Among 1,103,981 Korean adults followed a median 19.2 years, mortality climbed steadily with drinking, using occasional drinkers as the reference. All-cause hazard ratios were 1.146 for light, 1.330 for moderate and 1.954 for very heavy drinkers. Cancer mortality followed the same gradient (1.098, 1.230, 1.714), and alcohol-related disease deaths rose steeply, reaching 14.2 in very heavy drinkers. Abstainers fared better than occasional drinkers only for alcohol-related disease death (0.525).
The J-shaped curve that once suggested a cardioprotective sip has been eroding for a decade, and this study strengthens the case against it. The authors screened out participants with prior disease, inconsistent health reports, reduced intake between screenings and early cancer diagnoses, which targets the sick-quitter distortion that inflates abstainer risk. Mendelian randomization work and recent meta-analyses reached similar conclusions, so the result is confirmatory rather than paradigm-shifting. Its value lies in scale and in the careful bias handling within a single population.
Limitations matter. Lifetime abstainers could not be separated from former drinkers, which is why the reference group is occasional drinkers and why abstainer estimates remained sensitive to analytic choices. Intake is self-reported at one time point, residual confounding is possible, and East Asian drinking patterns, including genetic variation in alcohol metabolism, may limit generalisability. Practically, the data give no support for starting or continuing alcohol for health, and risk appears to rise from the lightest regular intake. Adults who drink regularly can reasonably aim to cut back, and those with cancer risk factors should weigh this especially.