Alcohol and mortality in British men: explaining the U-shaped curve

Long-term alcohol use patterns and HIV disease severity

OBJECTIVE

We examined the relationship between alcohol use trajectories and HIV disease severity among men and women participating in the Veterans Aging Cohort Study (VACS).

DESIGN

Prospective cohort of HIV-infected persons in care at eight US Veterans Health Administration sites.

METHODS

Between 2002 and 2010, we assessed alcohol consumption annually using the alcohol use disorders identification test-consumption (AUDIT-C). HIV disease severity was ascertained using the VACS index, a validated measure of morbidity and all-cause mortality. We examined the relationship between alcohol use and HIV disease severity patterns using joint trajectory modeling. Alcohol use trajectories were validated using phosphatidylethanol - a biomarker of alcohol consumption - measured between 2005 and 2006 among a subset of participants. We examined associations between membership in alcohol use and VACS index trajectories using multinomial regression.

RESULTS

Among eligible participants, we identified four alcohol consumption trajectories: abstainers (24% of the sample), lower risk (44%), moderate risk (24%), and higher risk drinkers (8%). Alcohol use trajectories were highly correlated with phosphatidylethanol (Cramér's V = 0.465, P < 0.001): mean concentrations were 4.4, 17.8, 57.7, and 167.6 ng/ml in the abstainer, lower risk, moderate risk, and higher risk groups, respectively. Four VACS index trajectories were identified: low (2%), moderate (46%), high (36%), and extreme (16%). Higher risk drinkers were most common in the extreme VACS index group, and were absent in the low index group. In multivariable analysis, the association between alcohol use and VACS index trajectory membership remained significant (P = 0.002).

CONCLUSION

Alcohol use trajectories characterized by persistent unhealthy drinking are associated with more advanced HIV disease severity among HIV-infected veterans in the United States.

Positive and negative affectivity as risk factors for heavy drinking in the second half of life: a prospective cohort study

AIMS

To estimate the prospective relations between levels of propensity to experience positive affect (PA) and propensity to experience negative affect (NA) and risk of heavy drinking in a cohort of Norwegians aged 40-80 years.

DESIGN

Clustered sampling was used to draw Norwegians aged 40-79 years in 2002/03 (t1). The relationship between PA and NA measured at t1 and heavy drinking measured in 2007/08 (t2) was estimated with random-intercept logistic regression.

SETTING

Norway.

PARTICIPANTS

A total of 2142 (44.0% men) who consumed mean = 3.07 [standard deviation (SD) = 3.15] UK units of alcohol on average per week and were intoxicated less than once per week at t1.

MEASURES

The Brief Measure of Positive and Negative Affect, quantity-frequency measure of alcohol use and frequency of drinking to intoxication. Heavy drinking at t2 (> 14 units per week and/or intoxication ≥ once per week) was regressed on PA and NA at t1.

FINDINGS

Controlling for alcohol consumption, gender, age, income and level of education (at t1) and change in PA and NA, there was little evidence for an association between level of PA and heavy drinking [odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.71, 1.29, Bayes factor = 0.15]. The level of NA at t1 was associated with greater risk of heavy drinking at t2 (OR = 1.40, 95% CI = 1.02, 1.93).

CONCLUSION

There is little evidence for an association between the propensity to experience positive affect and heavy drinking among Norwegians aged 40-80 years. Norwegian adults in the second half of life with a high propensity to experience negative affect are at greater risk of heavy drinking approximately 5 years later than those with a low propensity to experience negative affect.

Moderate alcohol consumption is associated with lower chronic disease burden expressed in disability-adjusted life years: a prospective cohort study

The relation of alcohol consumption with disease burden remains debated partly due to opposite associations with cardiovascular disease (CVD) and cancer. The relation of alcohol consumption with disease burden expressed in disability-adjusted life years (DALYs) summarizes opposing associations of alcohol consumption on chronic diseases. This study aimed to investigate the association of alcohol consumption with chronic disease burden expressed in DALYs based on individual-participant data. The study was a prospective study among 33,066 men and women from the EPIC-NL cohort. At baseline, alcohol consumption was assessed with a validated food-frequency questionnaire. Participants were followed for occurrence of and mortality from chronic diseases and DALYs were calculated. After 12.4 years follow-up, 6647 disease incidences and 1482 deaths were documented, resulting in 68,225 healthy years of life lost (6225 DALYs). Moderate drinkers (women 5–14.9 g/day, men 5–29.9 g/day) had a lower chronic disease burden (mean DALYs −0.27; 95% CI −0.43; −0.11) than light drinkers (0–4.9 g/day), driven by a lower disease burden due to CVD (−0.18: −0.29; −0.06) but not cancer (−0.05: −0.16; 0.06). The associations were most pronounced among older participants (≥50 years; −0.32; −0.53; −0.10) and not observed among younger women (−0.08; −0.43; 0.35), albeit non-significant (p_interaction > 0.14). Substantial drinking (women 15–29.9 g/day, men 30–59.9 g/day) compared to light drinking was not associated with chronic disease burden. Our results show that moderate compared to light alcohol consumption was associated with living approximately 3 months longer in good health. These results were mainly observed among older participants and not seen among younger women.

Lifecourse transitions, gender and drinking in later life

Older people consume less alcohol than any other adult age group. However, in recent years survey data on alcohol consumption in the United Kingdom have shown that while younger age groups have experienced a decline in alcohol consumption, drinking behaviours among the elderly have not reduced in the same way. This paper uses data from the English Longitudinal Study of Ageing to analyse both the frequency and quantity of older adult's alcohol consumption using a lifecourse approach over a ten-year period. Overall drinking declined over time and the analysis examined how socio-economic characteristics, partnership, employment and health statuses were associated with differences in drinking behaviours and how these changed over time. Higher wealth and level of education were associated with drinking more and drinking more frequently for men and women. Poorer self-rated health was associated with less frequent consumption and older people with poor and deteriorating health reported a steeper decline in the frequency of alcohol consumption over time. Men who were not in a partnership drank more than other men. For women, loss of a partner was associated with a steeper decline in drinking behaviours. These findings have implications for programmes to promote responsible drinking among older adults as they suggest that, for the most part, characteristics associated with sustaining wellbeing in later life are also linked to consuming more alcohol.

The relationship between different dimensions of alcohol use and the burden of disease-an update

BACKGROUND AND AIMS

Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs).

METHODS

Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others.

RESULTS

In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently.

CONCLUSIONS

Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.

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

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.

Changes in heavy drinking following onset of health problems in a U.S. general population sample

Heavy episodic drinking is a well-established risk factor for heart disease, diabetes, certain cancers, stroke, hypertension and injuries, however, little is known about whether health problems precipitate changes in subsequent drinking patterns. Retrospective cohort analyses of heavy drinking by decade were conducted using data from the 2010 U.S. National Alcohol Survey (n=5240). Generalized estimating equations models were used to predict any, monthly, and weekly heavy (5+) drinking occasions across decades of life following a diagnosis of hypertension, heart problems, diabetes, stroke, cancer, or serious injury. Experiencing heart problems was associated with higher odds of reduced weekly heavy drinking (adjusted odds ratio (ORadj)=3.5; 95% confidence interval (CI); 1.7-7.4). The onset of diabetes was also associated with higher odds of reducing any heavy drinking over the decade (ORadj=1.7; 95% CI; 1.1-2.6). Cancer survivors were less likely to report no heavy drinking (ORadj=0.5; 95% CI; 0.3-0.8) or no weekly heavy drinking (ORadj=0.3; 95% CI; 0.2-0.7). Hypertension, stroke and injury were not found to have any significant associations. Reduced heavy drinking was more likely to be reported by Black drinkers following heart problems and Whites following a diabetes diagnosis. Increased heavy drinking following a cancer diagnosis was significant among women and Whites. Future studies on alcohol's heath and mortality risks should take into consideration effects of health problems on drinking patterns. Additionally, study results support increased prevention efforts targeting heavy drinking among cancer survivors, especially White women, and individuals with or being treated for hypertension.

Sex-specific Relationship of Serum Uric Acid with All-cause Mortality in Adults with Normal Kidney Function: An Observational Study

OBJECTIVE

To explain the clinical effect of serum uric acid (SUA) levels as a risk factor for mortality, considering exclusion of kidney function.

METHODS

Participants aged over 40 years who underwent health checkups were recruited. Individuals with estimated glomerular filtrations rates < 60 ml/min/1.73 m² and who received laboratory study and colonoscopy on the same day were excluded.

RESULTS

SUA levels were higher in men than in women (5.7 ± 1.2 mg/dl for men and 4.2 ± 0.9 mg/dl for women, p < 0.001). During 12.3 ± 3.6 years of followup, 1402 deaths occurred among 27,490 participants. About 6.9% of men and 3.1% of women died. The overall mortality rate had a U-shaped association with SUA levels, a U-shaped association in men, and no association in women. There was a significant interaction of sex for the SUA-mortality association (p for interaction = 0.049); therefore, survival analysis was conducted by sex. In men, the lower SUA group had a higher mortality rate after adjustment (SUA ≤ 4.0 mg/dl, adjusted HR 1.413, 95% CI 1.158-1.724, p = 0.001) compared with the reference group (SUA 4.1-6.0 mg/dl). A higher SUA contributed to an insignificant increased mortality in men (> 8.0 mg/dl, adjusted HR 1.140, 95% CI 0.794-1.636, p = 0.479). Women failed to show any significant association between SUA and mortality.

CONCLUSION

This study provided novel evidence that SUA-mortality association differed by sex. We demonstrated that a lower SUA was an independent risk factor for all-cause mortality in men with normal kidney function.

Health Risk Factors Associated with Lifetime Abstinence from Alcohol in the 1979 National Longitudinal Survey of Youth Cohort

BACKGROUND

The choice and definition of a comparison group in alcohol-related health studies remains a prominent issue in alcohol epidemiology due to potential biases in the risk estimates. The most commonly used comparison group has been current abstainers; however, this includes former drinkers who may have quit drinking due to health problems. Lifetime abstention could be the best option, but measurement issues, selection biases due to health and other risk factors, and small numbers in populations are important concerns. This study examines characteristics of lifetime abstention and occasional drinking that are relevant for alcohol-related health studies.

METHODS

This study used data from the National Longitudinal Survey of Youth 1979 cohort of 14 to 21 year olds followed through 2012 (n = 7,515). Definitions of abstinence and occasional drinking were constructed based on multiple measurements. Descriptive analyses were used to compare the definitions, and in further analysis, lifetime abstainers (n = 718) and lifetime minimal drinkers (n = 1,027) were compared with drinkers across demographics and early-life characteristics (i.e., religion, poverty, parental education, and family alcohol problems) in logistic regression models.

RESULTS

Using a strict measurement of zero drinks from adolescence to the 50s, only 1.7% of the sample was defined as lifetime abstainer compared to a broader definition allowing a total of 1 drink over the lifetime that included 9.5% and to lifetime minimal drinking (a total of 3 drinks or less a month), which accounted for 13.7%. Factors significantly associated with lifetime abstention and lifetime minimal drinking included religion, poverty, having no family alcohol problems, Hispanic ethnicity, foreign-born, and female gender. Importantly, work-related health limitations in early life were significantly associated, but not childhood physical and mental health problems.

CONCLUSIONS

Alcohol-related health studies should utilize lifetime classifications of drinkers and abstainers, and, in doing so, should account for early-life socioeconomic adversity and childhood health factors or consider these as unmeasured confounders.

Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality

OBJECTIVE

Previous meta-analyses of cohort studies indicate a J-shaped relationship between alcohol consumption and allcause mortality, with reduced risk for low-volume drinkers. However, low-volume drinkers may appear healthy only because the "abstainers" with whom they are compared are biased toward ill health. The purpose of this study was to determine whether misclassifying former and occasional drinkers as abstainers and other potentially confounding study characteristics underlie observed positive health outcomes for lowvolume drinkers in prospective studies of all-cause mortality.

METHOD

A systematic review and meta-regression analysis of studies investigating alcohol use and mortality risk after controlling for quality-related study characteristics was conducted in a population of 3,998,626 individuals, among whom 367,103 deaths were recorded.

RESULTS

Without adjustment, meta-analysis of all 87 included studies replicated the classic J-shaped curve, with low-volume drinkers (1.3-24.9 g ethanol per day) having reduced mortality risk (RR = 0.86, 95% CI [0.83, 0.90]). Occasional drinkers (<1.3 g per day) had similar mortality risk (RR = 0.84, 95% CI [0.79, 0.89]), and former drinkers had elevated risk (RR = 1.22, 95% CI [1.14, 1.31]). After adjustment for abstainer biases and quality-related study characteristics, no significant reduction in mortality risk was observed for low-volume drinkers (RR = 0.97, 95% CI [0.88, 1.07]). Analyses of higher-quality bias-free studies also failed to find reduced mortality risk for low-volume alcohol drinkers. Risk estimates for occasional drinkers were similar to those for low- and medium-volume drinkers.

CONCLUSIONS

Estimates of mortality risk from alcohol are significantly altered by study design and characteristics. Meta-analyses adjusting for these factors find that low-volume alcohol consumption has no net mortality benefit compared with lifetime abstention or occasional drinking. These findings have implications for public policy, the formulation of low-risk drinking guidelines, and future research on alcohol and health.

Is alcohol consumption a risk factor for prostate cancer? A systematic review and meta-analysis

BACKGROUND

Research on a possible causal association between alcohol consumption and risk of prostate cancer is inconclusive. Recent studies on associations between alcohol consumption and other health outcomes suggest these are influenced by drinker misclassification errors and other study quality characteristics. The influence of these factors on estimates of the relationship between alcohol consumption and prostate cancer has not been previously investigated.

METHODS

PubMed and Web of Science searches were made for case-control and cohort studies of alcohol consumption and prostate cancer morbidity and mortality (ICD-10: C61) up to December 2014. Studies were coded for drinker misclassification errors, quality of alcohol measures, extent of control for confounding and other study characteristics. Mixed models were used to estimate relative risk (RR) of morbidity or mortality from prostate cancer due to alcohol consumption with study level controls for selection bias and confounding.

RESULTS

A total of 340 studies were identified of which 27 satisfied inclusion criteria providing 126 estimates for different alcohol exposures. Adjusted RR estimates indicated a significantly increased risk of prostate cancer among low (RR = 1.08, P < 0.001), medium (RR = 1.07, P < 0.01), high (RR = 1.14, P < 0.001) and higher (RR = 1.18, P < 0.001) volume drinkers compared to abstainers. There was a significant dose-response relationship for current drinkers (Ptrend < 0.01). Studies free from misclassification errors produced the highest risk estimates for drinkers versus abstainers in adjusted models (RR = 1.22, P < 0.05).

CONCLUSION

Our study finds, for the first time, a significant dose-response relationship between level of alcohol intake and risk of prostate cancer starting with low volume consumption (>1.3, <24 g per day). This relationship is stronger in the relatively few studies free of former drinker misclassification error. Given the high prevalence of prostate cancer in the developed world, the public health implications of these findings are significant. Prostate cancer may need to be incorporated into future estimates of the burden of disease alongside other cancers (e.g. breast, oesophagus, colon, liver) and be integrated into public health strategies for reducing alcohol related disease.

Can a Healthy Lifestyle Compress the Disabled Period in Older Adults?

OBJECTIVES

To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life.

DESIGN

Community-based cohort study of older adults followed from 1989 to 2015.

SETTING

Four U.S. communities.

PARTICIPANTS

Community-living men and women aged 65 and older (N = 5,248, mean age 72.7 ± 5.5, 57% female, 15.2% minority) who were not wheelchair dependent and were able to give informed consent at baseline.

MEASUREMENTS

Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index (BMI), social networks, and social support, were measured at baseline. Activities of daily living (ADLs) were assessed at baseline and throughout follow-up. Years of life (YoL) was defined as years until death. Years of able life (YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression or expansion of the disabled period.

RESULTS

The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity was associated with 7.3 percentage points (95% confidence interval (CI) = 5.4-9.2) lower YAL/YoL% than normal weight. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7% (95% CI = 1.6-5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with 0.5 percentage points (95% CI = 0.3-0.8) higher YAL/YoL%.

CONCLUSION

The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors.

To your health!: Re-examining the health benefits of moderate alcohol use

Although excessive alcohol use and alcohol misuse contribute to a broad range of health problems, recent research indicates that moderate alcohol consumption may in fact be beneficial. The present study builds on previous research to investigate the associations between alcohol use and self-rated health status among young adults. Using data collected in 2008 from the National Longitudinal Survey of Adolescent to Adult Health (Add Health), we use ordered probit models to determine whether the protective effects of moderate alcohol use are present after controlling for demographic, lifestyle, family background, and health-related characteristics. Our findings generally support earlier research with older samples, but some key gender differences are present. For women (n = 8275), moderate drinkers have better self-rated health status relative to former drinkers, infrequent drinkers, and light drinkers. Among men (n = 7207), the effects are mixed and less often significant. Differences in results between men and women point to the need for further gender-specific research and studies with other measures of health.

Not all non-drinkers with HIV are equal: demographic and clinical comparisons among current non-drinkers with and without a history of prior alcohol use disorders

Studies of persons living with HIV (PLWH) have compared current non-drinkers to at-risk drinkers without differentiating whether current non-drinkers had a prior alcohol use disorder (AUD). The purpose of this study was to compare current non-drinkers with and without a prior AUD on demographic and clinical characteristics to understand the impact of combining them. We included data from six sites across the US from 1/2013 to 3/2015. Patients completed tablet-based clinical assessments at routine clinic appointments using the most recent assessment. Current non-drinkers were identified by AUDIT-C scores of 0. We identified a prior probable AUD by a prior AUD diagnosis in the electronic medical record (EMR) or a report of attendance at alcohol treatment in the clinical assessment. We used multivariate logistic regression to examine factors associated with prior AUD. Among 2235 PLWH who were current non-drinkers, 36% had a prior AUD with more patients with an AUD identified by the clinical assessment than the EMR. Higher proportions with a prior AUD were male, depressed, and reported current drug use compared to non-drinkers without a prior AUD. Former cocaine/crack (70% vs. 25%), methamphetamine/crystal (49% vs. 16%), and opioid/heroin use (35% vs. 7%) were more commonly reported by those with a prior AUD. In adjusted analyses, male sex, past methamphetamine/crystal use, past marijuana use, past opioid/heroin use, past and current cocaine/crack use, and cigarette use were associated with a prior AUD. In conclusion, this study found that among non-drinking PLWH in routine clinical care, 36% had a prior AUD. We found key differences between those with and without prior AUD in demographic and clinical characteristics, including drug use and depression. These results suggest that non-drinkers are heterogeneous and need further differentiation in studies and that prior alcohol misuse (including alcohol treatment) should be included in behavioural health assessments as part of clinical care.

Alcohol abstention in early adulthood and premature mortality: Do early life factors, social support, and health explain this association?

OBJECTIVE

Adult alcohol abstainers have a heightened risk of premature mortality compared to light-to-moderate drinkers. We examine three plausible explanations, other than lack of alcohol, for this observed difference: Abstainers 1) have early life disadvantages that undermine long-term health; 2) lack social support; 3) are less healthy.

METHOD

In the National Child Development Study, an ongoing national British cohort study of individuals born in 1958, we investigated whether early life disadvantages, lack of social support, and poor physical health reduce or eliminate the elevated risk of mortality through age 51 among those abstaining from alcohol at age 33. Using Cox proportional hazard models in a stepwise approach we examined whether the alcohol-mortality relationship changed when potential confounders were included.

RESULTS

The risk of mortality by age 51 was greater among age-33 abstainers compared to light drinkers (Hazard Ratio [HR] = 2.18; 95% CI = 1.40, 3.40). Including early life disadvantages and social support in the hazard models did not alter these associations (HR = 2.12; 95% CI = 1.27, 3.54). Including physical health in the model resulted in a 25% reduction in risk of death among abstainers, though the difference in risk remained statistically significant (HR = 1.75; 95% CI = 1.04, 2.94).

CONCLUSIONS

Abstaining from alcohol in early adulthood, in comparison to light drinking, predicts increased risk for premature mortality, even after accounting for numerous early and young adult confounders. Future research should examine potential moderators of this association.

Alcohol and Immediate Risk of Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis

BACKGROUND

Although considerable research describes the cardiovascular effects of habitual moderate and heavy alcohol consumption, the immediate risks following alcohol intake have not been well characterized. Based on its physiological effects, alcohol may have markedly different effects on immediate and long-term risk.

METHODS AND RESULTS

We searched CINAHL, Embase, and PubMed from inception to March 12, 2015, supplemented with manual screening for observational studies assessing the association between alcohol intake and cardiovascular events in the following hours and days. We calculated pooled relative risks and 95% confidence intervals for the association between alcohol intake and myocardial infarction, ischemic stroke, and hemorrhagic stroke using DerSimonian and Laird random-effects models to model any alcohol intake or dose-response relationships of alcohol intake and cardiovascular events. Among 1056 citations and 37 full-text articles reviewed, 23 studies (29 457 participants) were included. Moderate alcohol consumption was associated with an immediately higher cardiovascular risk that was attenuated after 24 hours, and even protective for myocardial infarction and hemorrhagic stroke (≈2-4 drinks: relative risk=30% lower risk) and protective against ischemic stroke within 1 week (≈6 drinks: 19% lower risk). In contrast, heavy alcohol drinking was associated with higher cardiovascular risk in the following day (≈6-9 drinks: relative risk=1.3-2.3) and week (≈19-30 drinks: relative risk=2.25-6.2).

CONCLUSIONS

There appears to be a consistent finding of an immediately higher cardiovascular risk following any alcohol consumption, but, by 24 hours, only heavy alcohol intake conferred continued risk.

Alcohol consumption after health deterioration in older adults: a mixed-methods study

OBJECTIVE

To examine if and how older adults modify their drinking after health deterioration, and the factors that motivate changing or maintaining stable drinking behaviour.

STUDY DESIGN

Explanatory follow-up mixed-methods research.

METHODS

The association between health deterioration and changes in alcohol consumption was examined using secondary data from the English Longitudinal Study of Ageing, a biennial prospective cohort study of a random sample of adults aged 50 years and older living in England. Data were collected through a personal interview and self-completion questionnaire across three waves between 2004 and 2009. The sample size (response rate) across the three waves was 8781 (49.9%), 7168 (40.3%) and 6623 (37.3%). The Chi-squared test was used to examine associations between diagnosis with a long-term condition or a worsening of self-rated health (e.g. from good to fair or fair to poor) and changes in drinking frequency (e.g. everyday, 5-6 days per week, etc.) and volume (ethanol consumed on a drinking day) between successive waves. In-depth interviews with 19 older adults recently diagnosed with a long-term condition were used to explore the factors that influenced change or maintenance in alcohol consumption over time. A purposive sampling strategy was used to recruit a diverse sample of current and former drinkers from voluntary and community organizations in the north of England. An inductive approach was used to analyze the data, facilitating the development of an a posteriori framework for understanding drinking change.

RESULTS

There was no significant relationship between health deterioration and changes in drinking volume over time. There was however a significant association between health deterioration and changes in drinking frequency between successive waves (χ² = 15.24, P < 0.001 and χ² = 17.28, P < 0.001). For example, of participants reporting health deterioration between the first two waves, 47.6% had stable drinking frequency, 23.4% increased their drinking frequency and 29% reported decreased drinking frequency. In comparison, of participants reporting no health deterioration, 52.7% reported stable frequency, 20.8% increased frequency and 26.4% decreased frequency. In qualitative interviews, older adults described a wide range of factors that influence changes in drinking behaviour: knowledge gained from talking to healthcare professionals, online and in the media; tangible negative experiences that were attributed to drinking; mood and emotions (e.g. joy); the cost of alcohol; pub closures; and changes in social roles and activities. Health was just one part of a complex mix of factors that influenced drinking among older adults.

CONCLUSION

Patterns of drinking change after health deterioration in older adults are diverse, including stable, increasing and decreasing alcohol consumption over time. Although health motivations to change drinking influence behaviour in some older adults, social and financial motivations to drink are also important in later life and thus a holistic approach is required to influence behaviour.

Early Life Health, Trauma and Social Determinants of Lifetime Abstention from Alcohol

AIMS

Factors influencing lifetime abstention from alcohol may be relevant to the validity of analyses of alcohol's impact on health outcomes. We evaluate relationships between early life experiences, social factors, and demographic characteristics on lifetime abstainer status in models disaggregating by gender and, among women, race/ethnicity.

METHODS

Analyses use the landline sample (N = 5382) of the 2010 U.S. National Alcohol Survey. Surveyed participants who reported never drinking alcohol were defined as lifetime abstainers. Additional variables assessed included demographics, dispositions to risk taking and impulsivity, and indicators of early life stress like economic difficulty, childhood trauma and early onset of health conditions. Logistic regression models predicting lifetime abstention were estimated.

RESULTS

Lifetime abstainers are more likely to be women and, among women, to be non-White and Latina. Those reporting that their religion discouraged drinking and that religion was very important to them were more likely to be lifetime abstainers. Higher education levels were associated with reduced rates of lifetime abstention among women. Also among women, family problem drinking was associated with lower rates of lifetime abstention. However, childhood economic difficulty significantly predicted lower abstention only for White women, and childhood sexual abuse was significantly related to lower lifetime abstention only for Black women.

CONCLUSIONS

Understanding the characteristics and determinants of individuals who never drink alcohol is relevant to any analysis of alcohol-related health outcomes. Results point to specific factors related to lifetime abstention with potential to bias such analyses if not included as control measures.

SHORT SUMMARY

Analyses evaluating relationships between early life experiences, social factors, and demographics with lifetime abstainer status identified characteristics associated with both poor health and with better health. These included lower risk taking and impulsivity scores and lower rates of family problem drinking, childhood economic difficulties and childhood sexual abuse.

Alcohol consumption and survival of colorectal cancer patients: a population-based study from Germany

BACKGROUND

Studies on the association between alcohol consumption and colorectal cancer (CRC) prognosis have yielded inconsistent results.

OBJECTIVE

The associations of lifetime and 1-y prediagnostic alcohol consumption with relevant prognostic outcomes were evaluated in a large population-based cohort of CRC patients.

DESIGN

In 2003-2010, 3121 patients diagnosed with CRC were interviewed on sociodemographic and lifestyle factors, medication, and comorbidities. Cancer recurrence, vital status, and cause of death were documented for a median follow-up time of 4.8 y. With the use of Cox proportional hazard regression, associations between lifetime and recent alcohol consumption and overall, CRC-specific, recurrence-free, and disease-free survival were analyzed.

RESULTS

In this patient cohort with a median age of 69 y at diagnosis, lifetime abstainers showed poorer overall [adjusted HR (aHR): 1.25; 95% CI: 1.03, 1.52] and CRC-specific (aHR: 1.37; 95% CI: 1.10, 1.70) survival than lifetime light drinkers (women: >0-12 g/d; men: >0-24 g/d). Lifetime heavy drinkers showed poorer overall (aHR: 1.37; 95% CI: 1.06, 1.78) and disease-free (aHR: 1.38; 95% CI: 1.09, 1.74) survival. Alcohol abstaining in the year before diagnosis was associated with poorer overall (aHR: 1.42; 95% CI: 1.20, 1.68), CRC-specific (aHR: 1.38; 95% CI: 1.13, 1.68), and disease-free (aHR: 1.23; 95% CI: 1.05, 1.44) survival. Lifetime abstainers with nonmetastatic disease showed poorer CRC-specific (aHR: 1.48; 95% CI: 1.10, 2.00) and recurrence-free (aHR: 1.32; 95% CI: 1.02, 1.70) survival. Wine abstaining but not beer or liquor abstaining was associated with poorer survival. Associations between alcohol consumption and prognosis varied according to presence of diabetes and age.

CONCLUSIONS

Prediagnostic alcohol abstaining and heavy drinking were associated with poorer survival after a CRC diagnosis than light drinking. The protective effects of light consumption might be restricted to wine, and associations might differ according to age and presence of diabetes mellitus.

Worsening of health and a cessation or reduction in alcohol consumption to special occasion drinking across three decades of the life course

Background

Ex-drinkers suffer from worse health than drinkers; however, whether a worsening of health is associated with a change in drinking status from early adulthood has not been previously investigated. We assess whether a worsening of health is associated with a cessation in consumption or reduction to special occasion drinking from early adulthood to middle age.

Methods

Multinomial logistic regression assessing whether a change in self-reported limiting longstanding illness (LLI) was associated with ceasing alcohol consumption, or a reduction to special occasion drinking compared with being a persistent drinker from age 23 in separate models at ages 33, 42, and 50. All models adjusted for sex, poor psychosocial health, education, marital status, and children in the household. Sample included participants from Great Britain followed longitudinally in the National Child Development Study from ages 23 to 33 (N = 5,529), 42 (N = 4,787), and 50 (N = 4,476).

Results

Developing an LLI from the previous wave was associated with ceasing alcohol consumption at ages 33 (odds ratio [ORs] = 2.71, 95% confidence interval [CI] = 1.16–4.93), 42 (OR = 2.44, 95%CI = 1.24–4.81), and 50 (OR = 3.33, 95%CI = 1.56–7.12) and a reduction to special occasion drinking at ages 42 (OR = 2.04, 95%CI = 1.40–2.99) and 50 (OR = 2.04, 95%CI = 1.18–3.53). Having a persistent LLI across 2 waves increased the odds of ceasing consumption at ages 42 (OR = 3.22, 95%CI = 1.06–9.77) and 50 (OR = 4.03, 95%CI = 1.72–9.44) and reducing consumption to special occasion drinking at ages 33 (OR = 3.27, 95%CI = 1.34–8.01) and 42 (OR = 2.25, 95%CI = 1.23–4.50). Persistent drinkers at older ages had the best overall health suffering less from previous poor health compared with those who reduced or ceased consumption at an earlier time point.

Conclusions

Developing an LLI was associated with a cessation in alcohol consumption and a reduction in consumption to special occasion drinking from early adulthood. Persistent drinkers who drank at least till 50 were the healthiest overall. Health selection is likely to influence nondrinking across the life course.

Alcohol and All-Cause Mortality: A Pooled Analysis

Reviewing 59 studies of the risk curve for alcohol consumption level and all-cause mortality, a general J-shaped curve is confirmed, particularly in cohorts with experience starting at middle age (rather than in youth or old age). The divergence in most studies that are exceptions to this rule can be plausibly explained. A pooled analysis of studies with cohorts age 45 and above at entry shows the most beneficial effect for women in a drinking category with a midpoint of one drink every second day, and for men in the drinking category with a midpoint of one and a half drinks per day though most of the benefit can be obtained by men, too, in the category with a midpoint of one-half drink per day. For men under 45, there was an almost linear increase in mortality risk with increasing consumption; data are lacking for a similar analysis for women. Directions are suggested for development in future studies, including the use of data on patterns of drinking.

Examination of a possible J-shaped relationship between alcohol consumption and internalizing disorders in a longitudinal birth cohort

BACKGROUND

Many studies have reported a J-shaped relationship between alcohol use and affective or anxiety symptoms, with abstainers experiencing more severe symptoms than moderate drinkers. It is less clear whether this relationship is also present for the risk of syndromal internalizing disorders such as depression or anxiety disorders.

METHODS

A New Zealand longitudinal birth cohort study (n=1265). Participants were interviewed at ages 18, 21, 25, 30 and 35 years. Alcohol consumption level and the presence of internalizing disorders (major depression; anxiety disorder) for the previous 12 months were determined at each time point. The association between drinking status and major depression and anxiety disorders at ages 18, 21, 25, 30 and 35 years was investigated via Generalized Estimating Equation modelling.

RESULTS

There was little evidence of a statistically significant (p<.05) association between alcohol consumption levels and either: (a) major depression; or (b) anxiety disorder; across the period 18-35 years. Inspection of the annual data showed considerable fluctuation in rates of disorder across alcohol consumption categories.

CONCLUSION

In young adults there was little evidence of a J-shaped relationship between alcohol use and both major depression and anxiety disorder.

Interaction Between Alcohol Consumption Patterns, Antiretroviral Therapy Type, and Liver Fibrosis in Persons Living with HIV

We examined the longitudinal association between alcohol use and liver fibrosis, measured by FIB-4 Score, among HIV-infected individuals by (1) antiretroviral therapy (ART) class, and (2) the presence of hepatitis C (HCV) co-infection. This was a prospective cohort study of 550 individuals in the Johns Hopkins HIV Clinical Cohort initiating ART between 2000 and 2012. The relationship between alcohol consumption (defined using NIAAA categories of non-, moderate, and hazardous drinkers) and liver fibrosis (FIB-4 score) by ART class was assessed using linear mixed effects models. Additionally, we examined whether the presence of HCV modified and whether viral load mediated the relationship between alcohol use and liver fibrosis. Overall, FIB-4 levels were 15.6% higher in hazardous drinkers compared to moderate drinkers (p = 0.025) after adjusting by age, sex, and race. Hazardous drinkers on PI-based regimens had FIB-4 scores 26.9% higher than moderate drinkers (p = 0.015). However, there was no difference in FIB-4 levels between hazardous drinkers on non-PI-based regimens compared to moderate drinkers (1.83% versus moderate drinkers, p = 0.848). There was no significant difference in FIB-4 between nondrinkers and moderate drinkers, irrespective of ART regimen. These associations were not modified by HCV status or mediated by viral load changes. Individuals with hazardous alcohol consumption and on PI-based regimens had significantly increased liver fibrosis, as measured by the FIB-4. These data suggest that providers should consider level of alcohol consumption when choosing an ART regimen to minimize detrimental effects on the liver.

Positive linear dose-response relationships, but no J-shaped relationship, between drinking habits and estimated glomerular filtration rate in middle-aged Japanese men

The relationship between drinking frequency and amount of alcohol consumption (i.e., drinking habits) and the risk of chronic kidney disease (CKD) remains unclear. We aimed to clarify either a linear or J-shaped dose-response relationship between drinking habits and estimated glomerular filtration rate (eGFR) as a biomarker for identifying individuals at high risk of CKD. In a large-scale cross-sectional study, 403 men and 121 women with an eGFR of 30-60 mL/min per 1.73 m(2) were defined as cases, and 1209 men and 363 women with ≥60 mL/min/1.73 m(2) were randomly extracted as controls (one case subject was matched with three control subjects, matched according to age and season of data collection). We calculated multivariate-adjusted CKD risk and the corresponding mean eGFR according to drinking habits. In men, negative and positive linear relationships with drinking habits were found for CKD risk and mean eGFR (p < 0.001 for all linear terms), respectively, but there were no corresponding J-shaped relationships (not significant for all quadratic terms). In regard to the mean eGFR, however, positive linear relationships were only shown in men in the highest eGFR quartile (p < 0.05 and p < 0.01 for drinking frequency and amount of alcohol consumption, respectively). In women, no association was found. Regarding each drinking habit, we found a positive linear dose-response relationship to eGFR in middle-aged men with an eGFR ≥30 mL/min/1.73 m(2).

The Relationship between Alcohol Consumption and Incidence of Glycometabolic Abnormality in Middle-Aged and Elderly Chinese Men

Aim. The relationship between alcohol consumption and glycometabolic abnormality is controversial, especially in different ethnic population. In this study, a cross-sectional survey was carried out to examine the relationship between alcohol consumption and glycometabolic abnormality in middle-aged and elderly Chinese men. Methods. Using cluster random sampling, Chinese men aged more than 40 years from Changchun, China, were given standardized questionnaires. In total, 1996 individuals, for whom complete data was available, were recruited into the study. We calculated the incidence of prediabetes and newly diagnosed diabetes by three levels of alcohol consumption: light, moderate, and heavy. Multivariate logistic regression models adjusted for socioeconomic variables and diabetes-related risk factors were used to analyze the association between alcohol consumption and the onset of prediabetes and diabetes. Results. The univariate analysis revealed higher incidence of prediabetes among drinkers (32.8%) compared with nondrinkers (28.6%), particularly in heavy alcohol consumers. The logistic regression analysis showed that alcohol consumption, especially heavy consumption, was an independent risk factor for prediabetes. Conclusions. Alcohol consumption, heavy consumption in particular, is an independent risk factor for the development of prediabetes, but not for diabetes.

Moderate Alcohol Consumption Is Not Associated with Reduced All-cause Mortality

BACKGROUND

A large body of research suggests that light or moderate alcohol consumption is associated with reduced all-cause mortality. However, concerns remain that the observed relationship is due to selection bias, misclassification of ex-drinkers, or residual confounding.

METHODS

The association between alcohol consumption and all-cause mortality was analyzed using Cox regression. The analysis was performed using data from the Health and Retirement Study, a longitudinal cohort of 24,029 individuals from a nationally representative sample of US adults aged more than 50 years. Drinking level was based on alcohol consumption measured at 3 points over the 4 years before the start of follow-up. Occasional drinkers-those who reported drinking on at least 1 occasion, but always less than once per week-served as the reference category. There was extensive adjustment for sociodemographic variables, health status, and functional status.

RESULTS

During 206,966 person-years of follow up, 7902 individuals died. No level of regular alcohol consumption was associated with reduced all-cause mortality. The hazard ratio and 95% confidence interval in fully adjusted analyses was 1.02 (0.94-1.11) for <7 drinks/week, 1.14 (1.02-1.28) for 7 to <14 drinks/week, 1.13 (0.96-1.35) for 14 to <21 drinks/week, and 1.45 (1.16-1.81) for ≥ 21 drinks/week.

CONCLUSIONS

Moderate alcohol consumption is not associated with reduced all-cause mortality in older adults. The previously observed association may have been due to residual confounding.

Is regular drinking in later life an indicator of good health? Evidence from the English Longitudinal Study of Ageing

Background

Older people who drink have been shown to have better health than those who do not. This might suggest that moderate drinking is beneficial for health, or, as considered here, that older people modify their drinking as their health deteriorates. The relationship between how often older adults drink and their health is considered for two heath states: self-rated health (SRH) and depressive symptoms.

Methods

Data were analysed from the English Longitudinal Study of Ageing (ELSA), a prospective cohort study of older adults, using multilevel ordered logit analysis. The analysis involved 4741 participants present at wave 0, (1998/1999 and 2001), wave 4 (2008/2009) and wave 5 (2010/2011). The outcome measure was frequency of drinking in last year recorded at all three time points.

Results

Older adults with fair/poor SRH at the onset of the study drank less frequently compared with adults with good SRH (p<0.05). Drinking frequency declined over time for all health statuses, though respondents with both continual fair/poor SRH and declining SRH experienced a sharper reduction in the frequency of their drinking over time compared with older adults who remained in good SRH or whose health improved. The findings were similar for depression, though the association between depressive symptoms and drinking frequency at the baseline was not significant after adjusting for confounding variables.

Conclusions

The frequency of older adults’ drinking responds to changes in health status and drinking frequency in later life may be an indicator, rather than a cause, of health status.

Alcohol Use Predicts 10-Year Depressive Symptom Trajectories in the Health and Retirement Study

OBJECTIVE

To determine effects of late-middle-aged adults' baseline drinking behavior on their subsequent 10-year depressive symptom trajectories.

METHOD

Health and Retirement Study participants (N = 7,939) were assessed on baseline demographic, health, and drinking characteristics, and biennially assessed for the next 10 years on their depressive symptoms.

RESULTS

Growth mixture modeling generated four classes of depressive symptom trajectories: Consistently low (72%), consistently elevated (6%), increasing (12%), and decreasing (10%). Baseline abstinence from alcohol, possibly enforced by poorer health and a history of drinking problems, and heavier drinking, "binge" drinking, and having a history of drinking problems, raised risk of membership in the "consistently elevated" class. Abstinence by participants without history of drinking problems-and light, moderate, and heavier drinking-protected against membership in the "increasing" class. Abstinence by participants without history of drinking problems elevated-and moderate drinking reduced-likelihood of membership in the "decreasing" class.

DISCUSSION

Late-middle-aged adults' alcohol use is associated with the subsequent long-term course of their depressive symptoms.

Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study

BACKGROUND

Alcohol consumption is proposed to be the third most important modifiable risk factor for death and disability. However, alcohol consumption has been associated with both benefits and harms, and previous studies were mostly done in high-income countries. We investigated associations between alcohol consumption and outcomes in a prospective cohort of countries at different economic levels in five continents.

METHODS

We included information from 12 countries participating in the Prospective Urban Rural Epidemiological (PURE) study, a prospective cohort study of individuals aged 35-70 years. We used Cox proportional hazards regression to study associations with mortality (n=2723), cardiovascular disease (n=2742), myocardial infarction (n=979), stroke (n=817), alcohol-related cancer (n=764), injury (n=824), admission to hospital (n=8786), and for a composite of these outcomes (n=11,963).

FINDINGS

We included 114,970 adults, of whom 12,904 (11%) were from high-income countries (HICs), 24,408 (21%) were from upper-middle-income countries (UMICs), 48,845 (43%) were from lower-middle-income countries (LMICs), and 28,813 (25%) were from low-income countries (LICs). Median follow-up was 4.3 years (IQR 3.0-6.0). Current drinking was reported by 36,030 (31%) individuals, and was associated with reduced myocardial infarction (hazard ratio [HR] 0.76 [95% CI 0.63-0.93]), but increased alcohol-related cancers (HR 1.51 [1.22-1.89]) and injury (HR 1.29 [1.04-1.61]). High intake was associated with increased mortality (HR 1.31 [1.04-1.66]). Compared with never drinkers, we identified significantly reduced hazards for the composite outcome for current drinkers in HICs and UMICs (HR 0.84 [0.77-0.92]), but not in LMICs and LICs, for which we identified no reductions in this outcome (HR 1.07 [0.95-1.21]; pinteraction<0.0001).

INTERPRETATION

Current alcohol consumption had differing associations by clinical outcome, and differing associations by income region. However, we identified sufficient commonalities to support global health strategies and national initiatives to reduce harmful alcohol use.

FUNDING

Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.

A population-based study on health-related quality of life among urban community residents in Shenyang, Northeast of China

BACKGROUND

Due to the rising standard of living environment and advances in public health and medical care in China, it has been a tendency in recent years that health-related quality of life (HRQoL) has been increasingly acknowledged in community health management. However, large-scale population-based study on evaluating HQRoL in northeast of China was not conducted. This article aims to investigate the HRQoL in community residents in Northeast China and explore the associated factors.

METHODS

Stratified multiple-stage sampling method was used in the cross-sectional survey to investigate HRQoL of community residents in northeast of China. Univariate analysis and multiple linear regressions were used to analyze the factors associated to HRQoL of the community residents.

RESULTS

The results were confirmed that HRQoL in general population was well performed for the first time in northeast of China in a large scale population. Community residents had better mental health than physical health. The factors influencing HRQoL included gender, age, educational level, marital status, ethnic group, chronic disease status, having breakfast frequency weekly and sleep quality. However, drinking and smoking habits did not affect residents' HRQoL.

CONCLUSIONS

In this study, the result of the large-scale survey was satisfactory in northeast of China, providing HRQoL status of community residents. Policies on specific health management in community public health would emphasize on lifestyle behaviors especially eating habits in order to improving HRQoL.

Baseline and lifetime alcohol consumption and risk of differentiated thyroid carcinoma in the EPIC study

BACKGROUND

Results from several cohort and case-control studies suggest a protective association between current alcohol intake and risk of thyroid carcinoma, but the epidemiological evidence is not completely consistent and several questions remain unanswered.

METHODS

The association between alcohol consumption at recruitment and over the lifetime and risk of differentiated thyroid carcinoma was examined in the European Prospective Investigation into Cancer and Nutrition. Among 477 263 eligible participants (70% women), 556 (90% women) were diagnosed with differentiated thyroid carcinoma over a mean follow-up of 11 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards models.

RESULTS

Compared with participants consuming 0.1-4.9 g of alcohol per day at recruitment, participants consuming 15 or more grams (approximately 1-1.5 drinks) had a 23% lower risk of differentiated thyroid carcinoma (HR=0.77; 95% CI=0.60-0.98). These findings did not differ greatly when analyses were conducted for lifetime alcohol consumption, although the risk estimates were attenuated and not statistically significant anymore. Similar results were observed by type of alcoholic beverage, by differentiated thyroid carcinoma histology or according to age, sex, smoking status, body mass index and diabetes.

CONCLUSIONS

Our study provides some support to the hypothesis that moderate alcohol consumption may be associated with a lower risk of papillary and follicular thyroid carcinomas.

Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study

BACKGROUND & AIMS

Alcohol is the main contributing factor of alcoholic cirrhosis, but less is known about the significance of drinking pattern.

METHODS

We investigated the risk of alcoholic cirrhosis among 55,917 participants (aged 50-64 years) in the Danish Cancer, Diet, and Health study (1993-2011). Baseline information on alcohol intake, drinking pattern, and confounders was obtained from a questionnaire. Follow-up information came from national registers. We calculated hazard ratios (HRs) for alcoholic cirrhosis in relation to drinking frequency, lifetime alcohol amount, and beverage type.

RESULTS

We observed 257 and 85 incident cases of alcoholic cirrhosis among men and women, respectively, none among lifetime abstainers. In men, HR for alcoholic cirrhosis among daily drinkers was 3.65 (95% CI: 2.39; 5.55) compared to drinking 2-4 days/week. Alcohol amount in recent age periods (40-49 and 50-59 years) was associated with an increased risk, whereas the amount in 20-29 and 30-39 years was not. In men drinking 14-28 drinks/week, HR was 7.47 (95% CI: 1.68; 33.12), 3.12 (95% CI: 1.53; 6.39), and 1.69 (95% CI: 0.79; 3.65) in drinkers of little (<1% of weekly amount), some (1-15%), and mostly wine (50-100%), compared to drinking <14 drinks/week. In general, results were similar for women.

CONCLUSIONS

In men, daily drinking was associated with an increased risk of alcoholic cirrhosis. Recent alcohol consumption rather than earlier in life was associated with risk of alcoholic cirrhosis. Compared to beer and liquor, wine might be associated with a lower risk of alcoholic cirrhosis.

Involuntary wellness programs: the case of a large US company

Purpose

– The purpose of this paper is to investigate recent healthcare reform in the USA, which allows insurance companies to proactively intervene in improving the long-term health of employees, by providing wellness programs as part of their benefits package.

Design/methodology/approach

– The authors present and analyze data on how employees of a large US Midwest “media and education” company (n=154) perceive economic incentives toward well-being. Data are collected using survey methods and analyzed with a logistic regression.

Findings

– This study suggests that fairness, accessibility, intention to switch to a healthier lifestyle and desire to see more health-related initiatives affect the way employees seek to participate in the new involuntary wellness programs. By contrast, satisfaction, participation, and income to not affect how these new programs are perceived.

Research limitations/implications

– These findings suggest that human resource managers should pay attention to employees who are not active in existing wellness programs, and provide support during the transition toward the new involuntary programs, to avoid potential frustration, demotivation, disengagement and, ultimately, decreasing performance among employees.

Originality/value

– The study is among the first to analyze involuntary wellness programs in the USA, and it provides a basis on which to expand further studies. This research contributes to support the idea that employee wellness is unlikely to be enforced by rule or policy.

Light to Moderate Alcohol Consumption Is Associated With Lower Risk of Aortic Valve Sclerosis: The Study of Health in Pomerania (SHIP)

OBJECTIVE

In developed countries, sclerotic and calcific degeneration of the aortic valve is a common disorder showing pathophysiologic similarities with atherothrombotic coronary disease. Light to moderate alcohol consumption has been associated with a lower risk for atherothrombotic coronary disease and mortality. Whether alcohol consumption affects the development of aortic valve sclerosis (AVS) is not well known. In the present study, we aim to analyze the cross-sectional association between average daily alcohol consumption and AVS in the general population.

APPROACH AND RESULTS

We analyzed cross-sectional data from 2022 men and women, aged 45 to 81 years, from the population-based Study of Health in Pomerania. We used a computer-assisted interview that included beverage-specific questions about quantity and frequency of alcohol over the last 30 days to calculate the average quantity of alcohol consumption (in grams of ethanol per day). AVS was ascertained by echocardiography. The prevalence of AVS was 32.3%. Average daily alcohol intake displayed a J-type relation with AVS (fully adjusted P value: 0.005). Compared with individuals with an average consumption of 10 g of alcohol per day, multivariable-adjusted odds ratios were 1.60 (95% confidence interval, 1.19-2.14) among current abstainers and 1.56 (95% confidence interval, 1.01-2.41) among individuals with an average consumption of 60 g per day.

CONCLUSIONS

Our findings indicate that light to moderate alcohol consumption was associated with a lower odd of having AVS. Prospective data need to address whether alcohol consumption and related changes over time in several biological markers affect the progression of AVS.

Abstinence and current or former alcohol use as predictors of disability retirement in Finland

Aim: According to previous studies, abstinence from alcohol increases the risk of disability retirement (DR). We studied whether former alcohol users’ poor mental or physical health might have contributed to this result. Methods: Prospective population-based study of 3621 occupationally active Finns aged 30–55 years at baseline. Disability pension data for 2000−2011 was retrieved from national pension records. We examined medically certified disability retirement due to all causes and due to mental disorders among lifelong abstainers, former drinkers, those with an alcohol use disorder irrespective of consumption and current users, further classified according to weekly intake of alcohol. Chronic somatic diseases were evaluated in a clinical examination and common mental and alcohol use disorders using the Composite International Diagnostic Interview. Cox regression was used. Results: Neither lifelong abstinence nor alcohol consumption, even at hazardous levels, without alcohol use disorder was associated with disability retirement. Compared with light drinkers, former drinkers’ hazard ratio for DR due to mental disorders was 2.67 (95% CI 1.39−5.13), allowing for somatic and mental morbidity, physical and psychosocial workload, health behaviour and socio-demographic factors. The respective hazard ratio of DR due to all causes for those with alcohol use disorder was 2.17 (1.49−3.16) and of DR due to mental disorders 4.04 (2.02 to 8.06). Conclusions: Lifelong abstinence did not predict disability retirement. Former drinkers and people with alcohol use disorders were at a multi-fold risk of work disability due to mental disorders compared with light drinkers, thus it is important to support their work ability.

All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts

OBJECTIVES

To examine the suitability of age specific limits for alcohol consumption and to explore the association between alcohol consumption and mortality in different age groups.

DESIGN

Population based data from Health Survey for England 1998-2008, linked to national mortality registration data and pooled for analysis using proportional hazards regression. Analyses were stratified by sex and age group (50-64 and ≥ 65 years).

SETTING

Up to 10 waves of the Health Survey for England, which samples the non-institutionalised general population resident in England.

PARTICIPANTS

The derivation of two analytical samples was based on the availability of comparable alcohol consumption data, covariate data, and linked mortality data among adults aged 50 years or more. Two samples were used, each utilising a different variable for alcohol usage: self reported average weekly consumption over the past year and self reported consumption on the heaviest day in the past week. In fully adjusted analyses, the former sample comprised Health Survey for England years 1998-2002, 18,368 participants, and 4102 deaths over a median follow-up of 9.7 years, whereas the latter comprised Health Survey for England years 1999-2008, 34,523 participants, and 4220 deaths over a median follow-up of 6.5 years.

MAIN OUTCOME MEASURE

All cause mortality, defined as any death recorded between the date of interview and the end of data linkage on 31 March 2011.

RESULTS

In unadjusted models, protective effects were identified across a broad range of alcohol usage in all age-sex groups. These effects were attenuated across most use categories on adjustment for a range of personal, socioeconomic, and lifestyle factors. After the exclusion of former drinkers, these effects were further attenuated. Compared with self reported never drinkers, significant protective associations were limited to younger men (50-64 years) and older women (≥ 65 years). Among younger men, the range of protective effects was minimal, with a significant reduction in hazards present only among those who reported consuming 15.1-20.0 units/average week (hazard ratio 0.49, 95% confidence interval 0.26 to 0.91) or 0.1-1.5 units on the heaviest day (0.43, 0.21 to 0.87). The range of protective effects was broader but lower among older women, with significant reductions in hazards present ≤ 10.0 units/average week and across all levels of heaviest day use. Supplementary analyses found that most protective effects disappeared where calculated in comparison with various definitions of occasional drinkers.

CONCLUSIONS

Beneficial associations between low intensity alcohol consumption and all cause mortality may in part be attributable to inappropriate selection of a referent group and weak adjustment for confounders. Compared with never drinkers, age stratified analyses suggest that beneficial dose-response relations between alcohol consumption and all cause mortality may be largely specific to women drinkers aged 65 years or more, with little to no protection present in other age-sex groups. These protective associations may, however, be explained by the effect of selection biases across age-sex strata.

Prevalence of alcohol-interactive prescription medication use among current drinkers: United States, 1999 to 2010

BACKGROUND

The majority of Americans consume alcoholic beverages. Alcohol interacts negatively with numerous commonly prescribed medications. Yet, on a population level, little is known about use of alcohol-interactive (AI) prescription medications among drinkers. The purpose of our study was to determine the prevalence of AI prescription medication use among current drinkers in the U.S. population.

METHODS

Data were from the National Health and Nutrition Examination Survey (NHANES 1999 to 2010); 26,657 adults aged ≥20 years had data on past year alcohol consumption and past month prescription medication use. Analyses were adjusted for covariates: age, race/ethnicity, education, marital status, and smoking. Statistical procedures accounted for survey stratification, clustering, and nonresponse. Analyses were weighted to be nationally representative.

RESULTS

The unadjusted total prevalence of AI medication use was 42.8% (95% confidence interval [CI] 41.5 to 44.0). Among current drinkers, adjusted prevalence was 41.5% (CI 40.3 to 42.7). Among participants aged ≥65 total prevalence of AI medication use was 78.6% (CI 77.3 to 79.9) and adjusted prevalence among current drinkers was 77.8% (CI 75.7 to 79.7). The AI medications most commonly used by current drinkers were cardiovascular agents, central nervous system agents, and metabolic agents.

CONCLUSIONS

Our results suggest that there could be substantial simultaneous exposure to alcohol and AI prescription medications in the U.S. population. Given the adverse health risks of combining alcohol with AI prescription medications, future efforts are needed to collect data to determine actual simultaneous prevalence.

Alcohol in the second half of life: do usual quantity and frequency of drinking to intoxication increase with increased drinking frequency?

AIMS

We investigated if increased drinking frequency among adults in the second half of life co-occurred with increased usual quantity and increased intoxication frequency.

DESIGN

Two-wave panel study.

SETTING

Norway.

PARTICIPANTS

Norwegian adults (1017 women and 959 men) aged 40-79 years.

MEASUREMENTS

Drinking frequency, usual quantity and intoxication frequency was measured by self-report in 2002/03 and again in 2007/08. Information about gender, age and level of education was obtained from the public register. Health was collected by self-report.

FINDINGS

Because of a significant gender × change in drinking frequency interaction effect on change in intoxication frequency (b = 0.02, P = 0.013), women and men were analysed separately. After adjusting for covariates, women who increase their drinking frequency showed a non-significant decrease in usual quantity [low initial usual quantity (LIUQ): β = -0.01, P = 0.879; high initial usual quantity (HIUQ): β = -0.06, P = 0.164] and a non-significant increase in intoxication frequency (LIUQ: β = 0.04, P = 0.569; HIUQ: β = 0.09, P = 0.251). Men who increased their drinking frequency showed a small decrease in usual quantity (LIUQ: β = -0.06, P = 0.049; HIUQ: β = -0.05, P = 0.002) and a small increase in intoxication frequency (LIUQ: β = 0.05, P = 0.035; HIUQ: β = 0.13, P = 0.004).

CONCLUSION

Among Norwegian adults in the second half of life, increased drinking frequency appears to be associated with a small reduction in usual quantity, and a small increase in frequency of drinking to intoxication.

Alcohol consumption and physical functioning among middle-aged and older adults in Central and Eastern Europe: results from the HAPIEE study

Background: light-to-moderate drinking is apparently associated with a decreased risk of physical limitations in middle-aged and older adults.

Objective: to investigate the association between alcohol consumption and physical limitations in Eastern European populations.

Study design: a cross-sectional survey of 28,783 randomly selected residents (45–69 years) in Novosibirsk (Russia), Krakow (Poland) and seven towns of Czech Republic.

Methods: physical limitations were defined as <75% of optimal physical functioning using the Physical Functioning (PF-10) Subscale of the Short-Form-36 questionnaire. Alcohol consumption was assessed by a graduated frequency questionnaire, and problem drinking was defined as ≥2 positive responses on the CAGE questionnaire. In the Russian sample, past drinking was also assessed.

Results: the odds of physical limitations were highest among non-drinkers, decreased with increasing drinking frequency, annual consumption and average drinking quantity and were not associated with problem drinking. The adjusted odds ratio (OR) of physical limitations in non-drinkers versus regular moderate drinkers was 1.61 (95% confidence interval: 1.48–1.75). In the Russian sample with past drinking available, the adjusted OR in those who stopped drinking for health reasons versus continuing drinkers was 3.19 (2.58–3.95); ORs in lifetime abstainers, former drinkers for non-health reasons and reduced drinkers for health reasons were 1.27 (1.02–1.57), 1.48 (1.18–1.85) and 2.40 (2.05–2.81), respectively.

Conclusion: this study found an inverse association between alcohol consumption and physical limitations. The high odds of physical limitations in non-drinkers can be largely explained by poor health of former drinkers. The apparently protective effect of heavier drinking was partly due to less healthy former heavy drinkers who moved to lower drinking categories.

Hospital outcomes in major depression among older adults: differences by alcohol comorbidity

OBJECTIVE

The prevalence of depression in older adults has been increasing over the last 20 years and is associated with economic costs in the form of treatment utilization and caregiving, including inpatient hospitalization. Comorbid alcohol diagnoses may serve as a complicating factor in inpatient admissions and may lead to overutilization of care and greater economic cost. This study sought to isolate the comorbidity effect of alcohol among older adult hospital admissions for depression.

METHODS

We analyzed a subsample (N = 8,480) of older adults (65+) from the 2010 Nationwide Inpatient Sample who were hospitalized with primary depression diagnoses, 7,741 of whom had depression only and 739 of whom also had a comorbid alcohol disorder. To address potential selection bias based on drinking and health status, propensity score matching was used to compare length of stay, total costs, and disposition between the two groups.

RESULTS

Bivariate analyses showed that older persons with depression and alcohol comorbidities were more often male (59.9% versus 34.0%, p <.001) and younger (70.9 versus 75.9 years, p <.001) than those with depression only. In terms of medical comorbidities, those with depression and alcohol disorders experienced more medical issues related to substance use (e.g., drug use diagnoses, liver disease, and suicidality; all p <.001), while those with depression only experienced more general medical problems (e.g., diabetes, renal failure, hypothyroid, and dementia; all p <.001). Propensity score matched models found that alcohol comorbidity was associated with shorter lengths of stay (on average 1.08 days, p <.02) and lower likelihood of post-hospitalization placement in a nursing home or other care facility (OR = 0.64, p <.001). No significant differences were found in overall costs or likelihood of discharge to a psychiatric hospital.

CONCLUSIONS

In older adults, depression with alcohol comorbidity does not lead to increased costs or higher levels of care after discharge. Comorbidity may lead to inpatient hospitalization at lower levels of severity, and depression with alcohol comorbidity may be qualitatively different than non-comorbid depression. Additionally, increased costs and negative outcomes in this population may occur at other levels of care such as outpatient services or emergency department visits.

Cohort Profile: Hong Kong Department of Health Elderly Health Service Cohort

The Department of Health Elderly Health Service Cohort in Hong Kong was set up to promote understanding of ageing in a global context, to exploit the role of Hong Kong as a sentinel for populations currently experiencing very rapid economic development, to provide a developed non-Western 'social laboratory' where empirically derived hypotheses can be tested and to leverage the different patterns of common chronic diseases between East and West to generate novel hypotheses about their determinants. The initial cohort enrolled from July 1998 to the end of December 2001 includes 66 820 people aged 65 years or older, forming about 9% of the population of this age. A comprehensive health assessment was made at enrollment and then repeated regularly on an ongoing basis. The health assessment included a comprehensive assessment of lifestyle, social circumstances, physical health and mental health, including an assessment of cognition and depressive symptoms. Health services use and deaths have been obtained by record linkage and confirmed, where necessary, by telephone interview. Currently, the data are not publicly available; we would welcome collaborations and research proposals.

The association of pattern of lifetime alcohol use and cause of death in the European prospective investigation into cancer and nutrition (EPIC) study

BACKGROUND

There is limited evidence for an association between the pattern of lifetime alcohol use and cause-specific risk of death.

METHODS

Multivariable hazard ratios were estimated for different causes of death according to patterns of lifetime alcohol consumption using a competing risks approach: 111 953 men and 268 442 women from eight countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included. Self-reported alcohol consumption at ages 20, 30, 40 or 50 years and at enrollment were used for the analysis; 26 411 deaths were observed during an average of 12.6 years of follow-up.

RESULTS

The association between lifetime alcohol use and death from cardiovascular diseases was different from the association seen for alcohol-related cancers, digestive, respiratory, external and other causes. Heavy users (>5 drinks/day for men and >2.5 drinks/day for women), regardless of time of cessation, had a 2- to 5-times higher risk of dying due to alcohol-related cancers, compared with subjects with lifetime light use (≤1 and ≤0.5 drink/week for men and women, respectively). Compared with lifetime light users, men who used <5 drinks/day throughout their lifetime had a 24% lower cardiovascular disease mortality (95% confidence interval 2-41). The risk of death from coronary heart disease was also found to be 34-46% lower among women who were moderate to occasionally heavy alcohol users compared with light users. However, this relationship was only evident among men and women who had no chronic disease at enrollment.

CONCLUSIONS

Limiting alcohol use throughout life is associated with a lower risk of death, largely due to cardiovascular disease but also other causes. However, the potential health benefits of alcohol use are difficult to establish due to the possibility of selection bias and competing risks related to diseases occurring later in life.