Abstract
Educational attainment has been associated with drinking behaviors in observation studies. We performed Mendelian randomization analysis to determine whether educational attainment causally affected drinking behaviors, including amount of alcohol intakes (in total and various types), drinking frequency, and drinking with or without meals among 334,507 white British participants from the UK Biobank cohort. We found that genetically instrumented higher education (1 additional year) was significantly related to higher total amount of alcohol intake (inverse-variance weighted method (IVW): beta = 0.44, 95% confidence interval (CI) 0.40–0.49, P = 1.57E−93). The causal relations with total amount and frequency of alcohol drinking were more evident among women. In analyses of different types of alcohol, higher educational attainment showed the strongest causal relation with more consumption of red wine (IVW beta = 0.34, 95% CI 0.32–0.36, P = 2.65E−247), followed by white wine/champagne, in a gender-specific manner. An inverse association was found for beer/cider and spirits. In addition, we found that 1 additional year of educational attainment was causally related to higher drinking frequency (IVW beta = 0.54, 95% CI 0.51–0.57, P = 4.87E−230) and a higher likelihood to take alcohol with meals (IVW: odds ratio (OR) = 3.10, 95% CI 2.93–3.29, P = 0.00E + 00). The results indicate causal relations of higher education with intake of more total alcohol especially red wine, and less beer/cider and spirits, more frequent drinking, and drinking with meals, suggesting the importance of improving drinking behaviors, especially among people with higher education.
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References
Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SRM, Tymeson HD, et al. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392:1015–35.
World Health Organisation. Global Status Report on Alcohol and Health 2018. World Health Organisation; 2018.
Xi B, Veeranki SP, Zhao M, Ma C, Yan Y, Mi J. Relationship of alcohol consumption to all-cause, cardiovascular, and cancer-related mortality in U.S. adults. J Am Coll Cardiol. 2017;70:913–22.
Ricci C, Wood A, Muller D, Gunter MJ, Agudo A, Boeing H, et al. Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study. BMJ. 2018;361:k934.
Thadhani R, Camargo CA, Stampfer MJ, Curhan GC, Willett WC, Rimm EB. Prospective study of moderate alcohol consumption and risk of hypertension in young women. Arch Intern Med. 2002;162:569–74.
Witkow S, Sarusi B, Leitersdorf E, Blüher M, Schwarzfuchs D, Ceglarek U, et al. Effects of initiating moderate alcohol intake on cardiometabolic risk in adults with type 2 diabetes. Ann Intern Med. 2015;163:569.
Brien SE, Ghali WA, Mukamal KJ, Turner BJ, Ronksley PE. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011;342:d671–d671.
Martin MA, Goya L, Ramos S. Protective effects of tea, red wine and cocoa in diabetes. Evid Hum Stud Food Chem Toxicol. 2017;109:302–14.
Garaycoechea JI, Crossan GP, Langevin F, Mulderrig L, Louzada S, Yang F, et al. Alcohol and endogenous aldehydes damage chromosomes and mutate stem cells. Nature. 2018;553:171–7.
Holmes MV, Dale CE, Zuccolo L, Silverwood RJ, Guo Y, Ye Z, et al. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ. 2014;349:1–16.
Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA. 2011;306:1884–90.
Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, et al. Light alcohol drinking and cancer: a meta-analysis. Ann Oncol. 2013;24:301–8.
Cao Y, Willett WC, Rimm EB, Stampfer MJ, Giovannucci EL. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. BMJ. 2015;351:1–8.
Shearman D, Wishart J, Collins P, Horowitz M, Bochner M, Bratasiuk R, et al. Relationships between gastric emptying of solid and caloric liquid meals and alcohol absorption. Am J Physiol Liver Physiol. 2017;257:G291–G298.
Breslow RA, Graubard BI. Prospective study of alcohol consumption in the United States: quantity, frequency, and cause-specific mortality. Alcohol Clin Exp Res. 2008;32:513–21.
Foppa M, Fuchs FD, Preissler L, Andrighetto A, Rosito GA, Duncan BB. Red wine with the noon meal lowers post-meal blood pressure: a randomized trial in centrally obese, hypertensive patients. J Stud Alcohol. 2002;63:247–51.
Paschall MJ, Bersamin M, Flewelling RL. Racial/ethnic differences in the association between college attendance and heavy alcohol use: a national study. J Stud Alcohol. 2005;66:266–74.
Gilman SE, Breslau J, Conron KJ, Koenen KC, Subramanian SV, Zaslavsky AM. Education and race-ethnicity differences in the lifetime risk of alcohol dependence. J Epidemiol Community Health. 2008;62:224–30.
Crum RM, Helzer JE, Anthony JC. Level of education and alcohol abuse and dependence in adulthood: a further inquiry. Am J Public Health. 1993;83:830–7.
Huerta MC, Borgonovi F. Education, alcohol use and abuse among young adults in Britain. Soc Sci Med. 2010;71:143–51.
Moore AA, Gould R, Reuben DB, Greendale GA, Carter MK, Zhou K, et al. Longitudinal patterns and predictors of alcohol consumption in the United States. Am J Public Health. 2005;95:458–64.
Droomers M, Schrijvers CTM, Stronks K, Van De Mheen D, Mackenbach JP. Educational differences in excessive alcohol consumption: the role of psychosocial and material stressors. Prev Med. 1999;29:1–10.
Paschall M, Lipton RI. Wine preference and related health determinants in a U.S. national sample of young adults. Drug Alcohol Depend. 2005;78:339–44.
Davey Smith G, Ebrahim S. ‘Mendelian randomization’: can genetic epidemiology contribute to understanding environmental determinants of disease? Int J Epidemiol. 2003;32:1–22.
Angrist JD, Imbens GW, Rubin DB. Identification of causal effects using instrumental variables. J Am Stat Assoc. 1996;91:444–55.
Lee JJ, Wedow R, Okbay A, Kong E, Maghzian O, Zacher M, et al. Gene discovery and polygenic prediction from a genome-wide association study of educational attainment in 1.1 million individuals. Nat Genet. 2018;50:1112–21.
Kuntsche S, Gmel G, Knibbe RA, Kuendig H, Bloomfield K, Kramer S, et al. Gender and cultural differences in the association between family roles, social stratification, and alcohol use: a European cross-cultural analysis. Alcohol and Alcoholism. 2006;41(suppl_1):i37–46.
Okbay A, Beauchamp JP, Fontana MA, Lee JJ, Pers TH, Rietveld CA, et al. Genome-wide association study identifies 74 loci associated with educational attainment. Nature. 2016;533:539–42.
Hemani G, Zheng J, Elsworth B, Wade KH, Haberland V, Baird D, et al. The MR-Base platform supports systematic causal inference across the human phenome. Elife. 2018;7:e34408.
Wootton RE, Lawn RB, Millard LAC, Davies NM, Taylor AE, Munafo MR, et al. Evaluation of the causal effects between subjective wellbeing and cardiometabolic health: Mendelian randomisation study. BMJ. 2018;362:k3788.
Lawlor DA, Tilling K, Smith GD. Triangulation in aetiological epidemiology. Int J Epidemiol. 2016;45:1866–86.
Bowden J, Smith GD, Burgess S. Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression. Int J Epidemiol. 2015;44:512–25.
Verbanck M, Chen CY, Neale B, Do R. Detection of widespread horizontal pleiotropy in causal relationships inferred from Mendelian randomization between complex traits and diseases. Nat Genet. 2018;50:693–8.
Bowden J, Fabiola Del Greco M, Minelli C, Smith GD, Sheehan NA, Thompson JR. Assessing the suitability of summary data for two-sample Mendelian randomization analyses using MR-Egger regression: the role of the I2statistic. Int J Epidemiol. 2016;45:1961–74.
Valeri L, VanderWeele TJ. Mediation analysis allowing for exposure–mediator interactions and causal interpretation: theoretical assumptions and implementation with SAS and SPSS macros. Psychol Methods. 2013;18:137–50.
Burgess S, Daniel RM, Butterworth AS, Thompson SG. Network Mendelian randomization: using genetic variants as instrumental variables to investigate mediation in causal pathways. Int J Epidemiol. 2015;44:484–95.
Månsdotter A, Backhans M, Hallqvist J. The relationship between a less gender-stereotypical parenthood and alcohol-related care and death: a registry study of Swedish mothers and fathers. BMC Public Health. 2008;8:312.
Davies NM, Dickson M, Smith GD, van den Berg GJ, Windmeijer F. The causal effects of education on health outcomes in the UK Biobank. Nat Hum Behav. 2018;2:117–25.
OECD. Tackling harmful alcohol use: economics and public health policy. Sassi, F. editor. Paris: OECD Publishing; 2015.
Webb E, Ashton CH, Kelly P, Kamali F. Alcohol and drug use in UK university students. Lancet. 1996;348:922–5.
Paschall MJ, Flewelling RL. Postsecondary education and heavy drinking by young adults: the moderating effect of race. J Stud Alcohol. 2002;63:447–55.
Holmila M, Raitasalo K. Gender differences in drinking: why do they still exist? Addiction. 2005;100:1763–9.
Hines LM. Moderate alcohol consumption and coronary heart disease: a review. Postgrad Med J. 2002;77:747–52.
Golan R, Gepner Y, Shai I. Wine and health–new evidence. Eur J Clin Nutr. 2018. https://doi.org/10.1038/s41430-018-0309-5.
Tverdal A, Magnus P, Selmer R, Thelle D. Consumption of alcohol and cardiovascular disease mortality: a 16 year follow-up of 115,592 Norwegian men and women aged 40–44 years. Eur J Epidemiol. 2017;32:775–83.
Ceylan-Isik AF, McBride SM, Ren J. Sex difference in alcoholism: who is at a greater risk for development of alcoholic complication? Life Sci. 2010;87:133–8.
Klatsky AL, Armstrong MA, Kipp H. Correlates of alcoholic beverage preference: traits of persons who choose wine, liquor or beer. Br J Addict. 1990;85:1279–89.
Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992;82:816–20.
Christensen HN, Diderichsen F, Hvidtfeldt UA, Lange T, Andersen PK, Osler M, et al. Joint effect of alcohol consumption and educational level on alcohol-related medical events: A danish register-based cohort study. Epidemiology. 2017;28:872–9.
Breslow RA, Guenther PM, Smothers BA. Alcohol drinking patterns and diet quality: the 1999-2000 National Health and Nutrition Examination Survey. Am J Epidemiol. 2006;163:359–66.
Ramchandani VA, Kwo PY, Li T. Effect of food and food composition on alcohol elimination rates in healthy men and women. J Clin Pharm. 2001;41:1345–50.
Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391:1513–23.
Burton R, Sheron N. No level of alcohol consumption improves health. Lancet. 2018;392:987–8.
Baan R, Straif K, Grosse Y, Secretan B, El Ghissassi F, Bouvard V, et al. Carcinogenicity of alcoholic beverages. Lancet Oncol. 2007;8:292–3.
Smyth A, Teo KK, Rangarajan S, O’Donnell M, Zhang X, Rana P, et al. Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: A prospective cohort study. Lancet. 2015;386:1945–54.
Millwood IY, Walters RG, Mei XW, Guo Y, Yang L, Bian Z, et al. Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China. Lancet. 2019;6736:1–12.
Degenhardt L, Charlson F, Ferrari A, Santomauro D, Erskine H, Mantilla-Herrara A, et al. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 2018;5:987–1012.
Criqui MH, Thomas IC. Alcohol consumption and cardiac disease: where are we now? J Am Coll Cardiol. 2017;69:25–27.
Burgess S, Bowden J, Fall T, Ingelsson E, Thompson SG. Sensitivity analyses for robust causal inference from Mendelian randomization analyses with multiple genetic variants. Epidemiology. 2017;28:30–42.
Liu M, Jiang Y, Wedow R, Li Y, Brazel DM, Chen F, et al. Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use. Nat Genet. 2019. https://doi.org/10.1038/s41588-018-0307-5.
Card D. The causal effect of education on earnings. In: Handbook of labor economics, Ashenfelter OC, & Card D. editors. vol. 3, The Netherlands: Elsevier; 1999. pp 1801–63.
Holmes MV, Ala-Korpela M, Smith GD. Mendelian randomization in cardiometabolic disease: challenges in evaluating causality. Nat Rev Cardiol. 2017;14:577–99.
Burgess S, Davies NM, Thompson SG. Bias due to participant overlap in two-sample Mendelian randomization. Genet Epidemiol. 2016;40:597–608.
Acknowledgements
The study was supported by grants from the National Heart, Lung, and Blood Institute (HL071981, HL034594, and HL126024), the National Institute of Diabetes and Digestive and Kidney Diseases (DK091718, DK100383, and DK078616), the Boston Obesity Nutrition Research Center (DK46200), and United States–Israel Binational Science Foundation grant 2011036. LQ was a recipient of the American Heart Association Scientist Development Award (0730094N). All investigators are independent from funders.
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The UK Biobank study was approved by the North West Multi-Centre Research Ethics Committee and the Biomedical Committee of the Tulane University (New Orleans, Louisiana) Institutional Review Board. The study was conducted in accordance with the principles of the Declaration of Helsinki.
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Zhou, T., Sun, D., Li, X. et al. Educational attainment and drinking behaviors: Mendelian randomization study in UK Biobank. Mol Psychiatry 26, 4355–4366 (2021). https://doi.org/10.1038/s41380-019-0596-9
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DOI: https://doi.org/10.1038/s41380-019-0596-9
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