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Visontay R, Mewton L, Sunderland M, Chapman C, Slade T. Is low-level alcohol consumption really health-protective? A critical review of approaches to promote causal inference and recent applications. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:771-780. [PMID: 38643426 DOI: 10.1111/acer.15299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/16/2024] [Accepted: 02/29/2024] [Indexed: 04/22/2024]
Abstract
Heavy and disordered alcohol consumption is a known risk factor for several health conditions and is associated with considerable disease burden. However, at low-to-moderate levels, evidence suggests that drinking is associated with reduced risk for certain health outcomes. Whether these findings represent genuine protective effects or mere methodological artifacts remains unclear, but has substantial consequences for policy and practice. This critical review introduces methodological advances capable of enhancing causal inference from observational research, focusing on the 'G-methods' and Mendelian Randomization. We also present and evaluate recent research applying these methods and compare findings to the existing evidence base. Future directions are proposed for improving our causal understanding of the relationships between alcohol and long-term health outcomes.
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Affiliation(s)
- Rachel Visontay
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Mewton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
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Jurinsky J, Christie-Mizell CA. Variation by race/ethnicity-gender in the relationship between arrest history and alcohol use. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:729-742. [PMID: 38453188 DOI: 10.1111/acer.15285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Alcohol use contributes to the national burden of morbidity and mortality in the United States. Arrest, as a unique form of criminal justice system involvement, may be related to alcohol use from adolescence to adulthood. This study investigates the relationship between arrest and alcohol use across race/ethnicity-gender (R/E-G) status (e.g., Black, Latinx, and White men and women) as youth age. METHODS Data from 17 waves (1997-2015) of the National Longitudinal Survey of Youth, 1997 cohort (N = 8901) were used to explore how variation in R/E-G moderates the relationship between arrest history and alcohol use trajectories from 13 to 30 years old. Multilevel zero-inflated Poisson and Poisson regression were used to assess R/E-G variation in the relationship between arrest history and days of alcohol consumption, drinks per drinking occasion, and days of binge drinking after accounting for covariates, including incarceration. RESULTS The findings indicate that an arrest history is associated with alcohol use, and these results varied by R/E-G status, age, and alcohol use outcome. Those with an arrest history reported more days of drinking than their counterparts without an arrest; yet, the magnitude and direction of average drinks per occasion and binge drinking days varied by R/E-G status and age. Paradoxically, Black men, Black women, and Latinx men with an arrest history reported fewer days of binge drinking as they aged than their counterparts without an arrest. CONCLUSIONS A history of arrest is important for alcohol use from adolescence to adulthood and varies by R/E-G status, age, and alcohol use outcome. This work confirms previous scholarship showing that arrest and alcohol use are socially patterned and R/E-G status is an essential consideration in understanding the relationship. Future work should include additional identities and health behaviors and the consequences related to alcohol use outcomes.
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Affiliation(s)
- Jordan Jurinsky
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee, USA
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Deutsch AR, Chau E, Motabar N, Jalali MS. Grounding alcohol simulation models in empirical and theoretical alcohol research: a model for a Northern Plains population in the United States. SYSTEM DYNAMICS REVIEW 2023; 39:207-238. [PMID: 38107548 PMCID: PMC10723070 DOI: 10.1002/sdr.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/05/2023] [Indexed: 12/19/2023]
Abstract
The growing number of systems science simulation models for alcohol use (AU) are often disconnected from AU models within empirical and theoretical alcohol research. As AU prevention/intervention efforts are typically grounded in alcohol research, this disconnect may reduce policy testing results, impact, and implementation. We developed a simulation model guided by AU research (accounting for the multiple AU stages defined by AU behavior and risk for harm and diverse transitions between stages). Simulated projections were compared to historical data to evaluate model accuracy and potential policy leverage points for prevention and intervention at risky drinking (RD) and alcohol use disorder (AUD) stages. Results indicated prevention provided the greatest RD and AUD reduction; however, focusing exclusively on AUD prevention may not be effective for long-term change, given the continued increase in RD. This study makes a case for the strength and importance of aligning subject-based research with systems science simulation models.
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Affiliation(s)
- Arielle R Deutsch
- Avera Research Institute, Avera Health, Sioux Falls, SD, USA
- Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| | | | - Nikki Motabar
- University of California Santa Barbara, Santa Barbara, CA, USA
| | - Mohammad S Jalali
- University of California Santa Barbara, Santa Barbara, CA, USA
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
- Sloan School of Management, Massachusetts, Institute of Technology, Cambridge, MA, USA
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Garduno AC, Laughlin GA, Bergstrom J, Tu XM, Cummins KM, Franz CE, Elman JA, Lyons MJ, Reynolds CA, Neale MC, Gillespie NA, Xian H, McKenzie RE, Toomey R, Kremen WS, Panizzon MS, McEvoy LK. Alcohol use and cognitive aging in middle-aged men: The Vietnam Era Twin Study of Aging. J Int Neuropsychol Soc 2023; 29:235-245. [PMID: 35465863 PMCID: PMC9592679 DOI: 10.1017/s1355617722000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine associations of alcohol use with cognitive aging among middle-aged men. METHOD 1,608 male twins (mean 57 years at baseline) participated in up to three visits over 12 years, from 2003-2007 to 2016-2019. Participants were classified into six groups based on current and past self-reported alcohol use: lifetime abstainers, former drinkers, very light (1-4 drinks in past 14 days), light (5-14 drinks), moderate (15-28 drinks), and at-risk drinkers (>28 drinks in past 14 days). Linear mixed-effects regressions modeled cognitive trajectories by alcohol group, with time-based models evaluating rate of decline as a function of baseline alcohol use, and age-based models evaluating age-related differences in performance by current alcohol use. Analyses used standardized cognitive domain factor scores and adjusted for sociodemographic and health-related factors. RESULTS Performance decreased over time in all domains. Relative to very light drinkers, former drinkers showed worse verbal fluency performance, by -0.21 SD (95% CI -0.35, -0.07), and at-risk drinkers showed faster working memory decline, by 0.14 SD (95% CI 0.02, -0.20) per decade. There was no evidence of protective associations of light/moderate drinking on rate of decline. In age-based models, light drinkers displayed better memory performance at advanced ages than very light drinkers (+0.14 SD; 95% CI 0.02, 0.20 per 10-years older age); likely attributable to residual confounding or reverse association. CONCLUSIONS Alcohol consumption showed minimal associations with cognitive aging among middle-aged men. Stronger associations of alcohol with cognitive aging may become apparent at older ages, when cognitive abilities decline more rapidly.
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Affiliation(s)
- Alexis C Garduno
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Gail A Laughlin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Jaclyn Bergstrom
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Xin M Tu
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Kevin M Cummins
- Department of Public Health, California State University, Fullerton, CA, USA
| | - Carol E Franz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, San Diego, CA, USA
| | - Jeremy A Elman
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, San Diego, CA, USA
| | - Michael J Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Chandra A Reynolds
- Department of Psychology, University of California Riverside, Riverside, CA, USA
| | - Michael C Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Hong Xian
- Department of Statistics, St Louis University, St Louis, MO, USA
- Research Service, VA St Louis Healthcare System, St Louis, MO, USA
| | - Ruth E McKenzie
- Department of Psychology, Boston University, Boston, MA, USA
- Department of Applied Human Development and Community Studies, Merrimack College, North Andover, MA, USA
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - William S Kremen
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, San Diego, CA, USA
| | - Matthew S Panizzon
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, San Diego, CA, USA
| | - Linda K McEvoy
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
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Moderate Alcohol Use Is Associated with Reduced Cardiovascular Risk in Middle-Aged Men Independent of Health, Behavior, Psychosocial, and Earlier Life Factors. Nutrients 2022; 14:nu14112183. [PMID: 35683983 PMCID: PMC9182350 DOI: 10.3390/nu14112183] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/21/2022] [Accepted: 05/21/2022] [Indexed: 02/04/2023] Open
Abstract
We examined whether the often-reported protective association of alcohol with cardiovascular disease (CVD) risk could arise from confounding. Our sample comprised 908 men (56−67 years), free of prevalent CVD. Participants were categorized into 6 groups: never drinkers, former drinkers, and very light (1−4 drinks in past 14 days), light (5−14 drinks), moderate (15−28 drinks), and at-risk (>28 drinks) drinkers. Generalized linear mixed effect models examined the associations of alcohol use with three established CVD risk scores: The Framingham Risk Score (FRS); the atherosclerotic CVD (ASCVD) risk score; and the Metabolic Syndrome (MetS) Severity score, adjusting for group differences in demographics, body size, and health-related behaviors. In separate models we additionally adjusted for several groups of potentially explanatory factors including socioeconomic status, social support, physical and mental health status, childhood factors, and prior history of alcohol misuse. Results showed lower CVD risk among light and moderate alcohol drinkers, relative to very light drinkers, for all CVD risk scores, independent of demographics, body size, and health-related behaviors. Alcohol-CVD risk associations were robust to further adjustment for several groups of potential explanatory factors. Study limitations include the all-male sample with limited racial and ethnic diversity, and the inability to adjust for sugar consumption and for patterns of alcohol consumption. Although this observational study does not address causation, results show that middle-aged men who consume alcohol in moderation have lower CVD risk and better cardiometabolic health than men who consume little or no alcohol, independent of a variety of health, behavioral, psychosocial, and earlier life factors.
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Visontay R, Sunderland M, Slade T, Wilson J, Mewton L. Are there non-linear relationships between alcohol consumption and long-term health?: a systematic review of observational studies employing approaches to improve causal inference. BMC Med Res Methodol 2022; 22:16. [PMID: 35027007 PMCID: PMC8759175 DOI: 10.1186/s12874-021-01486-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/29/2021] [Indexed: 12/29/2022] Open
Abstract
Background Research has long found ‘J-shaped’ relationships between alcohol consumption and certain health outcomes, indicating a protective effect of moderate consumption. However, methodological limitations in most studies hinder causal inference. This review aimed to identify all observational studies employing improved approaches to mitigate confounding in characterizing alcohol–long-term health relationships, and to qualitatively synthesize their findings. Methods Eligible studies met the above description, were longitudinal (with pre-defined exceptions), discretized alcohol consumption, and were conducted with human populations. MEDLINE, PsycINFO, Embase and SCOPUS were searched in May 2020, yielding 16 published manuscripts reporting on cancer, diabetes, dementia, mental health, cardiovascular health, mortality, HIV seroconversion, and musculoskeletal health. Risk of bias of cohort studies was evaluated using the Newcastle-Ottawa Scale, and a recently developed tool was used for Mendelian Randomization studies. Results A variety of functional forms were found, including reverse J/J-shaped relationships for prostate cancer and related mortality, dementia risk, mental health, and certain lipids. However, most outcomes were only evaluated by a single study, and few studies provided information on the role of alcohol consumption pattern. Conclusions More research employing enhanced causal inference methods is urgently required to accurately characterize alcohol–long-term health relationships. Those studies that have been conducted find a variety of linear and non-linear functional forms, with results tending to be discrepant even within specific health outcomes. Trial registration PROSPERO registration number CRD42020185861. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01486-5.
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Affiliation(s)
- Rachel Visontay
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, G02, Sydney, NSW, 2006, Australia. .,Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, NSW, 2052, Australia.
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, G02, Sydney, NSW, 2006, Australia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, G02, Sydney, NSW, 2006, Australia
| | - Jack Wilson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, G02, Sydney, NSW, 2006, Australia
| | - Louise Mewton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, G02, Sydney, NSW, 2006, Australia.,Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, NSW, 2052, Australia
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John U, Rumpf HJ, Hanke M, Meyer C. Alcohol abstinence and mortality in a general population sample of adults in Germany: A cohort study. PLoS Med 2021; 18:e1003819. [PMID: 34727120 PMCID: PMC8562854 DOI: 10.1371/journal.pmed.1003819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Evidence suggests that people who abstain from alcohol have a higher mortality rate than those who drink low to moderate amounts. However, little is known about factors that might be causal for this finding. The objective was to analyze former alcohol or drug use disorders, risky drinking, tobacco smoking, and fair to poor health among persons who reported abstinence from alcohol drinking in the last 12 months before baseline in relation to total, cardiovascular, and cancer mortality 20 years later. METHODS AND FINDINGS A sample of residents aged 18 to 64 years had been drawn at random among the general population in northern Germany and a standardized interview conducted in the years 1996 to 1997. The baseline assessment included 4,093 persons (70.2% of those who had been eligible). Vital status and death certificate data were retrieved in the years 2017 and 2018. We found that among the alcohol-abstinent study participants at baseline (447), there were 405 (90.60%) former alcohol consumers. Of the abstainers, 322 (72.04%) had met one or more criteria for former alcohol or drug dependence or abuse, alcohol risky drinking, or had tried to cut down or to stop drinking, were daily smokers, or self-rated their health as fair to poor. Among the abstainers with one or more of these risk factors, 114 (35.40%) had an alcohol use disorder or risky alcohol consumption in their history. Another 161 (50.00%) did not have such an alcohol-related risk but were daily smokers. The 322 alcohol-abstinent study participants with one or more of the risk factors had a shorter time to death than those with low to moderate alcohol consumption. The Cox proportional hazard ratio (HR) was 2.44 (95% confidence interval (CI), 1.68 to 3.56) for persons who had one or more criteria for an alcohol or drug use disorder fulfilled in their history and after adjustment for age and sex. The 125 alcohol-abstinent persons without these risk factors (27.96% of the abstainers) did not show a statistically significant difference from low to moderate alcohol consumers in total, cardiovascular, and cancer mortality. Those who had stayed alcohol abstinent throughout their life before (42; 9.40% of the alcohol-abstinent study participants at baseline) had an HR 1.64 (CI 0.72 to 3.77) compared to low to moderate alcohol consumers after adjustment for age, sex, and tobacco smoking. Main limitations of this study include its reliance on self-reported data at baseline and the fact that only tobacco smoking was analyzed as a risky behavior alongside alcohol consumption. CONCLUSIONS The majority of the alcohol abstainers at baseline were former alcohol consumers and had risk factors that increased the likelihood of early death. Former alcohol use disorders, risky alcohol drinking, ever having smoked tobacco daily, and fair to poor health were associated with early death among alcohol abstainers. Those without an obvious history of these risk factors had a life expectancy similar to that of low to moderate alcohol consumers. The findings speak against recommendations to drink alcohol for health reasons.
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Affiliation(s)
- Ulrich John
- University Medicine Greifswald, Prevention Research and Social Medicine, Institute of Community Medicine, Greifswald, Germany
- German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
- * E-mail:
| | - Hans-Juergen Rumpf
- University of Luebeck, Department of Psychiatry and Psychotherapy, Research Group S:TEP, Luebeck, Germany
| | - Monika Hanke
- University Medicine Greifswald, Prevention Research and Social Medicine, Institute of Community Medicine, Greifswald, Germany
| | - Christian Meyer
- University Medicine Greifswald, Prevention Research and Social Medicine, Institute of Community Medicine, Greifswald, Germany
- German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
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Lui CK, Kerr WC, Li L, Mulia N, Ye Y, Williams E, Greenfield TK, Lown EA. Lifecourse Drinking Patterns, Hypertension, and Heart Problems Among U.S. Adults. Am J Prev Med 2020; 58:386-395. [PMID: 31928761 PMCID: PMC7176748 DOI: 10.1016/j.amepre.2019.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Understanding the role of alcohol in hypertension and heart problems requires a lifecourse perspective accounting for drinking patterns before onset of health problems that distinguishes between lifetime abstinence and former drinking, prior versus current drinking, and overall alcohol consumption in conjunction with heavy episodic drinking. Using prospective data among U.S. adults aged 21-55 years, this study accounts for these lifecourse factors to investigate the effect of alcohol on hypertension and heart problems. METHODS Data from the U.S. National Longitudinal Survey of Youth, aged 14-21 years in 1979 and followed through 2012 (n=8,289), were analyzed in 2017-18 to estimate hypertension and heart problems onset from lifecourse drinking patterns. Discrete-time survival models stratified by sex and race/ethnicity, controlling for demographics and time-varying factors of employment, smoking, and obesity. RESULTS Elevated risks for hypertension were found for women drinking >14 drinks/week regardless of any heavy drinking (AOR=1.57, p=0.023) and for men engaged in risky drinking (15-28 drinks/week) together with monthly heavy drinking (AOR=1.64, p=0.016). Having a history of weekly heavy drinking elevated the risk for women but not for men. No significant relationship was evident for alcohol and heart problems onset. CONCLUSIONS This study confirms previous findings of increased hypertension risk from higher volume and heavier drinking patterns among women and men but did not find any support for increased heart problems risk, which may be due to the younger age profile of the sample. Further research that incorporates lifecourse drinking patterns is needed to better understand the alcohol-health relationship.
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Affiliation(s)
- Camillia K Lui
- Alcohol Research Group, Public Health Institute, Emeryville, California.
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Libo Li
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Edwina Williams
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | | | - E Anne Lown
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California
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Lown EA, Lui CK, Karriker-Jaffe K, Mulia N, Williams E, Ye Y, Li L, Greenfield TK, Kerr WC. Adverse childhood events and risk of diabetes onset in the 1979 National longitudinal survey of youth cohort. BMC Public Health 2019; 19:1007. [PMID: 31351463 PMCID: PMC6661082 DOI: 10.1186/s12889-019-7337-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 07/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset. Methods Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes. Results T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2–3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (ORadj = 1.14; 95% CI 1.02–1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI). Conclusion ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.
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Affiliation(s)
- E Anne Lown
- Department of Social and Behavioral Sciences, School of Nursing, University of California, 3333 California Street, San Francisco, CA, 94118, USA.
| | - Camillia K Lui
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Kate Karriker-Jaffe
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Edwina Williams
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Libo Li
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
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Kerr WC, Ye Y, Williams E, Lui CK, Greenfield TK, Lown EA. Lifetime Alcohol Use Patterns and Risk of Diabetes Onset in the National Alcohol Survey. Alcohol Clin Exp Res 2018; 43:262-269. [PMID: 30422306 DOI: 10.1111/acer.13924] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies of the role of alcohol use in diabetes risk have rarely included lifetime alcohol use measures, including the frequency of heavy occasions, or evaluated risks among Black or Hispanic respondents in US samples. METHODS Data from the 2014 to 2015 National Alcohol Survey of the U.S. population were used to estimate diabetes risk from drinking patterns at the time of onset in Cox proportional hazards models in a retrospective cohort design. Models for the population, males and females, and for White, Black, and Hispanic respondents of both genders were estimated using 2 versions of drinking pattern groupings at each age. RESULTS While a number of significant results were found with the first version of the drinking measures, we focus on those confirmed with measures from responses strictly prior to the age of risk estimation. Compared to the lifetime abstainer group, the "drinking at least weekly with less than monthly 5+" group had a significantly lower hazard ratio (HR) for the total sample (HR = 0.64) and among Whites (HR = 0.42). Significantly reduced risks were found in the same models for those who drank 5+ at least monthly but not weekly. No significantly elevated risks were found for either current or prior heavy occasion drinking. CONCLUSIONS These results are consistent with some prior studies in finding reduced risks for regular light-to-moderate drinkers, but not consistent with findings from other studies showing increased risk from heavy occasion drinking, particularly among women. New and larger studies with well-defined drinking pattern measures are needed, particularly for U.S. Blacks and Hispanics, to address varying results in this literature.
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Affiliation(s)
- William C Kerr
- Alcohol Research Group , Public Health Institute, Emeryville, California
| | - Yu Ye
- Alcohol Research Group , Public Health Institute, Emeryville, California
| | - Edwina Williams
- Alcohol Research Group , Public Health Institute, Emeryville, California
| | - Camillia K Lui
- Alcohol Research Group , Public Health Institute, Emeryville, California
| | | | - E Anne Lown
- Department of Social and Behavioral Sciences , School of Nursing, University of California, San Francisco, San Francisco, California
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Wood AM, Kaptoge S, Paige E, Di Angelantonio E, Danesh J. Risk thresholds for alcohol consumption - Authors' reply. Lancet 2018; 392:2167-2168. [PMID: 30496096 DOI: 10.1016/s0140-6736(18)32181-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/29/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Ellie Paige
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | | | - John Danesh
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
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12
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Kerr WC, Williams E, Li L, Lui CK, Ye Y, Greenfield TK, Lown EA. Alcohol use patterns and risk of diabetes onset in the 1979 National Longitudinal Survey of Youth Cohort. Prev Med 2018; 109:22-27. [PMID: 29366820 PMCID: PMC5843547 DOI: 10.1016/j.ypmed.2018.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 01/12/2023]
Abstract
One of the major limitations in studying alcohol's effect on risk for diabetes is the issue of classifying drinking patterns across the life course prior to the onset of diabetes. Furthermore, this research often overlooks important life course risk factors such as obesity and early-life health problems that may complicate estimation of the relationship between alcohol and diabetes. This study used data from the US National Longitudinal Survey of Youth 1979 cohort of 14-21 year olds followed through 2012 (n = 8289). Alcohol use was captured through time-varying measures of past month volume and frequency of days with 6+ drinks. Discrete-time survival models controlling for demographics, early-life characteristics and time-varying risk factors of employment, smoking, and body mass index (BMI) group, stratified by sex and race/ethnicity, were estimated. Increased odds of diabetes onset was found among lifetime abstainers for women compared to the low volume reference group (odds ratio (OR) 1.57; 95% Confidence Interval (CI) 1.07-2.3). Increased odds of diabetes onset was also found among women who reported drinking 6+ drinks in a day on a weekly basis during the prior 10 years (OR 1.55; CI 1.04-2.31). Models interacting alcohol and BMI groups found increased odds of diabetes onset from lifetime abstention among overweight women only (OR 3.06; CI 1.67-5.60). This study confirms previous findings of protective effects from low volume drinking compared to lifetime abstention and harmful effects from regular heavy occasion drinking for women. Further, protective effects in this US sample were found to be limited to overweight women only.
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Affiliation(s)
- William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States.
| | - Edwina Williams
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - Libo Li
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - Camillia K Lui
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - E Anne Lown
- School of Nursing, University of California, San Francisco, Department of Social and Behavioral Sciences, 3333 California Street, San Francisco, CA 94118, United States
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13
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Ng Fat L. Commentary on Kerr and Colleagues (): More Evidence that Social and Health Limitations in Childhood Increase the Risk of Lifetime Abstention from Alcohol. Alcohol Clin Exp Res 2017; 41:876-879. [PMID: 28222224 DOI: 10.1111/acer.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Linda Ng Fat
- Department of Epidemiology & Public Health (LNF), Institute of Epidemiology & Health Care, University College London, London, United Kingdom
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