Coffee Drinking and Mortality in 10 European Countries: A Multinational Cohort Study

Abstract

Background: The relationship between coffee consumption and mortality in diverse European populations with variable coffee preparation methods is unclear.

Objective: To examine whether coffee consumption is associated with all-cause and cause-specific mortality.

Design: Prospective cohort study.

Setting: 10 European countries.

Participants: 521 330 persons enrolled in EPIC (European Prospective Investigation into Cancer and Nutrition).

Measurements: Hazard ratios (HRs) and 95% CIs estimated using multivariable Cox proportional hazards models. The association of coffee consumption with serum biomarkers of liver function, inflammation, and metabolic health was evaluated in the EPIC Biomarkers subcohort (n = 14 800).

Results: During a mean follow-up of 16.4 years, 41 693 deaths occurred. Compared with nonconsumers, participants in the highest quartile of coffee consumption had statistically significantly lower all-cause mortality (men: HR, 0.88 [95% CI, 0.82 to 0.95]; P for trend < 0.001; women: HR, 0.93 [CI, 0.87 to 0.98]; P for trend = 0.009). Inverse associations were also observed for digestive disease mortality for men (HR, 0.41 [CI, 0.32 to 0.54]; P for trend < 0.001) and women (HR, 0.60 [CI, 0.46 to 0.78]; P for trend < 0.001). Among women, there was a statistically significant inverse association of coffee drinking with circulatory disease mortality (HR, 0.78 [CI, 0.68 to 0.90]; P for trend < 0.001) and cerebrovascular disease mortality (HR, 0.70 [CI, 0.55 to 0.90]; P for trend = 0.002) and a positive association with ovarian cancer mortality (HR, 1.31 [CI, 1.07 to 1.61]; P for trend = 0.015). In the EPIC Biomarkers subcohort, higher coffee consumption was associated with lower serum alkaline phosphatase; alanine aminotransferase; aspartate aminotransferase; γ-glutamyltransferase; and, in women, C-reactive protein, lipoprotein(a), and glycated hemoglobin levels.

Limitations: Reverse causality may have biased the findings; however, results did not differ after exclusion of participants who died within 8 years of baseline. Coffee-drinking habits were assessed only once.

Conclusion: Coffee drinking was associated with reduced risk for death from various causes. This relationship did not vary by country.

Primary funding source: European Commission Directorate-General for Health and Consumers and International Agency for Research on Cancer.

Figure 1

Subgroup analysis of the associations of daily coffee consumption and all-cause mortality among men and women. Hazard ratios for all-cause mortality are for the comparison of men and women in the highest quartile of consumers (high consumption) compared versus non-consumers. Multivariable model only - Cox regression using body mass index (<22; 22–<25; 25–<30; 30–<35; 35+ kg/m²), physical activity index (inactive; moderately inactive; moderately active; active), education status (none; primary school completed; technical/professional school; secondary school; longer education including university; or not specified), alcohol consumption (non-consumers; <5; 5–<15; 15–<30; 30+ g/day), smoking status and intensity (never; current, 1–15 cigarettes per day; current, 16–25 cigarettes per day; current, 16+ cigarettes per day; former, quit ≤10 years; former, quit 11–20 years; former, quit 20+ years; current, pipe/cigar/occasional; current/former, missing; unknown), smoking duration (<10; 10–<20; 20–<30; 30–<40; 40+ years; smoking duration unknown), ever use of contraceptive pill (yes; no; or unknown), menopausal status (premenopausal; postmenopausal; perimenopausal/unknown menopausal status; or surgical postmenopausal), ever use of menopausal hormone therapy (yes; no; or unknown), and intakes of total energy (kcal/day), red and processed meat (g/day), and fruits and vegetables (g/day) (all continuous), and stratified by age (1-year categories) and center. Categories were based on country-specific quartiles of coffee consumption after exclusion of non-consumers. Quartile cut-offs (in mL) were: Denmark: 500, 900 and 1,300; France: 150, 280 and 450; Germany: 261, 395 and 580; Greece: 70, 140 and 240; Italy: 60, 92 and 138; The Netherlands: 375, 500 and 750; Norway: 300, 420 and 540; Spain: 50, 105 and 196; Sweden: 300, 400 and 601; and the United Kingdom: 83, 380 and 488. Median consumption: alcohol = 12.6 g/day (men) and 3.4 g/day (women); red and processed meat = 90.2 g/day (men) and 60.3 g/day (women); fruit and vegetables = 324 g/day (men) and 413 g/day (women).