Selection biases in observational studies affect associations between 'moderate' alcohol consumption and mortality

Addiction. 2017 Feb;112(2):207-214. doi: 10.1111/add.13451. Epub 2016 Jun 17.


Selection biases may lead to systematic overestimate of protective effects from 'moderate' alcohol consumption. Overall, most sources of selection bias favor low-volume drinkers in relation to non-drinkers. Studies that attempt to address these types of bias generally find attenuated or non-significant relationships between low-volume alcohol consumption and cardiovascular disease, which is the major source of possible protective effects on mortality from low-volume consumption. Furthermore, observed mortality effects among established low-volume consumers are of limited relevance to health-related decisions about whether to initiate consumption or to continue drinking purposefully into old age. Short of randomized trials with mortality end-points, there are a number of approaches that can minimize selection bias involving low-volume alcohol consumption.

Keywords: Alcohol; bias; epidemiology; moderate drinking; mortality; selection bias.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Alcohol Drinking / mortality*
  • Humans
  • Observational Studies as Topic / statistics & numerical data*
  • Selection Bias
  • Young Adult