Table 1.
Characteristics of the 39 primary research studies on AD and all-cause mortality included in the meta-analyses.
| Study | Sex | Location | Study design | Baseline age of subjects (years) | Time period | Maximum follow-up (years) | Number of alcohol-dependent individuals | Setting and subjects | Definition of AD | Comparison groups used |
|---|---|---|---|---|---|---|---|---|---|---|
| Berglund and Tunving (1985) | M | Sweden | Prospective cohort | Mean 42 | 1960 to 1980 | 20 | 257 | Alcoholics treated at the outpatient alcoholic unit at the University Hospital, Lund | NR | AD vs general population |
| Campos et al. (2011) | M, F | Spain | Retrospective cohort | 18 to 89 | 1996 to 2006 | 10 | 1265 | Admissions to a university hospital in Spain who were either admitted for alcohol withdrawal syndrome (AWS) or developed AWS during admission | ICD-9-CM AWS | AD vs general population |
| de Lint and Levinson (1975) | M, F | Canada | Prospective cohort | 20 to 74 | 1969 to 1974 | 5 | 154 | Admissions to the Donwood Institute who were addicted primarily to alcohol | Addicted primarily to alcohol | AD vs general population |
| De Silva and Ellawala (1994) | M | Sri Lanka | Prospective cohort | Mean 39 | 1986 to 1991 | 6 | 188 | Alcohol-dependent men admitted to the Sumithrayo Rehabilitation Unit | World Health Organization (WHO) 1951 definition (“an excessive intake of alcohol leading to physical, psychological or social harm”) | AD vs general population; AD with continued heavy drinking vs reduced intake |
| Denison et al. (1997) | M | Sweden | Prospective cohort | ≥ 20 | 1986 to 1991 | 5 | 1049 | Alcohol-dependent men treated as inpatients in the detoxification ward at the University Psychiatric Clinic, Lillhagen Hospital, Göteborg | DSM-III-R AD | AD vs general population |
| Feuerlein et al. (1994) | M, F | Germany | Prospective cohort | ≥ 20 | 1981 to 1985 | 4 | 1401 | Alcoholics treated at 21 different treatment centres in West Germany | NR | AD vs general population |
| Finney and Moos (1991) | M, F | USA | Prospective cohort | NR | NR | 8 | 113 | Alcoholic patients treated in one of five residential facilities who returned to family settings | NR | AD vs general population; AD with continued heavy drinking vs reduced intake |
| Gerdner and Berglund (1997) | M, F | Sweden | Prospective cohort | 26 to 63 | 1985 to 1994 | 8.5 | 116 | Patients competing a five-week Alcoholics Anonymous-oriented programme at Runnagarden Social Welfare Institution | AD (diagnostic criteria NR) | AD vs general population; AD with continued heavy drinking vs reduced intake |
| Gillis (1969) | M, F | South Africa | Prospective cohort | 20 to 74 | 1959 to 1965 | 6 | 802 | Chronic alcoholic white patients admitted to three treatment centres in South Africa | Chronic addictive alcoholics | AD vs general population |
| Gual et al. (2009) | M, F | Spain | Prospective cohort | 18 to 55 | 1987 to 2008 | 20 | 850 | Alcohol-dependent patients who had accepted to enter a treatment programme, and who had a stable home with at least one other family member | DSM-III AD | AD with continued heavy drinking vs reduced intake |
| Haver et al. (2009) | F | Sweden | Prospective cohort | Mean 42.5 | 1981 to 2007 | 25 | 420 | Subjects receiving their first treatment at the Early Treatment for Women with Alcohol Addiction programme at Karolinska Hospital, Stockholm | Alcohol addiction | AD vs general population |
| Hiroeh et al. (2008) | M, F | Denmark | Retrospective cohort | ≥ 15 | 1973 to 1993 | 21 | NR (275,874 person-years) | All Danish adults aged 15 years or over, identified through the Danish Civil Registration System | ICD-8 alcoholism | AD vs general population |
| John et al. (2013) | M, F | Germany | Prospective cohort | 18 to 64 | 1996 to 2010 | 14 | 147 | Random sample of the general population of Germany | DSM-IV AD | AD vs general population; AD with continued heavy drinking vs reduced intake |
| Johnson (2001) | M, F | UK | Retrospective cohort | 47 to 74 | 1978 to 1998 | 20 | 100 | Subjects who attended the Robert Smith Unit, a day centre for the treatment of alcohol problems in Bristol, as part of their first referral for treatment | ICD-10 AD | AD vs general population |
| Mackenzie et al. (1986) | M | USA | Prospective cohort | Mean 41 | 1969 to 1979 | 8.2 | 85 | Male alcoholics who had participated in the Francis Scott Key Medical Center inpatient alcoholism research programme | NR | AD vs general population |
| Markkula et al. (2012) | M, F | Finland | Prospective cohort | 30 to 70 | 2000 to 2008 | 8 | 6372 | Participants in the Health 2000 Study, a nationally representative sample of Finnish people | DSM-IV AD | AD vs alcohol abuse |
| Marshall et al. (1994) | M | UK | Prospective cohort | 39 to 43 | 1968 to 1990 | 20 | 99 | Married men with a diagnosis of alcoholism but no psychotic illness, who attended the specialist alcohol problems clinic at Maudsley Hospital, London | NR | AD vs general population |
| Martin et al. (1985b) | M, F | USA | Prospective cohort | 14 to 84 | 1967 to 1979 | 12 | 70 | Outpatients admitted to the Washington University Psychiatry Clinic | Similar to Feighner Criteria | AD vs general population |
| Mattisson et al. (2011) | M, F | Sweden | Prospective cohort | Median 27 (M)/16 (F) | 1947 to 1997 | 50 | 208 | The Lundby Cohort, comprising all subjects living in Lundby District | DSM-IV AD | AD vs alcohol abuse |
| Min et al. (2008) | M, F | South Korea | Nested case–control | 22 to 82 | 1998 to 2004 | 6 | 59 | Adults living in Guyrae-myon village | ≥ 16 on the Severity of Alcohol Dependence Questionnaire (SADQ) for men; ≥ 10 on the SADQ for women | AD vs no AUDs |
| Moos et al. (1994) | M, F | USA | Prospective cohort | ≥ 55 | 1986 to 1991 | 4 | 12,309 | AD patients in Department of Veterans Affairs (VA) Medical Centers | ICD-9-CM AD | AD vs general population |
| Murphy et al. (2008) | M, F | Canada | Prospective cohort | 18 to 88 | 1952 to 1992 | 40 | NR | Heads of household in Stirling County | Psychiatric diagnosis of alcoholism with high confidence | AD vs general population |
| Neumark et al. (2000) | M, F | USA | Prospective cohort | ≥ 18 | 1981 to 1996 | 14 | 284 | Adult household residents living in the Baltimore Epidemiologic Catchment Area | DSM-III AD | AD vs no AUDs |
| Noda et al. (2001) | M | Japan | Prospective cohort | 21 to 77 | 1972 to 1992 | 20 | 306 | Patients diagnosed with alcoholism at a psychiatric institution | Alcoholism (Japanese Committee for the Diagnosis of Alcoholism criteria) | AD vs general population |
| Pell and D'Alonzo (1973) | M, F | USA | Prospective cohort | Median 51.1 | 1963 to 1969 | 5 | 899 | Active or retired (with pension) employees of the DuPont company | Persons who exhibit alcohol dependency, drinking patterns and behavioural characteristics such as disturbed personal relations and impaired work efficiency, that clearly demonstrate they are chronic, uncontrolled alcoholics | AD vs no AUDs; AD with continued heavy drinking vs reduced intake |
| Perälä et al. (2010) | M, F | Finland | Prospective cohort | ≥ 30 | 2000 to 2008 | 8 | 443 | Participants in the Health 2000 Study, a nationally representative sample of Finnish people | DSM-IV AD | AD vs no AUDs |
| Poser et al. (1992) | M, F | Germany | Prospective cohort | Mean 28.7 | 1974 to 1991 | 17 | 620 | Patients with known AD who had any contact with the psychiatric or neurological department of the University Hospital of Göttingen for therapy or expert opinion | DSM-III AD | AD vs general population |
| Rankin et al. (1970) | M, F | Australia | Prospective cohort | NR | 1964 to 1969 | 4.75 | 56 | Alcoholics with cirrhosis, attending the Alcoholism Clinic at St. Vincent's Hospital, Melbourne | NR | AD with continued heavy drinking vs reduced intake |
| Saieva et al. (2012) | M, F | Italy | Prospective cohort | 14 to 93 | 1985 to 2006 | 21.7 | 2272 | Alcoholic residents of Tuscany, treated at the Alcohol Centre of Florence | ICD-9 AD | AD vs general population |
| Schmidt and de Lint (1969) | M, F | Canada | Prospective cohort | ≥ 15 | 1951 to 1966 | 14 | 6514 | Patients admitted to the Toronto Clinic of the Addiction Research Foundation | NR | AD vs general population |
| Smith et al. (1983) | F | USA | Prospective cohort | 18 to 67 | 1967 to 1980 | 11 | 103 | Women diagnosed with alcoholism at two psychiatric hospitals in the St. Louis area | Feighner Criteria | AD vs general population; AD with continued heavy drinking vs reduced intake |
| Storbjörk and Ullman (2012) | M, F | Sweden | Prospective cohort | Mean 43.3 | 2000 to 2008 | 8 | 929 | Patients from 21 treatment units, who started treatment for AD that they had not previously been given at the same treatment unit during the previous six months | ICD-10 AD | AD vs no AUDs |
| Tashiro and Lipscomb (1963) | M, F | USA | Prospective cohort | 20 to 79 | 1954 to 1958 | 5 | 1692 | Individuals admitted to four alcoholism treatment facilities in California | NR | AD vs general population |
| Thorarinsson (1979) | M | Iceland | Prospective cohort | Mean 37 | 1951 to 1974 | 23 | 2863 | First-admission alcoholic males treated as either an outpatient or an inpatient at one of three clinics, or identified as attending a private clinic by the Psychiatric Register of Iceland | NR | AD vs general population |
| Vaillant et al. (1983) | M, F | USA | Prospective cohort | NR | 1972 to 1980 | 8 | 110 | Patients admitted for alcohol withdrawal to the inpatient ward at the Cambridge and Somerville Program for Alcohol Rehabilitation at the Cambridge Hospital | Patients with alcohol withdrawal who required ≥ 750 mg of chlorodiazepoxide during detoxification or who revealed signs of severe withdrawal such as seizures or delirium tremens during prior admissions | AD with continued heavy drinking vs reduced intake |
| Vaillant (2003) | M | USA | Prospective cohort | 9 to 20 | 1940 to 2000 | 23 | 91 | College cohort: Male Harvard University sophomores selected for a study of normal development, with no known physical or mental illness at baseline Core city cohort: Men studied from early adolescence as a non-delinquent community control group for a study of institutionalised juvenile delinquents |
DSM-III AD | AD vs no AUDs; AD vs alcohol abuse |
| Wallerstedt et al. (1995) | M | Sweden | Prospective cohort | 17 to 79 | 1980 to 1987 | 7 | 52 | Patients in the medical, surgical and orthopaedic wards of the Ostra Hospital, Göteborg | Patients with presence of one or more of the following criteria: interview reports of altered reactions to alcohol or notes on alcohol addiction in their case files; treatment for alcohol addiction at a psychiatric clinic; registration by the social authorities for alcohol addiction | AD vs general population |
| Wells and Walker (1990) | M, F | New Zealand | Prospective cohort | ≥ 15 | 1972 to 1984 | 11 | 616 | Alcoholic patients admitted to Mahu Clinic, Sunnyside Hospital, Christchurch | NR | AD vs general population |
| Yoshino et al. (1997) | M | Japan | Prospective cohort | Mean 50.1 | 1989 to 1996 | 3 | 74 | Alcoholics hospitalised at the Komagino Hospital Alcoholism Treatment Unit for a detoxification and rehabilitation programme | DSM-III AD | AD vs alcohol abuse |
AD, alcohol dependence; AWS, alcohol withdrawal syndrome; DSM, Diagnostic and Statistical Manual of Mental Disorders; F, female; ICD, International Classification of Diseases; M, male; NR, not reported; SADQ, Severity of Alcohol Dependence Questionnaire; WHO, World Health Organization.