In a nationally representative Korean cohort of 64,756 adults followed a median 9.7 years, hazardous drinking on the AUDIT-C predicted suicide death in women but not men. Women in the hazardous category had a 2.50-fold higher hazard (95% CI 1.18-5.32) versus non-drinkers, and each AUDIT-C point raised risk 15% (HR 1.15). Men showed no association (HR 1.01 for hazardous use; 1.02 per point). Only 190 suicides occurred in total.
The sex split is provocative but should be read cautiously. With 190 events spread across two sexes and three exposure groups, the female estimate rests on very few deaths, and the wide confidence interval (1.18-5.32) signals real imprecision. A lack of association in men is also not proof of safety, since men in this and other cohorts carry far higher baseline suicide rates, and null results in smaller strata can reflect low power. Alcohol exposure was measured once, by self-report, so changes in drinking over time and reverse causation (distress driving drinking) cannot be excluded, and residual confounding by depression or psychiatric history is likely. Prior work, including Nordic and US cohorts, has linked heavy drinking to suicide in both sexes, so this finding is better treated as hypothesis-generating than as evidence of a female-specific mechanism. Practically, it reinforces that heavy drinking in women deserves attention in mental-health screening, and that anyone drinking hazardously while experiencing low mood should raise both with a clinician. Incremental and confirmatory in direction, but not yet decisive on the sex difference.