Background/Aims General population studies have shown a strong association between alcohol intake and death from alcoholic cirrhosis, but whether this is a dose-response or a threshold effect remains unknown, and the relation among alcohol misusers has not been studied. Methods A cohort of 6152 alcohol misusing men and women aged 15-83 were interviewed about drinking pattern and social issues and followed for 84,257 person-years. Outcome was alcoholic cirrhosis mortality. Data was analyzed by means of Cox-regression models. Results In this large prospective cohort study of alcohol misusers there was a 27 fold increased mortality from alcoholic cirrhosis in men and a 35 fold increased mortality from alcoholic cirrhosis in women compared to the Danish population. Number of drinks per day was not significantly associated with death from alcoholic cirrhosis, since there was no additional risk of death from alcoholic cirrhosis when exceeding an average daily number of five drinks (>60 g/alcohol) in neither men nor women. Conclusions The results indicate that alcohol has a threshold effect rather than a dose-response effect on mortality from alcoholic cirrhosis in alcohol misusers. Background / Aims General population studies have shown a strong association between alcohol intake and death from alcoholic cirrhosis, but whether this is a dose-response or a threshold effect remains unknown, and the relation among alcohol misusers has not been studied. Methods A cohort of 6152 alcohol misusing men and women aged 15-83 were interviewed about drinking pattern and social issues and followed for 84,257 person-years. Outcome was alcoholic cirrhosis mortality. Data was analyzed by means of Cox-regression models. Results In this large prospective cohort study of alcohol misusers there was a 27 fold increased mortality from alcoholic cirrhosis in men and a 35 fold increased mortality from alcoholic cirrhosis in women compared to the Danish population. Number of drinks per day was not significantly associated with death from alcoholic cirrhosis, since there was no additional risk of death from alcoholic cirrhosis when exceeding an average daily number of five drinks (> 60 g / alc Conclusions The results indicate that alcohol has a threshold effect rather than a dose-response effect on mortality from alcoholic cirrhosis in alcohol misusers.