Public health consequences of the J-curve hypothesis of alcohol problems

Leisure time activities and biomarkers of chronic stress: The mediating roles of alcohol consumption and smoking

AIMS

Previous research found an association between leisure time activities such as arts and cultural activities and self-reported health over the life course-a measure prone to response bias. This study tested the relationship between arts and cultural activities and allostatic load, a biomarker of chronic stress, and examined risky health behaviors, including alcohol consumption and smoking, as possible mediators.

METHODS

The sample consists of 8948 adults from the second wave of the United Kingdom Household Longitudinal Study, which is representative of the British population. The cross-sectional association between arts and cultural activities and allostatic load was tested with negative binomial models, and the mediation roles of alcohol consumption and smoking in the association was tested with the Karlson-Holm-Breen (KHB) decomposition method.

RESULTS

Frequent participation in arts, frequent attendance of cultural events, visits to museums or galleries, and visits to historical sites have negative associations with allostatic load. The associations are mediated by lower frequency of alcohol drinking and smoking.

CONCLUSIONS

Cultural capital may promote health by reducing the frequency of health risk behaviors such as drinking alcohol and smoking. Future research and public health policies should consider whether cultural capital acts as a social determinant of health to promote healthy leisure activities over the life course.

Trends in alcohol consumption in relation to cause-specific and all-cause mortality in the United States: a report from the NHANES linked to the US mortality registry

BACKGROUND

Excessive alcohol use is the third leading cause of mortality in the United States, where alcohol use consistently increased over the last decades. This trend is currently maintained, despite regulatory policies aimed to counteract it. While the increased health risks resulting from alcohol use are evident, some open questions regarding alcohol use and its consequences in the US population remain.

OBJECTIVES

The current work aims to evaluate the relation between alcohol consumption trends over a period of 15 y with all-cause and cause-specific mortality. In addition, we evaluate the adequacy of the current alcohol recommended limits according to the 2015-2020 US Dietary Guidelines for Americans (USDGA).

METHODS

This was a prospective population-based study defined by the NHANES conducted over the period 1999-2014 linked to US mortality registry in 2015.

RESULTS

The sample, composed of 34,672 participants, was observed for a median period of 7.8 y, totaling 282,855 person-years. In the present sample, 4,303 deaths were observed. Alcohol use increased during the period 1999-2014. Alcohol use above the current US recommendations was associated with increased all-cause and cause-specific mortality risk, ranging from 39% to 126%. A proportion of these deaths, ranging from 19% to 26%, could be theoretically prevented if US citizens followed current guidelines, and 13% of all-cause deaths in men could be avoided if the current US guidelines for women (1 standard drink/d) were applied to them.

CONCLUSIONS

The present study provides evidence in support of limiting alcohol intake in adherence to the USDGA recommendations.

Association between alcohol consumption and impaired work performance (presenteeism): a systematic review

OBJECTIVES

The aim of this review was to explore the notion of alcohol-related presenteeism; that is, whether evidence in the research literature supports an association between employee alcohol consumption and impaired work performance.

DESIGN

Systematic review of observational studies.

DATA SOURCES

MEDLINE, Web of Science, PsycINFO, CINAHL, AMED, Embase and Swemed+ were searched through October 2018. Reference lists in included studies were hand searched for potential relevant studies.

ELIGIBILITY CRITERIA

We included observational studies, published 1990 or later as full-text empirical articles in peer-reviewed journals in English or a Scandinavian language, containing one or more statistical tests regarding a relationship between a measure of alcohol consumption and a measure of work performance.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data. Tested associations between alcohol consumption and work performance within the included studies were quality assessed and analysed with frequency tables, cross-tabulations and χ² tests of independence.

RESULTS

Twenty-six studies were included, containing 132 tested associations. The vast majority of associations (77%) indicated that higher levels of alcohol consumption were associated with higher levels of impaired work performance, and these positive associations were considerably more likely than negative associations to be statistically significant (OR=14.00, phi=0.37, p<0.001). Alcohol exposure measured by hangover episodes and composite instruments were over-represented among significant positive associations of moderate and high quality (15 of 17 associations). Overall, 61% of the associations were characterised by low quality.

CONCLUSIONS

Evidence does provide some support for the notion of alcohol-related presenteeism. However, due to low research quality and lack of longitudinal designs, evidence should be characterised as somewhat inconclusive. More robust and less heterogeneous research is warranted. This review, however, does provide support for targeting alcohol consumption within the frame of workplace interventions aimed at improving employee health and productivity.

PROSPERO REGISTRATION NUMBER

CRD42017059620.

Current practices and perceived implementation barriers for working with alcohol prevention in occupational health services: the WIRUS OHS study

BACKGROUND

Alcohol is associated with detrimental health and work performance outcomes, and one to three out of ten employees may benefit from interventions. The role of occupational health services (OHS) in alcohol prevention has received little attention in research. The primary aims of this study were to explore current practices of alcohol prevention targeting employees in occupational health settings, and examine whether and which perceived implementation barriers were associated with alcohol prevention activity. The secondary aim was to explore whether barriers were differentially associated with primary, secondary and tertiary prevention activities.

METHODS

In this cross-sectional study, survey data were collected from 295 OHS professionals in Norway in 2018. Data were analysed by means of descriptive statistics, one-way analysis of variance, paired samples t-tests, and multivariate linear regression analyses.

RESULTS

Overall, seven out of ten OHS professionals worked with alcohol-related cases less than monthly, while only one out of ten did so on a weekly basis. Their activities were more focused on tertiary prevention than on primary and secondary prevention. Physicians, psychologists and nurses reported to handle alcohol-related issues more often than occupational therapists and physical therapists. Higher levels of implementation barriers internal to the OHS' organisation (competence, time and resources) were associated with lower alcohol prevention activity. Barriers external to the OHS' organisation (barriers concerning employers and employees) were not. This pattern was evident for primary, secondary and tertiary prevention activities. A majority of OHS professionals agreed that employees' alcohol consumption constitute a public health challenge, and that OHS' should focus more on alcohol prevention targeting employees.

CONCLUSIONS

Occupational health settings at workplaces may be particularly serviceable for alcohol prevention programmes since the majority of the population is employed and the majority of employees consume alcohol. An increase in overall prevention activity, and a shift from mainly focusing on tertiary prevention to an increased emphasis on primary and secondary prevention, may both hinge on increased training of OHS professionals, emphasising knowledge on the importance of working with alcohol prevention, and training in administering alcohol prevention programmes. Making alcohol prevention a priority may also require increased allocation of time and resources.

Draining the ocean to prevent shark attacks?: The empirical foundation of alcohol policy

Jürgen Rehm: Draining the ocean to prevent shark attacks? The empirical foundation of alcohol policy

The line of reasoning behind current alcohol policy is examined and related to empirical research on the consequences of alcohol consumption. It is found that current alcohol policy places too much emphasis on both aggregate consumption and chronic disease as the main problems, and availability and access to alcohol as the most important instruments in reducing alcohol-related harm. There is empirical evidence, however, that other forms of harm are equally if not more important in many cases, and that the empirical links between availability and consumption, and between consumption and harm, are not always as important as predicted. Some consequences for alternative alcohol policy strategies for the future are discussed.

Alcohol Consumption and All-Cause Mortality in the United States, 1950–2002

The aim of the study was to estimate the relationship between per capita alcohol consumption and male all-cause mortality in the United States (U.S.) for the period 1950–2002. Alcohol sales (in litres of 100% alcohol) were used as proxy for per capita consumption. The data were analyzed using the Box-Jenkins technique. Two models were estimated, one including only female mortality as a control, the other including in addition cigarette sales. The first model yielded a significant alcohol effect that implied a 2.8% (p < 0.001) increase in mortality given a 1-litre increase in consumption. This estimate coincides with those obtained for Canada, northern Europe and Russia in previous research but is stronger than estimates for southern Europe. When cigarette sales were included in the model, the alcohol effect was almost halved but still statistically significant. The results indicate that population drinking is of great importance for public health.

Alcohol and Alcohol Effects: Constituting Causality in Alcohol Epidemiology

Taking cues from Science and Technology Studies, we examine how one type of alcohol epidemiology constitutes the causality of alcohol health effects, and how three realities are made along the way: (1) alcohol is a stable agent that acts consistently to produce quantifiable effects; (2) these effects may be amplified or diminished by social or other factors but not mediated in other ways; and (3) alcohol effects observable at the population level are priorities for public health. We describe how these propositions are predicated upon several simplifications and that these simplifications have political implications, including the attribution of responsibility for health effects to a pharmacological substance; the deletion of other agentic forces that might share responsibility; and a prioritization of simple effects over complex effects. We argue that epidemiological research on alcohol might expand its range of ontological, epistemological and methodological practices to identify new ways of understanding and addressing health effects.

Are psychosocial stressors associated with the relationship of alcohol consumption and all-cause mortality?

BACKGROUND

Several studies have shown a protective association of moderate alcohol intake with mortality. However, it remains unclear whether this relationship could be due to misclassification confounding. As psychosocial stressors are among those factors that have not been sufficiently controlled for, we assessed whether they may confound the relationship between alcohol consumption and all-cause mortality.

METHODS

Three cross-sectional MONICA surveys (conducted 1984-1995) including 11,282 subjects aged 25-74 years were followed up within the framework of KORA (Cooperative Health Research in the Region of Augsburg), a population-based cohort, until 2002. The prevalences of diseases as well as of lifestyle, clinical and psychosocial variables were compared in different alcohol consumption categories. To assess all-cause mortality risks, hazard ratios (HRs) were estimated by Cox proportional hazards models which included lifestyle, clinical and psychosocial variables.

RESULTS

Diseases were more prevalent among non-drinkers than among drinkers: Moreover, non-drinkers showed a higher percentage of an unfavourable lifestyle and were more affected with psychosocial stressors at baseline. Multivariable-adjusted HRs for moderate alcohol consumption versus no consumption were 0.74 (95% confidence interval (CI): 0.58-0.94) in men and 0.87 (95% CI: 0.66-1.16) in women. In men, moderate drinkers had a significantly lower all-cause mortality risk than non-drinkers or heavy drinkers (p=0.002) even after multivariable adjustment. In women, moderate alcohol consumption was not associated with lowered risk of death from all causes.

CONCLUSIONS

The present study confirmed the impact of sick quitters on mortality risk, but failed to show that the association between alcohol consumption and mortality is confounded by psychosocial stressors.

The effect of belonging to an alcohol-proscribing religious group on the relationship between moderate alcohol consumption and mortality

The purpose of this study was to examine whether belonging to a religious group that proscribes alcohol use moderated the relationship between moderate alcohol use and mortality. Data came from the Americans' Changing Lives study, based on a representative probability sample of adults 25 and older in the US, including 3390 participants (2135 female). Survey data were collected in 1986, and mortality tracked by death certificate through 2005. Proportional hazards modeling indicated that, consistent with previous research, moderate alcohol consumption (two drinks or fewer per day on average) was related with lower mortality compared with both total abstention from alcohol and heavy consumption (more than two drinks per day) among participants who did not belong to an alcohol-proscribing group. By contrast, moderate drinkers who belonged to alcohol-proscribing groups had higher mortality risk compared with non-drinkers. Means comparisons suggested possible group differences including health behaviors (moderate drinkers in proscribing groups drank somewhat less often but more on each occasion and were more likely to smoke) and social relationships (they had fewer close friends, felt more isolated, and had more negative social interactions). Members of religious groups that proscribe alcohol use may have health risks associated with moderate alcohol use that are not present in the general population. Practitioners should be aware of religious cultural differences when assessing individuals' risk from alcohol use.

Alcohol consumption and health status in older adults: a longitudinal analysis

Objective. This longitudinal study examines the relationship of alcohol consumption to mortality and changes in mental and functional health in older adults. Method.In a national population health survey, 4,187 participants aged 50 and older at baseline provided information on alcohol consumption, potential confounders, and follow-up vital status. Logistic regression estimated the odds ratio for mortality, increase in psychological distress, and decline in functional health 10 years later. Results. Compared with lifelong abstainers, light and moderate drinkers were at nonsignificantly lower risk of mortality. Among survivors, alcohol consumption showed no consistent relationship with increases in psychological distress. Occasional and light drinkers had significantly reduced risk of a substantial functional health decline, whereas moderate drinkers had nonsignificantly reduced risk. Discussion. Findings suggest that light-to-moderate alcohol consumption reduces the risk of substantial functional health decline in older middle-aged drinkers.

Changes in alcohol consumption: an analysis of self-reported use of alcohol in a Swedish national sample 1988-89 and 1996-97

AIM

To analyse factors associated with alcohol consumption, and how these changed over the period 1988-97, a period during which Sweden entered the European Union.

METHODS

Data were used from two waves (1988-89 and 1996-97) of the representative longitudinal micro-level ULF survey in Sweden to estimate a two-part model of consumption.

RESULTS

Experiencing financial stress, monthly salary, and not being married were all correlated with alcohol consumption, especially for males in 1988-89. In 1996-97 these correlations were much weaker, revealing a levelling-out trend towards conformity. The pattern was less clear for females. Further, the youngest age group (16-29 years) increased its consumption significantly more than the older age groups.

CONCLUSION

There were significant changes in alcohol behaviour, especially for males, coinciding with Sweden joining the EU and preceding the very substantial general increase in consumption levels since 1998. This underlying process should be kept in mind when analysing the more recent trends. The results support the contention that alcohol policy should be a combination of measures targeting the whole population (e.g. via public health campaigns) with specific measures directed towards more vulnerable groups (e.g. young people).

Alcohol Consumption and Problems: The Relevance of Drinking Patterns

BACKGROUND

Data on risks and benefits associated with drinking patterns provide the scientific basis for moderate, low-risk drinking guidelines. Illustrated are methods to investigate and adjust for heterogeneity in relations between three-dimensional drinking patterns and 41 alcohol problems assessed among current regular drinkers in the 1988 National Health Interview Survey.

METHODS

Three dimensions of mean drinking patterns, (i.e., usual quantities, heavy drinking rates (days of 5+ drinks/drinking days x 100), and drinking frequencies) were estimated in overlapping subsets of the population reporting each of the 41 problems, and mean usual quantities and heavy drinking rates were plotted against frequencies. Respondents were categorized into drinking problem groups associated with comparable mean drinking patterns; and main and interactive effects of age and sex on drinking patterns were examined by conducting three regression analyses within each group, with quantity, frequency, and heavy drinking rates as dependent variables, respectively.

RESULTS

Analyses revealed substantial heterogeneity in relations between drinking patterns and alcohol problems. Respondents having only minor problems drank on average two days a week, usually had 2.6 drinks, and drank heavily 12-13 days a year. Whereas, those having minor and severe problems drank an average of 3.5 days a week, usually had 4.7 drinks, and drank heavily 58 days a year. Within each problem group, usual quantity and frequency were higher among males than females, but the greatest gender differences were seen in heavy-drinking rates. Age-related differences in drinking patterns were striking. Usual quantity and heavy-drinking rates associated with problems decreased with age, whereas drinking frequency increased.

CONCLUSIONS

Findings demonstrated the importance of assessing and adjusting for heterogeneity in relations between drinking patterns and alcohol problems when aggregating and interpreting such data, (e.g., when assessing alcohol dependence criteria or evaluating guidelines for moderate drinking), and illustrated new methods for doing so.

Nuevas y viejas adicciones: implicaciones para la salud pública

According to certain authors, any pleasure giving behaviour may become a habit, and depending on the circumstances, an addiction. The objective of this study is to examine the situation of addictions in Spain and the responses generated by health policies. In recent years, both the type and pattern of drug consumption in Spain, has undergone a noticeable change. Studies of the evolution of tobacco consumption suggest that the peak has passed, even though prevalence is still high. Alcohol consumption per capita has fallen by 25% in the last 25 years. During the same period, pattern of consumption has been modified. Sporadic drinking, in episodes of binging and drinking away from meals, is one of the patterns on the rise. According to the European Monitoring Centre for Drugs and Drug Addiction, in Spain, 27.8% of the population between 15- 64 years old has consumed an illegal drug at least once in their lives, with the prevalence rising to 38% among the 15- 34 year olds. Cannabis is the most consumed (29% among 1564 age group), followed by cocaine (5.9%), and ecstasy (4.6%). Spain, comparing with other countries of European Union, is the third in cannabis, ecstasy, and amphetamine and the first in cocaine consumption. With respect to the so-called behavioral addictions, no consensus in the field of psychiatry has been reached. The only psychological addiction with clear diagnostic criteria is gambling. The rest (Internet, sex, etc.), perhaps for their novelty, continue to be the object of controversy. New addictions, as much to addictive substances as to addictive behaviors, run parallel to the development of industrialized societies, leisure, free time, and a new way of life. This is the new challenge for Public Health.

Does personality mediate the relation between alcohol consumption and cardiovascular disease morbidity and mortality?

Alcohol volume and pattern have been previously demonstrated to predict cardiovascular disease (CVD) in these data. The objective of this study is to assess whether personality is a mediator in this relationship. Interview data from 1154 men and women aged 18-64 in Winnipeg, Canada were linked to health care utilization and mortality records, with 8 years of follow-up. Cox regressions were performed for men and women on time to first event for physician visits, hospitalizations, and deaths due to coronary heart disease (CHD), hypertension, or other CVD. Models linking drinking to CHD outcomes were unaffected by personality covariates. Models of hypertension and other CVD outcomes were significantly affected by inclusion of personality covariates, but the only significant individual personality covariate was in the effect on other CVD in men: Ego strength had a protective effect [hazard ratio (HR)=0.95]. Personality covariates as measured by the Eysenck Personality Questionnaire (EPQ) and Barron's Ego Strength Scale make only a modest contribution to statistical models of the relation between drinking and cardiovascular health.

Alcohol and public health

Alcoholic beverages, and the problems they engender, have been familiar fixtures in human societies since the beginning of recorded history. We review advances in alcohol science in terms of three topics: the epidemiology of alcohol's role in health and illness; the treatment of alcohol use disorders in a public health perspective; and policy research and options. Research has contributed substantially to our understanding of the relation of drinking to specific disorders, and has shown that the relation between alcohol consumption and health outcomes is complex and multidimensional. Alcohol is causally related to more than 60 different medical conditions. Overall, 4% of the global burden of disease is attributable to alcohol, which accounts for about as much death and disability globally as tobacco and hypertension. Treatment research shows that early intervention in primary care is feasible and effective, and a variety of behavioural and pharmacological interventions are available to treat alcohol dependence. This evidence suggests that treatment of alcohol-related problems should be incorporated into a public health response to alcohol problems. Additionally, evidence-based preventive measures are available at both the individual and population levels, with alcohol taxes, restrictions on alcohol availability, and drinking-driving countermeasures among the most effective policy options. Despite the scientific advances, alcohol problems continue to present a major challenge to medicine and public health, in part because population-based public health approaches have been neglected in favour of approaches oriented to the individual that tend to be more palliative than preventative.

Per capita alcohol consumption and all-cause mortality in Canada, 1950-98

AIMS

To estimate the relationship between per capita alcohol consumption and male all-cause mortality in Canada.

DATA AND METHOD

The outcome measure comprised annual data on male all-cause mortality for the period 1950-98. Alcohol sales (in litres 100% alcohol) were used as proxy for per capita consumption. The data were analysed using the Box-Jenkins technique. Two models were estimated, one including only female mortality as control, the other in addition cigarette sales.

RESULTS

The first model yielded a significant alcohol effect that implied a 2.9%[standard error (SE) = 0.6%] increase in mortality given a 1-litre increase in consumption. This estimate coincides with that obtained for northern Europe in previous research. When cigarette sales were included in the model the alcohol effect was still statistically significant but markedly reduced, to 1.7% (SE = 0.6%).

CONCLUSIONS

Total mortality is a classic indicator of the general health status of the population. Its relationship with per capita consumption of alcohol supports the view that total consumption is a concern for public health.

Assessing drinking outcomes in alcohol treatment efficacy studies: selecting a yardstick of success

BACKGROUND

Although the number of alcohol treatment efficacy trials has mushroomed, there is no consensus on how best to measure outcomes. To advance the goal of establishing cross-trial consistency in measuring outcomes in clinical efficacy studies, the National Institute on Alcohol Abuse and Alcoholism convened a panel of experts and charged them with exploring, debating, and, ultimately, selecting a "sentinel" or "optimal" outcome measure to be used in future alcohol treatment studies. The goal of this article, one in a series of several presented at the National Institute on Alcohol Abuse and Alcoholism conference, is to discuss (1) the rationale underlying selection of an optimal outcome measure, (2) the necessary characteristics of an optimal outcome measure, (3) the utility of selecting an optimal measure, and (4) which drinking assessment methods could be used to collect data to portray the optimal outcome measure.

METHODS

At a minimum, the criteria for an "optimal" measure include that it be psychometrically sound. In addition, it should have considerable currency in the field, thereby increasing its prospects for adoption. The measure should also be consistent with the concepts of greatest interest and relevance to the field (e.g., directly reflect the fundamental goal of alcohol treatment). In light of these highly desired features, percent of days heavy drinking was chosen at the conference as a practical and relevant measure of alcohol treatment outcome.

CONCLUSIONS

Percent of days heavy drinking should be the optimal measure of alcohol treatment outcome. Currently, daily drinking estimation methods are the most useful for gathering data that can reflect the optimal measure. In addition, data gathered by daily drinking estimation methods can be used to study a variety of other outcome variables of interest to clinical researchers.

Abstention, alcohol use and risk of myocardial infarction in men and women taking account of social support and working conditions: the SHEEP case-control study

AIMS

Very few studies indicating that low-moderate alcohol consumption protects from myocardial infarction (MI) controlled for social support and working conditions, which could confound the findings. Therefore, a first aim was to study the risk of non-fatal and total MI in relation to volume of alcohol consumption and measures of social support and working conditions. A second aim was to analyse the impact of the volume of earlier alcohol use in abstainers.

DESIGN

Data came from a case-control study, the Stockholm Heart Epidemiology Program (SHEEP), including first MI among Swedish citizens 45-70 years old.

SETTING

Stockholm County 1992-94.

PARTICIPANTS

There were 1095 cases of MI in men and 471 in women (928 and 372 were non-fatal), and 2339 living controls from the general population.

MEASUREMENT

Information about alcohol use at different periods in life and job strain, social anchorage and life control besides pre-existing health problems, smoking, physical activity, socio-economic status and marital status was obtained by a questionnaire from the cases and the controls.

FINDINGS

In multivariate logistic regression analyses, the relative risk for MI (especially non-fatal) was reduced among alcohol consumers. RR for non-fatal MI was 0.52 (95% confidence intervals 0.32, 0.85) in men with a consumption of 50-69.9 g 100% ethanol/day and 0.21 (95% confidence interval 0.06, 0.77) in women with a consumption of 30 g or more per day (reference category 0.1-5 g 100% ethanol/day). Men who were abstainers during the previous 1-10 years and with an earlier average consumption of 5-30 g 100% ethanol/day had a significantly lower relative risk compared to such abstainers with an earlier higher consumption. Earlier consumption among abstainers may also have an impact on gender differences in MI. Analyses showed positive interaction between abstention and low life-control in women, but only 4% of the female cases were due to this interaction. There were no other interactions between measures of alcohol use and social anchorage, life control and working situations.

CONCLUSION

Alcohol use had a protective impact on MI, with little impact of job strain, social anchorage and life control, giving increased support for a protective impact of low-moderate alcohol use. The level of previous alcohol consumption among male 1-10-year-long abstainers influenced the risk of MI.

Alcohol and cardiovascular disease--more than one paradox to consider. Average volume of alcohol consumption, patterns of drinking and risk of coronary heart disease--a review

The effect of average volume of alcohol on coronary heart disease (CHD) is J-shaped in established market economies. Light to moderate drinkers have less risk than abstainers, with heavy drinkers displaying the highest level of risk. This relationship between average volume of alcohol consumption and CHD is modified by different patterns of drinking. Heavy drinking occasions as well as drinking outside meals are related to increased CHD risk, independently of volume of drinking. Beverage type does not seem to have much impact, even though there are some indications that wine is more protective than other forms of alcohol. Physiological mechanisms have been identified to explain this complex relationship between alcohol and CHD. Since patterns of drinking are important in determining CHD risk, they should be included in future epidemiologic studies, together with biomarkers further to test hypotheses about pathways.

Alcohol volume, drinking pattern, and cardiovascular disease morbidity and mortality: is there a U-shaped function?

The health effects of a binge pattern of alcohol consumption have not been widely investigated. The objective of this study was to evaluate the cardiovascular consequences of binge drinking (consumption of eight or more drinks at one sitting) and usual (nonbinge) drinking in a longitudinal, population-based study. Data obtained from 1,154 men and women aged 18-64 years interviewed in Winnipeg, Manitoba, Canada, in 1990 and 1991 were linked to health care utilization and mortality records. Using an 8-year follow-up period, the authors performed separate Cox proportional hazards regression analyses for men and women on time to first event for physician visits, hospitalizations, and deaths due to coronary heart disease, hypertension, and other cardiovascular disease. Binge drinking increased the risk of coronary heart disease in both men (hazard ratio (HR) = 2.26, 95% confidence interval (CI): 1.22, 4.20) and women (HR = 1.10, 95% CI: 1.02, 1.18). It increased the risk of hypertension in men (HR = 1.57, 95% CI: 1.04, 2.35) but not in women. Binge drinking had no effect on the risk of other cardiovascular disease. In contrast, usual drinking had significant cardioprotective effects in both men and women. Thus, the harmful effects of binge drinking on cardiovascular disease morbidity and mortality can be disaggregated from the protective effects of usual drinking at various levels of consumption.

Effects of depression and social integration on the relationship between alcohol consumption and all-cause mortality

AIMS

This study was designed to assess the potentially confounding influences of social integration and depression on the form of the relationship between alcohol consumption and all-cause mortality. DESIGN, PARTICIPANTS AND MEASUREMENT: Respondents from the 1984 US National Alcohol Survey (N = 5177) were followed by searching the National Death Index (NDI) through 1995; 540 were identified as deceased. Predictor variables in a Cox proportional hazards model included gender, ethnicity, marital status, income, smoking, age and alcohol consumption (volume and patterns). Two social variables and their interactions with alcohol consumption were added, the Center for Epidemiological Studies Depression (CES-D) scale and an eight-item social isolation scale.

FINDINGS

The J-shaped risk curve for all-cause mortality by volume was approximated for men but not significantly for women. In addition heavy drinking occasions independently contributed to mortality in men. Low social integration (bottom 12%) had no significant effects on mortality or on the relationship between alcohol consumption and mortality curve. Inclusion of the interaction between alcohol consumption and depression proved significant for heavy male drinkers (> six drinks on average per day) and for female former drinkers with heavy drinking occasions. In both cases, the respective subgroup, which additionally was depressed, had about four times the risk of a life-time abstainer.

CONCLUSIONS

The relationship of alcohol consumption to 11-year all-cause mortality in a general population indicated little confounding effect of social isolation, but revealed important interactions with depression for heavy male drinkers and heavy female ex-drinkers.

Average volume of alcohol consumption, patterns of drinking, and all-cause mortality: results from the US National Alcohol Survey

The objective of this study was to investigate the effects of an average volume of alcohol consumption and drinking patterns on all-cause mortality. The sample (n = 5,072) was drawn from the 1984 National Alcohol Survey, representative of the US population living in households. Follow-up time was until the end of 1995, with 532 people deceased during this period. The authors found a significant influence of drinking alcohol on mortality with a J-shaped association for males and an insignificant relation of the same shape for females. When the largest categories of equivalent average volume of consumption were divided into people with and without heavy drinking occasions, serving as an indicator of drinking pattern, this differentiation proved important in predicting mortality. Light to moderate drinkers had higher mortality risks when they reported heavy drinking occasions (defined by either eight drinks per occasion or getting drunk at least monthly). Similarly, when the category of exdrinkers was divided into people who did or did not report heavy drinking occasions in the past, people with heavy drinking occasions had a higher mortality risk. Finally, indicating alcohol problems in the past was related to higher mortality risk. Results emphasized the importance of routinely including measures of drinking patterns into future epidemiologic studies on alcohol-related mortality.

Explaining differential rates of mortality decline for Swedish men and women: a time-series analysis, 1945-1992

The aim of this study is to identify social factors that could be related to differential rates of mortality decline for men and women in Sweden. The annual changes in fifteen indicators and their relationship with changes in absolute excess male mortality were analyzed by means of time series analysis for the period 1945-1992. Economic growth seems to have been more beneficial for women's survival than for that of men. A few labor market indicators (unemployment rate and the wage ratio men/women) may have had some influence on changes in excess male mortality as well. Consumption factors, such as alcohol consumption and cigarette consumption, have been important for changes in excess male mortality. Changes in excess male mortality have been particularly pronounced among 65-74 year olds, due to rapidly improved female survival in these age groups. I discuss the finding that there seem to be connections between, on the one hand, changes in general social factors such as economic growth and labor market factors, and perhaps urbanization and alcohol and cigarette consumption on the other. I therefore suggest that gender-specific consumer behavior, seen as an outcome of gender-specific norm systems, is one mechanism which links changes in general social factors to changes in excess male mortality.