ORIGINAL PAPER Severity of alcohol-related problems and mortality: results from a 20-year prospective epidemiological community study Manfred M. Fichter • Norbert Quadflieg • Uwe C. Fischer Received: 25 May 2010 / Accepted: 17 August 2010 / Published online: 14 September 2010 Ó Springer-Verlag 2010 Abstract There is evidence that high alcohol use is associated with an increase in mortality. Little is known about long-term effects of problematic alcohol consump- tion in non-clinical (community) populations. The aim of our study was to obtain data on this and related issues in a representative rural community sample assessed longitu- dinally over a period of 20 years. Assessments focused on a baseline survey from 1980 to 1984 and 20-year follow-up from 2001 to 2004. Based on expert interviews and stan- dardized self-rating scales (e.g. MALT; Munich Alcohol- ism Test), the following three groups were defined (a) severe alcohol problems, (b) moderate alcohol problems, and (c) no alcohol problems. Mortality and hazard rates were analyzed with logistic and Cox regression adjusted for several health risk factors. From an original community sample of 1,465 individuals, 448 were deceased at 20-year follow-up. Participation rates were high. Baseline preva- lence according to the MALT was 1.6% for severe alcohol problems and 4.0% for moderate alcohol problems. Over the 20-year time span, individuals with severe alcohol problems had a significantly elevated risk for dying earlier than the group with no alcohol problems (2.4 times higher). Mortality for those with moderate alcohol problems at baseline had a non-significantly elevated 20-year mortality risk (1.5 times higher) compared to those with no alcohol problems. Cox survival analyses corroborate these findings from multiple sequential logistic regression analyses. In discussing the mortality risk of persons with alcohol problems, the severity of the alcohol problems must be taken into account. Keywords Psychiatric epidemiology Á Alcoholism Á Mortality Á Prospective longitudinal community studies Introduction Patterns of risk factors and mortality among alcoholics appear to be well examined [1–6]. However, most pro- spective studies addressed samples selected for pre-defined characteristics such as medical treatment, or type of health services used, and age and gender, thus including one or several selection biases. Finney and Moos [7], for example, reported that, compared to matched community controls, patients receiving inpatient treatment for alcohol problems were almost ten times as likely to have died over a 10-year follow-up period. In another study, middle-aged and older inpatients treated for substance abuse by Department of Veterans Affairs Medical Centers showed a 2.64 times higher than expected overall mortality [8]. Another male sample from a Department of Veterans Affairs Medical Center treated for alcoholism indicated a 2.5 times greater overall mortality than controls after 10–14 years [9]. Late middle-aged individuals recruited from general health service settings, not from alcohol treatment programs, and including a wide range of drinking pattern showed a crude 4-year mortality rate of 8.7% [10]. Little is known about long-term effects of alcohol on all- cause mortality from unselected representative prospective community samples [11]. Very few studies on representa- tive community samples addressed the course of alcoholism M. M. Fichter Á N. Quadflieg Á U. C. Fischer Department of Psychiatry, University of Munich (LMU), 80336 Munich, Germany M. M. Fichter (&) Scho ¨n Klinik Roseneck affiliated with the University of Munich (LMU), Am Roseneck 6, 83209 Prien, Germany e-mail: MFichter@Schoen-Kliniken.de 123 Eur Arch Psychiatry Clin Neurosci (2011) 261:293–302 DOI 10.1007/s00406-010-0141-y