0.54; 95% CI, 0.33 to 0.90; p<0.05). Albertans with hazardous alcohol use were less likely to believe that alcohol contributes to health problems (OR, 0.48; 95% CI, 0.26 to 0.92; p<0.05) and were also less likely to choose a highly effective strategy as the best way for the government to reduce alcohol problems (OR, 0.63; 95% CI, 0.43 to 0.91; p=0.01). Queenslanders with hazardous alcohol use were less likely to believe that alcohol was a major contributor to injury (OR, 0.39; 95% CI, 0.20 to 0.77; p<0.01).
Conclusions
Our results suggest that people with hazardous alcohol use tend to underestimate the negative effect of alcohol consumption on health and its contribution to injuries. In addition, Albertans with hazardous alcohol use were less in favor of strategies considered highly effective to reduce alcohol harm, probably because they perceive them as a potential threat to their own alcohol consumption. These findings represent valuable sources of information for local health authorities and policymakers when designing suitable strategies to target alcohol-related problems.

Summary

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Hazardous Alcohol Use in 2 Countries: A Comparison Between Alberta, Canada and Queensland, Australia: Diana C. Sanchez-Ramirez, Richard Franklin, Donald Voaklander; J Prev Med Public Health. 2017;50(5):311-319. Published online July 14, 2017; DOI: https://doi.org/10.3961/jpmph.17.040

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135 Download
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Abstract PDF

Objectives
This article aimed to compare alcohol consumption between the populations of Queensland in Australia and Alberta in Canada. Furthermore, the associations between greater alcohol consumption and socio-demographic characteristics were explored in each population. Methods: Data from 2500 participants of the 2013 Alberta Survey and the 2013 Queensland Social Survey were analyzed. Regression analyses were used to explore the associations between alcohol risk and socio-demographic characteristics. Results: A higher rate of hazardous alcohol use was found in Queenslanders than in Albertans. In both Albertans and Queenslanders, hazardous alcohol use was associated with being between 18 and 24 years of age. Higher income, having no religion, living alone, and being born in Canada were also associated with alcohol risk in Albertans; while in Queenslanders, hazardous alcohol use was also associated with common-law marital status. In addition, hazardous alcohol use was lower among respondents with a non-Catholic or Protestant religious affiliation. Conclusions: Younger age was associated with greater hazardous alcohol use in both populations. In addition, different socio-demographic factors were associated with hazardous alcohol use in each of the populations studied. Our results allowed us to identify the socio-demographic profiles associated with hazardous alcohol use in Alberta and Queensland. These profiles constitute valuable sources of information for local health authorities and policymakers when designing suitable preventive strategies targeting hazardous alcohol use. Overall, the present study highlights the importance of analyzing the socio-demographic factors associated with alcohol consumption in population-specific contexts.

Summary

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Associations Between Socio-demographic Characteristics and Healthy Lifestyles in Korean Adults: The Result of the 2010 Community Health Survey: So Yeon Ryu, Jong Park, Seong Woo Choi, Mi Ah Han; J Prev Med Public Health. 2014;47(2):113-123. Published online March 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.2.113

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Abstract PDF

Objectives

Several previous studies have found that healthy behaviors substantially reduce non-communicable disease incidence and mortality. The present study was performed to estimate the prevalence of four modifiable healthy behaviors and a healthy lifestyle among Korean adults according to socio-demographic and regional factors.

Methods

We analyzed data from 199 400 Korean adults aged 19 years and older who participated in the 2010 Korean Community Health Survey. We defined a healthy lifestyle as a combination of four modifiable healthy behaviors: non-smoking, moderate alcohol consumption, regular walking, and a healthy weight. We calculated the prevalence rates and odds ratios of each healthy behavior and healthy lifestyle according to socio-demographic and regional characteristics.

Results

The prevalence rates were as follows: non-smoking, 75.0% (53.7% in men, 96.6% in women); moderate alcohol consumption, 88.2% (79.7% in men, 96.9% in women); regular walking, 45.0% (46.2% in men, 43.8% in women); healthy weight, 77.4% (71.3% in men, 73.6% in women); and a healthy lifestyle, 25.5% (16.4% in men, 34.6% in women). The characteristics associated with a low prevalence of healthy lifestyle were male gender, younger age (19 to 44 years of age), low educational attainment, married, living in a rural area, living in the Chungcheong, Youngnam, or Gwangwon-Jeju region, and poorer self-rated health.

Conclusions

Further research should be implemented to explore the explainable factors of disparities for socio-demographic and regional characteristics to engage in the healthy lifestyle among adults.

Summary

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Drinking Patterns Among Korean Adults: Results of the 2009 Korean Community Health Survey: So Yeon Ryu, Catherine M. Crespi, Annette E. Maxwell; J Prev Med Public Health. 2013;46(4):183-191. Published online July 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.4.183

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Abstract PDF

Objectives

In Korea, the proportion of deaths due to alcohol is estimated at 8.9%, far exceeding the global estimate of 3.8%. Therefore, this study was performed to examine the factors associated with low-risk, moderate-risk, and high-risk drinking patterns in Korean adults and to identify target populations for prevention and control of alcohol-related diseases and deaths.

Methods

We analyzed data from 230 715 Korean adults aged 19 years and older who participated in the 2009 Korean Community Health Survey. Multinomial logistic regression analysis was used to examine associations between socio-demographic and health-related factors and patterns of alcohol use.

Results

A substantially larger proportion of men than women engaged in high risk (21.2% vs. 3.4%) and moderate-risk alcohol use (15.5% vs. 8.2%). In both sexes, moderate- and high-risk uses were associated with younger age, higher income, being currently employed, smoking, being overweight/obese, and good self-rated health.

Conclusions

Given the large proportion of the population that is engaging in moderate- and high-risk drinking and given the social norms that support this behavior, public health policies and campaigns to reduce alcohol consumption targeting the entire population are indicated.

Summary

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Special Article

Burden of Noncommunicable Diseases and National Strategies to Control Them in Korea: Young-Ho Khang; J Prev Med Public Health. 2013;46(4):155-164. Published online July 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.4.155; Correction in: J Prev Med Public Health 2013;46(5):292

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Noncommunicable diseases (NCDs) are the most important causes of premature mortality and disability-adjusted life years in Korea. NCDs are also the main contributor to socioeconomic inequalities in mortality and life expectancy. Reduction of NCDs and NCD inequalities would result in significant improvement in healthy life expectancy and health equity in Korea. Major NCD risk factors such as dietary risks (including salt intake), alcohol consumption, cigarette smoking, and high blood pressure were found to be the leading modifiable risk factors of disability-adjusted life years in Korea, based on the 2010 Global Burden of Disease Study. Several Korean studies have shown that these risk factors play an important role in creating socioeconomic inequalities in NCD mortality and total mortality. Current international discussions on NCD policies in the United Nations and the World Health Organization would provide better opportunities for developing aggressive population-wide policy measures in Korea. Considering the paucity of population-wide policies to control major NCD risk factors in Korea, rigorous population approaches such as taxation and regulation of unhealthy commodities as well as public education and mass campaigns should be further developed in Korea.

Summary

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Original Article

Alcohol Consumption and Mortality in the Korean Multi-center Cancer Cohort Study: En-Joo Jung, Aesun Shin, Sue K. Park, Seung-Hyun Ma, In-Seong Cho, Boyoung Park, Eun-Ha Lee, Soung-Hoon Chang, Hai-Rim Shin, Daehee Kang, Keun-Young Yoo; J Prev Med Public Health. 2012;45(5):301-308. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.301

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Abstract PDF

Objectives

To examine the association between alcohol consumption habit, types of beverages, alcohol consumption quantity, and overall and cancer-specific mortality among Korean adults.

Methods

The alcohol consumption information of a total of 16 320 participants who were 20 years or older from the Korean Multi-center Cancer Cohort were analyzed to examine the association between alcohol consumption habit and mortality (median follow-up of 9.3 years). The Cox proportional hazard model was used to estimate the hazard ratio (HR) of alcohol consumption to mortality adjusting for age, sex, geographic areas, education, smoking status, and body mass index.

Results

Alcohol drinkers showed an increased risk for total mortality compared with never drinkers (HR, 1.72; 95% confidence interval [CI], 1.38 to 2.14 for past drinkers; HR, 1.21; 95% CI, 1.06 to 1.39 for current drinkers), while past drinkers only were associated with higher risk for cancer deaths (HR, 1.84; 95% CI, 1.34 to 2.53). The quantity of alcohol consumed per week showed a J-shaped association with risk of mortality. Relative to light drinkers (0.01 to 90 g/wk), never drinkers and heavy drinkers (>504 g/wk) had an increased risk for all-cause and cancer deaths: (HR, 1.18; 95% CI, 0.96 to 1.45) and (HR, 1.39; 95% CI, 1.05 to 1.83) for all-cause mortality; and (HR, 1.55; 95% CI, 1.15 to 2.11) and (HR, 2.07; 95% CI, 1.39 to 3.09) for all cancer mortality, respectively. Heavy drinkers (>504 g/wk) showed an elevated risk for death from stomach and liver cancers.

Conclusions

The present study supports the existence of a J-shaped association between alcohol consumption quantity and the risk of all-cause and cancer deaths. Heavy drinkers had an increased risk of death from cancer overall and liver and stomach cancer.

Summary

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English Abstracts

Estimating the Socioeconomic Costs of Alcohol Drinking Among Adolescents in Korea.: Jaeyeun Kim, Woojin Chung, Sunmi Lee, Chongyon Park; J Prev Med Public Health. 2010;43(4):341-351.; DOI: https://doi.org/10.3961/jpmph.2010.43.4.341

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Abstract PDF

OBJECTIVES
The purpose of this study was to estimate the socioeconomic costs resulting from alcohol drinking among adolescents as of 2006 from a societal perspective. METHODS: The costs were classified into direct costs, indirect costs, and other costs. The direct costs consisted of direct medical costs and direct non-medical costs. The indirect costs were computed by future income losses from premature death, productivity losses from using medical services and reduction of productivity from drinking and hangover. The other costs consisted of property damage, public administrative expenses, and traffic accident compensation. RESULTS: The socioeconomic costs of alcohol drinking among adolescents as of 2006 were estimated to be 387.5 billion won (0.05% of GDP). In the case of the former, the amount included 48.25% for reduction of productivity from drinking and hangover, 39.38% for future income losses from premature death, and 6.71% for hangover costs. CONCLUSIONS: The results showed that the socioeconomic costs of alcohol drinking among adolescents in Korea were a serious as compared with that of the United States. Therefore, the active interventions such as a surveillance system and a prevention program to control adolescents drinking by government and preventive medicine specialist are needed.

Summary

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Cohort Study on the Association between Alcohol Consumption and the Risk of Colorectal Cancer in the Korean Elderly.: Hoi Jeong Lim, Byung Joo Park; J Prev Med Public Health. 2008;41(1):23-29.; DOI: https://doi.org/10.3961/jpmph.2008.41.1.23

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OBJECTIVES
We examined the association between alcohol consumption and incidence of colorectal cancer in elderly Koreans. METHODS: The cohort members (n=14,304) consisted of 4,834 males and 9,470 females derived from the Korea Elderly Pharmacoepidemiologic Cohort (KEPEC), a population-based dynamic cohort. They were aged 65 years old or older and lived in Busan between 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). Baseline information was surveyed by a self-administered, mailed questionnaire. This study population was restricted to 14,304 participants who reported alcohol drinking habits on the questionnaire and had not been diagnosed with colorectal cancer at baseline. The adjusted hazard ratios (aHR) of status, type, frequency and daily average amount of alcohol consumption were computed with Cox's proportional hazard model, with the never-drinkers as a reference group and controlling for age and gender. RESULTS: After 4.82 person-years of mean follow-up 112 cases of colorectal cancer occurred. The incidence densities of colorectal cancer were 161 (95% CI=123-200) for never-drinkers, 219 (95% CI=125-339) for ex-drinkers, and 137 (95% CI=84-189) for current-drinkers per 100,000 person-year. The status, type, frequency, and daily average amount of alcohol consumption were not significantly related to the incidence of colorectal cancer after controlling for age and gender. CONCLSIONS: There was no significant association between alcohol consumption and colorectal cancer among elderly people after controlling for age and gender.

Summary

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Multicenter Study

Cigarette Smoking, Alcohol Consumption, Tuberculosis and Risk of Lung Cancer: The Korean Multi-center Cancer Cohort Study.: Jisuk Bae, Jin Gwack, Sue Kyung Park, Hai Rim Shin, Soung Hoon Chang, Keun Young Yoo; J Prev Med Public Health. 2007;40(4):321-328.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.321

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Abstract PDF

OBJECTIVES
The aim of this study was to evaluate the roles of cigarette smoking, alcohol consumption, tuberculosis, and their interactions in the risk of lung cancer in a Korean cohort. METHODS: The study subjects comprised 13,150 males and females aged above 20 years old. During the follow up period from 1993 to 2002, 79 lung cancer cases were identified by the central cancer registry and the national death certificate database. Information on cigarette smoking, alcohol consumption and the history of physiciandiagnosed tuberculosis was obtained by interview. Indirect chest X-ray findings were also evaluated to ascertain tuberculosis cases. Cox proportional hazard models were used to estimate relative risks (RR) and 95% confidence intervals (CI) after adjusting for age and gender. RESULTS: Cigarette smoking was statistically significantly associated with an increased risk of lung cancer [for current smokers, RR = 2.33 (95% CI = 1.23 - 4.42) compared to non-smokers]. After further adjustment for cigarette smoking, both alcohol consumption and tuberculosis showed no statistically significant association with the risk of lung cancer [for current drinkers, RR = 0.80 (95% CI = 0.48 - 1.33) compared to non-drinkers] [for tuberculosis cases, RR = 1.17 (95% CI = 0.58 - 2.36) compared to noncases]. There was no statistically significant interaction between cigarette smoking and alcohol consumption (pinteraction = 0.38), or cigarette smoking and tuberculosis (p-interaction = 0.74). CONCLUSIONS: Although cigarette smoking was confirmed as a risk factor of lung cancer in this cohort study, this study suggests that alcohol consumption and tuberculosis may not be associated with the risk of lung cancer.

Summary

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Original Article

Prevalence of Hazardous and Harmful Alcohol Consumption Using Alcohol Use Disorders Identification Test in Chungju Area.: Hyeongsu Kim, Sounghoon Chang, Kunsei Lee, Cheongsik Kim, Kiock Kim; Korean J Prev Med. 2001;34(3):277-283.

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Abstract PDF: OBJECTIVES
To investigate the prevalence of hazardous and harmful alcohol use, which are a subthreshold of alcohol related disorders. METHODS: Direct-interview questionnaires to 1,183 rural persons (489 male, 694 female) were conducted in Chungju-city from July 2 to 26, 1998. As a screening instrument, the alcohol use disorders identification test (AUDIT) was used. RESULTS: The prevalence of alcohol use was 41.7%. In males, it was 66.3% and in females, it was 24.4%. The mean of the AUDIT score of males and females was 13.2 and 5.6, respectively. As WHO guideline, the prevalence of hazardous alcohol use in males and females was 80.3% and 20.7%, respectively. This suggests that the prevalence of 'hazardous drinking' and 'harmful drinking' was 45.4% and 29.3% for males and 1.2% and 2.4% for females, respectively. CONCLUSIONS: This study presented the prevalence of hazardous and harmful drinking of a rural population in Korea and reviewed those health problems. Further evaluation to detect and treat lower alcoholic drinkers is recommended; Summary

English Abstract

Socioeconomic Costs of Alcohol Drinking in Korea.: Woo Jin Chung, Hyun Jun Chun, Sun Mi Lee; J Prev Med Public Health. 2006;39(1):21-29.

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Abstract PDF: OBJECTIVES
We wanted to estimate the annual socioeconomic costs of alcohol drinking in Korea. METHODS: The costs were classified as direct costs, indirect costs and the other costs. The direct costs consisted of direct medical costs, indirect medical costs and subsidiary medical costs. Particularly, the medical costs and population attributable fraction for disease were considered to reflect the calculation of the direct medical costs. The indirect costs were computed by the extent to which the loss of productivity and loss of the workforce might have occurred due to changes in mortality and morbidity according to alcohol drinking. The other costs consisted of property loss, administration costs and costs of alcoholic beverage. RESULTS: The annual costs, which seemed to be attributable to alcohol drinking, were estimated to be 149,352 hundred million won (2.86% of GDP). In case of the latter, the amount includes 9,091 hundred million won for direct costs (6.09%), 62,845 hundred million won for the reduction and loss of productivity (42.08%), 44,691 hundred million won for loss of the workforce (29.92%), and the other costs (21.91%). CONCLUSIONS: Our study confirms that compared with the cases of Japan (1.9% of GNP) and the other advanced countries (1.00-1.42% of GDP), alcohol drinking incurs substantial socioeconomic costs to the Korean society. Therefore, this study provides strong support for government interventions to control alcohol drinking in Korea.; Summary

Original Article

Association between Alcohol Drinking and Cardiovascular Disease Mortality and All-cause Mortality: Kangwha Cohort Study.: Sang Wook Yi, Sang Hyun Yoo, Jae Woong Sull, Heechoul Ohrr; J Prev Med Public Health. 2004;37(2):120-126.

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Abstract PDF: OBJECTIONS: This study sought to examine relationships between alcohol drinking and cardiovascular disease mortality and all-cause mortality. METHODS: From March 1985 through December 1999, 2, 696 males and 3, 595 females aged 55 or over as of 1985 were followed up for their mortality until 31 December 1999. We calculated the mortality risk ratios by level of alcohol consumption. Among the drinker, the level of alcohol consumption was calculated by the frequency of alcohol comsumption and the type of alcohol. Cox proportional hazard model was used to adjust for confounding factors. RESULTS: Among males, compared to abstainer, heavy drinker had significantly higher mortality in all cause (Risk ratio=1.35), cardiovascular disease (Risk ratio=1.52) and cerebrovascular disease (Risk ratio =1.66). Although not significant, moderate drinker had lower ischemic heart disease mortality (Risk ratio =0.38). Among females, there was no statistically significant association between alcohol comsumption and mortality. CONCLUSION: The results of this study suggest that alcohol drinking has harmful effect on all-cause mortality, cardiovascular disease mortality and cerebrovascular disease mortality among males, especially in heavy drinker among males. Minimal evidence on protective effect for cardiovascular disease mortality in low or moderate drinker is observed.; Summary

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