Simou, Evangelia
(2019)
The effect of alcohol consumption on the risk of severe respiratory diseases : a series of systematic reviews and meta-analyses.
PhD thesis, University of Nottingham.
Abstract
Introduction: Alcohol is the most commonly used substance in the world and causes approximately 3.3 million deaths every year. Alcohol consumption is a well-recognized risk factor for a range of diseases and injuries. However, there is little knowledge on the relation between alcohol consumption and the occurrence of respiratory diseases.
Objectives: To investigate and quantify the magnitude of the association between alcohol consumption and acute respiratory distress syndrome (ARDS), asthma, chronic obstructive pulmonary disease (COPD), community-acquired pneumonia (CAP), obstructive sleep apnoea (OSA) and tuberculosis (TB).
Methods: Systematic reviews identified comparative observational studies listed on Medline, EMBASE, and Web of Science, published between 1985 and December 2015, with the exception of tuberculosis, for which we performed a separate search from 2005 to 2017. The reference lists of eligible studies were also searched. We imposed no language restrictions. Random effects meta-analysis was used to estimate pooled effect sizes with 95% confidence intervals (CI). Heterogeneity was explored using subgroup analyses. Funnel plots and Egger’s asymmetry test were used for the assessment of publication bias.
Results: A total of 145 papers were included in the reviews. Our reviews demonstrated a 83% higher risk of CAP among drinkers (RR= 1.83, 95% CI: 1.30-2.57, I2= 91%, 17 studies). In addition, the dose-response analysis showed that there is an 8% increase in the risk of CAP for every 10-20 grams higher alcohol intake per day (p for trend=0.136). Also, heavy alcohol consumption was found to significantly increase the odds of ARDS by 89% (OR=1.89; 95% CI, 1.45-2.48, I2=48%, 13 studies). Furthermore, a sensitivity analysis indicated that this association was primarily due to alcohol abuse (OR=1.90; 95% CI, 1.40-2.60, I2=56%, 10 studies). People who consume alcohol are approximately 25% more likely to have OSA compared to people who don’t consume alcohol (RR= 1.25, 95%CI 1.13-1.38, I2=82%, 21 studies). Alcohol consumption increased the risk of TB between 1.9 and 2.8- fold, depending on study design. Moreover, there is a 12% increase in the risk of TB development for a daily alcohol consumption of every 10-20 grams (p for trend=0.559). However, it was not found evidence of an effect of alcohol consumption on the risk of asthma (RR=0.94; 95% CI 0.85-1.04, 12 studies) and COPD (RR=1.11; 95% CI, 0.88-1.40, I2=94%, I2 = 75%, 13 studies).
Conclusions: This thesis has established that high alcohol intake is associated with increased risks of several respiratory diseases, and therefore that reducing alcohol intake may have an important role to play in respiratory disease prevention.
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