Objective: While the relation between alcohol consumption and mortality has been well explored, little is known about the link between alcohol problems and mortality in general population-based studies, particularly among women. This was the objective of the present study Methods: In this prospective cohort study, 5333 non-abstaining individuals (2539 women) from the UK-wide Health and Lifestyle Survey (aged 42.9 years at study induction) completed the CAGE questionnaire of alcohol problems and participated in a medical examination in 1984/1985; they were then followed up for mortality experience until 2005. Results: Alcohol problems at baseline were less common in women (2.4%) than in men (7.8%). A total of 21 years of follow-up gave rise to 1201 deaths. Elevated rates of mortality were evident in persons reporting symptoms of alcohol problems in comparison to those who did not. In gender-stratified analyses, alcohol problems were more strongly associated with mortality risk in women (age-adjusted hazards ratio: 2.25; 95% confidence interval: 1.22-4.12) than in men (1.49; 1.12-1.99), although this effect modification was not statistically significant (P value for interaction=0.125). Controlling for a range of covariates-including socioeconomic position, co-morbidity (somatic and psychiatric), and alcohol intake-had essentially no impact on these associations. Conclusion: The CAGE questionnaire may have some utility in routine health assessments in the general population. (C) 2009 Elsevier Inc. All rights reserved.