Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers

Drinking Patterns and Risk of Ischemic Stroke in Middle-Aged Adults: Do Beneficial Drinking Habits Indeed Exist?

BACKGROUND AND PURPOSE

Although it has been reported that the amount of alcohol consumption has a J-shaped association with ischemic stroke, it is unclear whether differences in drinking patterns affect this relationship. We aimed to clarify the impact of drinking patterns on ischemic stroke in midlife.

METHODS

We used data from the National Health Insurance Service-National Sample Cohort, which is a large-sized, standardized population cohort in Korea. Five different drinking patterns were defined by combining the frequency of alcohol consumption and quantity of alcohol consumed per occasion, that is, abstainers, not drinking alcohol; drinker group I, ≤30 g/d and <5 d/wk; drinker group II, ≤30 g/d and ≥5 d/wk; drinker group III, >30 g/d and <5 d/wk; and drinker group IV, >30 g/d and ≥5 d/wk. The association between the drinking patterns and ischemic stroke occurrence was analyzed using the Cox proportional hazard model.

RESULTS

A total of 152 469 middle-aged participants (mean age, 50.2 years; 72 285 men [47.4%]) were eligible for the analyses. The median follow-up time was 9.0 years. Compared with abstainers, those who drank <5 d/wk (drinker groups I and III) had a significantly lower risk of ischemic stroke (group I hazard ratio, 0.71 [95% CI, 0.59-0.85]; group III hazard ratio, 0.80 [95% CI, 0.68-0.93]) during the first 7 years from the baseline, while other drinker groups showed no such differences. However, the effect of drinking patterns on ischemic stroke risk was attenuated after the first 7 years.

CONCLUSIONS

Reduced risk of ischemic stroke was observed in middle-aged participants with specific drinking patterns, but it was limited to the earlier period. Physicians should be cautious in educating patients on alcohol consumption, considering the long-term association between drinking patterns and ischemic stroke.

Determinants of harmful use of alcohol among urban slum dwelling adults in Kenya

BACKGROUND

Harmful alcohol use is a public health problem associated with negative health and socio-economic impacts. However, patterns and dynamics of alcohol use among slum-dwellers in Kenya are poorly understood.

OBJECTIVE

To establish determinants of harmful alcohol use among adults in an urban slum setting in Kenya.

MATERIALS AND METHODS

Cross-sectional study involving a consecutively selected sample (N=215) from Githurai, in Nairobi. A pre-tested questionnaire that captured data on socio-demographics, drinking patterns, type, reasons, initiator, and support system.

RESULTS

Of the respondents, those above 31 years, married, separated/divorced/widowed, of high education, earning above 50 USD, and from dysfunctional families consumed more alcohol. Low earners consumed (p < 0.05) unrecorded while high earners drank (p< 0.001) recorded alcohol. Adults from families with a drinking father and sibling consumed more alcohol (p=0.001). Single, low educational attainment/earners, and those in dysfunctional families (p <0.05) drank due to stress and reported alcohol-related problems. Young, unmarried, and casual laborers were introduced (p < 0.05) to alcohol by friends.

CONCLUSION

Socio-demographic, economic, familial, social interactions, and stress are associated with harmful alcohol use among adults from slums calling for interventions targeting these factors.

Genome-Wide Association Study Meta-Analysis of the Alcohol Use Disorders Identification Test (AUDIT) in Two Population-Based Cohorts

OBJECTIVE

Alcohol use disorders are common conditions that have enormous social and economic consequences. Genome-wide association analyses were performed to identify genetic variants associated with a proxy measure of alcohol consumption and alcohol misuse and to explore the shared genetic basis between these measures and other substance use, psychiatric, and behavioral traits.

METHOD

This study used quantitative measures from the Alcohol Use Disorders Identification Test (AUDIT) from two population-based cohorts of European ancestry (UK Biobank [N=121,604] and 23andMe [N=20,328]) and performed a genome-wide association study (GWAS) meta-analysis. Two additional GWAS analyses were performed, a GWAS for AUDIT scores on items 1-3, which focus on consumption (AUDIT-C), and for scores on items 4-10, which focus on the problematic consequences of drinking (AUDIT-P).

RESULTS

The GWAS meta-analysis of AUDIT total score identified 10 associated risk loci. Novel associations localized to genes including JCAD and SLC39A13; this study also replicated previously identified signals in the genes ADH1B, ADH1C, KLB, and GCKR. The dimensions of AUDIT showed positive genetic correlations with alcohol consumption (rg=0.76-0.92) and DSM-IV alcohol dependence (rg=0.33-0.63). AUDIT-P and AUDIT-C scores showed significantly different patterns of association across a number of traits, including psychiatric disorders. AUDIT-P score was significantly positively genetically correlated with schizophrenia (rg=0.22), major depressive disorder (rg=0.26), and attention deficit hyperactivity disorder (rg=0.23), whereas AUDIT-C score was significantly negatively genetically correlated with major depressive disorder (rg=-0.24) and ADHD (rg=-0.10). This study also used the AUDIT data in the UK Biobank to identify thresholds for dichotomizing AUDIT total score that optimize genetic correlations with DSM-IV alcohol dependence. Coding individuals with AUDIT total scores ≤4 as control subjects and those with scores ≥12 as case subjects produced a significant high genetic correlation with DSM-IV alcohol dependence (rg=0.82) while retaining most subjects.

CONCLUSIONS

AUDIT scores ascertained in population-based cohorts can be used to explore the genetic basis of both alcohol consumption and alcohol use disorders.

Wine and beer within a moderate alcohol intake is associated with higher levels of HDL-c and adiponectin

The scientific evidence available on the association between moderate alcohol intake and levels of blood cardiometabolic markers is still inconsistent and difficult to interpret for future disease prevention. However, we hypothesize that moderate consumption of alcohol is associated with lower levels of inflammation markers and higher levels of protective cardiometabolic markers. Thus, this work aimed to examine the associations of moderate alcohol intake and the type of alcoholic beverage with metabolic and inflammatory biomarkers. An observational, cross-sectional study including 143 apparently healthy adults 55 years of age and older was performed. Interviewer-administered questionnaires were used to collect information on alcoholic beverage intake frequency, food frequency, physical activity, socioeconomic status, diseases and medications, and other health-related habits. Three groups were established prior to recruitment: (1) abstainers and occasional consumers (ABS, n = 54); (2) beer consumers (BEER ≥80% of total alcohol intake; n = 40), and (3) mixed beverage consumers (MIXED; n = 49). Univariate analysis of variance models, adjusted for confounding factors and covariables, were performed. High-density lipoprotein cholesterol (HDL-c) and sP-selectin were significantly higher in the MIXED group than in the ABS group, and adiponectin was higher in the MIXED group compared to the BEER group. All alcohol consumers also had higher mean platelet volume values compared to ABS. In linear regression analyses, HDL-c, sP-selectin, and adiponectin were positively associated with wine intake (g/d) (P < .001, P = .014, and P = .017, respectively); and mean platelet volume, with beer intake (P = .017). In conclusion, this cross-sectional study showed that moderate alcohol intake is associated with higher levels of HDL-c and adiponectin compared to those in abstainers, which are mainly explained by wine intake.

Sociodemographic, behavioral, and health factors associated with positive self-perceived health of long-lived elderly residents in Florianópolis, Santa Catarina, Brazil

The objective of this study was to identify the factors associated with positive self-perceived health of long-lived elderly (80+) individuals. This cross-sectional study was conducted in the city of Florianópolis, Santa Catarina, Brazil, and included 239 elderly participants from the EpiFloripa Ageing Project. We used collection instruments to verify sociodemographic and economic data, self-reported health status, falls, and lifestyle. Then, we identified factors associated with positive self-perceived health using a Poisson regression adjusted for sex. We found that a positive self-reported health status was more prevalent among the long-lived elderly who were not depressed (PR = 0.49), and among those who consumed alcohol (PR = 1.99). Understanding which variables may interfere in the self-perceived health of the long-lived elderly can result in better health options for this population, mainly, new methods to prevent depression. Additionally, this information can help reduce costs associated with hospitalizations, medications and health treatments, all of which are very common among the long-lived elderly.

The association of lifetime alcohol use with mortality and cancer risk in older adults: A cohort study

BACKGROUND

While current research is largely consistent as to the harms of heavy drinking in terms of both cancer incidence and mortality, there are disparate messages regarding the safety of light-moderate alcohol consumption, which may confuse public health messages. We aimed to evaluate the association between average lifetime alcohol intakes and risk of both cancer incidence and mortality.

METHODS AND FINDINGS

We report a population-based cohort study using data from 99,654 adults (68.7% female), aged 55-74 years, participating in the U.S. Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Cox proportional hazards models assessed the risk of overall and cause-specific mortality, cancer incidence (excluding nonmelanoma skin cancer), and combined risk of cancer and death across categories of self-reported average lifetime alcohol intakes, with adjustment for potential confounders. During 836,740 person-years of follow-up (median 8.9 years), 9,599 deaths and 12,763 primary cancers occurred. Positive linear associations were observed between lifetime alcohol consumption and cancer-related mortality and total cancer incidence. J-shaped associations were observed between average lifetime alcohol consumption and overall mortality, cardiovascular-related mortality, and combined risk of death or cancer. In comparison to lifetime light alcohol drinkers (1-3 drinks per week), lifetime never or infrequent drinkers (<1 drink/week), as well as heavy (2-<3 drinks/day) and very heavy drinkers (3+ drinks/day) had increased overall mortality and combined risk of cancer or death. Corresponding hazard ratios (HRs) and 95% confidence intervals (CIs) for combined risk of cancer or death, respectively, were 1.09 (1.01-1.13) for never drinkers, 1.08 (1.03-1.13) for infrequent drinkers, 1.10 (1.02-1.18) for heavy drinkers, and 1.21 (1.13-1.30) for very heavy drinkers. This analysis is limited to older adults, and residual confounding by socioeconomic factors is possible.

CONCLUSIONS

The study supports a J-shaped association between alcohol and mortality in older adults, which remains after adjustment for cancer risk. The results indicate that intakes below 1 drink per day were associated with the lowest risk of death.

TRIAL REGISTRATION

NCT00339495 (ClinicalTrials.gov).

Factors Related to Unemployment in Europe. A Cross-Sectional Study from the COURAGE Survey in Finland, Poland and Spain

Background: Research addressing the impact of a large number of factors on unemployment is scarce. We aimed to comprehensively identify factors related to unemployment in a sample of persons aged 18-64 from Finland, Poland and Spain. Methods: In this cross-sectional study, factors from different areas were considered: socio-demographic indicators, health habits, chronic conditions, health state markers, vision and hearing indicators, and social networks and built environment scores. Results: Complete data were available for 5003 participants, mean age 48.1 (SD 11.5), 45.4% males. The most important factors connected to unemployment were health status indicators such as physical disability (OR = 2.944), self-rated health (OR = 2.629), inpatient care (OR = 1.980), and difficulties with getting to the toilet (OR = 2.040), while the most relevant factor related to employment were moderate alcohol consumption (OR = 0.732 for non-heavy drinkers; OR = 0.573 for infrequent heavy drinkers), and being married (OR = 0.734), or having been married (OR = 0.584). Other factors that played a significant role included presence of depression (OR = 1.384) and difficulties with near vision (OR = 1.584) and conversation hearing (OR = 1.597). Conclusions: Our results highlight the importance of selected factors related to unemployment, and suggest public health indications that could support concrete actions on modifiable factors, such as those aimed to promote physical activity and healthy behaviors, tackling depression or promoting education, in particular for the younger.

Alcohol Intake and Cognitively Healthy Longevity in Community-Dwelling Adults: The Rancho Bernardo Study

To better understand the association of alcohol intake with cognitively healthy longevity (CHL), we explored the association between amount and frequency of alcohol intake and CHL among 1,344 older community-dwelling adults. Alcohol intake was assessed by questionnaire in 1984-1987. Cognitive function was assessed in approximate four-year intervals between 1988 and 2009. Multinomial logistic regression, adjusting for multiple lifestyle and health factors, was used to examine the association between alcohol consumption and CHL (living to age 85 without cognitive impairment), survival to age 85 with cognitive impairment (MMSE score >1.5 standard deviations below expectation for age, sex, and education), or death before age 85. Most participants (88%) reported some current alcohol intake; 49% reported a moderate amount of alcohol intake, and 48% reported drinking near-daily. Relative to nondrinkers, moderate and heavy drinkers (up to 3 drinks/day for women and for men 65 years and older, up to 4 drinks/day for men under 65 years) had significantly higher adjusted odds of survival to age 85 without cognitive impairment (p's < 0.05). Near-daily drinkers had 2-3 fold higher adjusted odds of CHL versus living to at least age 85 with cognitive impairment (odds ratio (OR) = 2.06; 95% confidence interval (CI): 1.21, 3.49) or death before 85 (OR = 3.24; 95% CI: 1.92, 5.46). Although excessive drinking has negative health consequences, these results suggest that regular, moderate drinking may play a role in cognitively healthy longevity.

Increased alcohol use over the past 20 years among the oldest old in Sweden

Aims

Increased alcohol consumption among old people, reported in many countries, will likely present a major challenge to public health and policy in the future. In Sweden, current knowledge about old people's alcohol consumption is incomplete because of limited historical data and a dearth of nationally representative studies. We describe the frequency of alcohol consumption among the oldest old in Sweden over a 20-year period by sex, age, education, living situation, mobility and Activities of Daily Living.

Methods

We used repeated cross-sectional survey data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), conducted in 1992, 2002 and 2011. The samples were nationally representative of the Swedish population aged 77+, with response rates of 95.4%, 84.4% and 86.2% (total n=2007). Self-reported consumption frequency was measured with the question “How often do you drink alcoholic beverages, such as wine, beer or spirits?”

Results

Frequency of alcohol consumption increased among the oldest old from 1992 to 2011. The proportion reporting no or less-than-monthly alcohol consumption decreased, whereas the proportion reporting weekly consumption increased. This was true for men, women and most age and educational groups. The period change in consumption frequency was not explained by changes in demographic factors, living situation or functional capacity during the study period.

Conclusions

Alcohol use increased among the oldest old in Sweden during the 20-year study period. More liberal attitudes toward alcohol could contribute to the increased use. The increase in weekly alcohol consumers suggests an increase in the number of older risk consumers.

Problem Drinking and Depression in Older Adults with Multiple Chronic Health Conditions

OBJECTIVES

To examine the intersection of depression and alcohol use among older adults with multiple chronic health conditions (MCCs).

DESIGN

Wave 1 data from the National Social Life, Health and Aging Project (2005-06).

SETTING

Community-based sampling throughout the United States.

PARTICIPANTS

Individuals aged 57 to 85 who identified as active alcohol consumers (N = 1,643).

MEASUREMENTS

Participants reported whether they currently had MCCs, problem drinking (defined as affirming two or more of the four CAGE screening questions), symptoms associated with depression, and other social and health measures.

RESULTS

Although older adults with MCCs were no more likely to be problem drinkers than those with no MCCs, those with MCCs and depression were nearly five times as likely to experience problem drinking as older adults with MCCs and no depression.

CONCLUSION

Older adults with MCCs have differences that have implications for health, including mental health problems. Implementing screening and assessment in medical care settings for problem drinking and improving self-management interventions to include consequences of alcohol use components are critical avenues for reducing healthcare expenditures and improving quality of life of individuals with MCC.

Factors That May Enhance Longevity: A Literature Review and a Comprehensive Update for Aesthetic Surgeons

INTRODUCTION

After surgery, the plastic surgeon is very often questioned about how to maintain the result and more frequently how to slow down the aging process. However, this type of knowledge is not commonly delivered during medical education or at least needs an update. This review could be used as a guide to help plastic surgeons to manage these frequent postoperative consultations. The aim of this literature review was to focus discussion on specific positive factors, identified to have a significant impact on human longevity.

MATERIALS AND METHODS

A literature review was performed using the automated computerized PubMed search, with the keywords "human longevity." Only papers written in the English language were included. References were screened to identify further relevant articles. Experimental studies based on microorganisms and animals, works published in non-indexed journals, case reports, letters, and viewpoints were excluded.

RESULTS

One hundred and twenty-four articles reporting factors influencing human longevity were analyzed for data extraction. A total of 59 articles reporting only positive factors were included. Fourteen factors seemed to have a positive impact on longevity: caloric restriction, active effort and sports, happiness, vitamins, vegetarian or Mediterranean diet, oriental practices, socioeconomic status, genetics, sexual activity, sleep, moderate wine consumption, religion, and education.

CONCLUSION

While some factors with a positive impact on longevity are clearly identified and should be integrated in the postoperative process, further studies are still needed to be able to slow down the aging process.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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.

Relationship of moderate alcohol intake and type of beverage with health behaviors and quality of life in elderly subjects

PURPOSE

This work was aimed to study the relationships of moderate alcohol intake and the type of beverages consumed with health behaviors and quality of life in elderly people.

METHODS

In this observational study, 231 subjects (55-85 years) voluntarily answering to advertisements were enrolled and divided in three study groups: abstainers and occasional consumers (ABS; n = 98), moderate drinkers of beer (BEER; n = 63) and moderate drinkers of all sorts of alcoholic beverages (MIXED; n = 70). Variables assessed included physical activity, activities of daily living, Mediterranean diet-adherence score, tobacco consumption, quality of sleep, body composition, medication and perception of health through the SF-36 questionnaire. Their relationship with alcohol consumption was assessed through general linear models including confounding variables (age, sex, chronic disease prevalence and socioeconomic status). ABS were also compared to moderate drinkers (MOD = BEER + MIXED).

RESULTS

The mean daily alcohol consumption in each group was (mean ± SD): ABS: 0.7 ± 1.1; BEER: 12.7 ± 8.1; MIXED: 13.9 ± 10.2 g/day. MOD and MIXED showed significantly higher physical activity (metabolic standard units; METs) than ABS (p = 0.023 and p = 0.004, respectively). MOD spent significantly less time doing housework activities than ABS (p = 0.032). Daily grams of alcohol consumption were significantly associated with METs (B = 21.727, p = 0.023). Specifically, wine consumption (g/day) was associated with METs (B = 46.196, p = <0.001) and showed borderline significant relationships with mental health (B = 0.245, p = 0.062) and vitality perception (B = 0.266, p = 0.054).

CONCLUSION

Moderate alcohol consumption, and in particular wine consumption, is associated with a more active lifestyle and better perception of own health in the Spanish elderly subjects studied.

Alcohol consumption and hazardous drinking in western Kenya--a household survey in a health and demographic surveillance site

BACKGROUND

Alcohol use and hazardous drinking have been studied in school children and in urban areas of Kenya, but there has been no adult survey of these issues in a rural household population.

METHODS

This study reports the prevalence of alcohol consumption and hazardous drinking in a household survey of a demographic surveillance site in rural Kenya. Information collected included demographic characteristics, socio-economic factors, recent life events and perceived social support. Alcohol consumption was assessed by questions about quantity and frequency. The Alcohol Use Disorders Identification Test (AUDIT) measured hazardous alcohol use. The Clinical Interview Schedule- Revised assessed common mental disorder, and the Psychosis Screening Questionnaire indicated the presence of psychotic symptoms.

RESULTS

The study found that lifetime and current alcohol consumption were 10.8% and 9.2% respectively. Current alcohol consumption was significantly higher in men (OR 0.4, p < 0.001 for women) and in the self-employed (OR 1.8, p = 0.013), after adjustment for factors significant at the bivariate level. Hazardous drinking was significantly higher in men (OR 0.3, p < 0.001 for women), people living in larger households (OR 1.8, p = 0.021), people who were single (OR 1.7, p = 0.093), and in those who are self-employed (OR 1.8, p = 0.036), after adjustment for factors significant at the bivariate level.

CONCLUSION

This study suggests that alcohol consumption and hazardous drinking in the general population in a poor rural area in Nyanza Province is still relatively low. This represents an important public health educational opportunity to keep such rates low before increasing income and employment opportunities enable higher access to alcohol and other substances, and before the higher consumption found by studies on urban youth, especially neighbouring Kisumu town, spreads to the rural areas.

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.

Secondary prevention of acute coronary syndrome. Socio-economic and lifestyle determinants: a literature review

Although cardiovascular disease mortality rates seem to decline, especially among middle-aged people in developed countries, the prevalence of acute coronary syndrome (ACS) increases, representing the most common cause of morbidity in both developed and developing countries and generating large economic burden. It is estimated that one fifth of the ACS patients die suddenly and half of them belong to a fast growing popula- tion age-group, i.e., those between 70 and .80 years. A substantial number of these deaths has been attributed to various lifestyles, modifiable factors; therefore, it can be prevented. However, factors such as dietary habits and behaviours, physical activity, life stress and smoking habits, although thoroughly discussed, are not well understood and appreciated in the spectrum of secondary ACS prevention. The latter deserves further attention under the prism of socio-economic status that has changed dramatically in the last years in some populations. The aim of this review was to discuss the role of lifestyle factors on secondary ACS prevention under the prism of individual's socio-economic status. Based on the retrieved information it was revealed that there is vast evidence that secondary prevention of cardiovascular events cannot be accomplished simply through medical treatment, but it requires a multifaceted approach incorporating lifestyle modifications, too. Therefore, public health policy endeavours should be directed towards multifocal strategies, i.e., to motivate and support cardiac patients to consistently follow treatment regimens and to establish more effective and efficient community lifestyle interventions.

Feasibility and Utility of Experience Sampling to Assess Alcohol Consumption Among Older Adults

In the literature on alcohol use and aging, drinking has often been conceptualized as a means of coping with negative feelings, such as stress, yet much of the literature on older adults and drinking has utilized cross-sectional or other data ill-suited for exploring dynamic processes. Experience sampling methods have the ability to measure and analyze dynamic processes in real time, such as relations between alcohol use and mood states. Nonetheless, these approaches are intensive and may burden respondents. Therefore, this study evaluated the feasibility, acceptability, and validity of a modified daily diary to measure alcohol use and explored alternate methods of collecting diary data. Findings suggest that a modified diary was acceptable and not burdensome. Respondents were reluctant to consider technology (e.g., cellphone)-based means of data collection. Measures of alcohol use showed little within-person variation suggesting that for those who drink at all, drinking is a daily habit.

The association between alcohol use and long-term care placement among older Canadians: a 14-year population-based study

Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors.

Predicting 10-year alcohol use trajectories among men age 50 years and older

OBJECTIVE

To describe common 10-year drinking trajectories followed by men age 50 years or older and identify risk factors for those trajectories.

DESIGN

Longitudinal data were used to derive a semiparametric group-based model.

PARTICIPANTS

Men from the Health and Retirement Study age 50-65 years in 1998 who completed three or more of the six interviews conducted from 1998 to 2008, including our 1998 baseline interview.

MEASUREMENTS

Biannual data on number of drinks per drinking day were used to derive drinking trajectories. Risk factors included baseline age, race, ethnicity, education, marital status, retirement, smoking, binge drinking, vigorous exercise, body mass index, depression, pain, self-reported health, and chronic disease.

RESULTS

The best-fitting model included consistent infrequent drinkers and nondrinkers (40.6% of cohort), increasing drinkers (5.5%), decreasing drinkers (7.6%), consistent at-risk drinkers (15.6%), and consistent moderate drinkers (30.7%). Adjusted logistic regression models comparing men with similar 1998 drinking levels who subsequently followed different trajectories identified significant risks associated with age, education, smoking, binge drinking, depression, pain, and self-reported health. To illustrate, odds ratios (ORs) and 95% confidence intervals (95% CIs) suggest that baseline infrequent drinkers were less likely to follow an increasing drinkers trajectory if they were older (OR: 0.57, 95% CI: 0.38-0.82) and smoked cigarettes (OR: 0.47, 95% CI: 0.30-0.74). Baseline drinkers were less likely to follow a decreasing trajectory if they reported more than 12 years of education (OR: 0.58, 95% CI: 0.42-0.82) and thought that their health was excellent or very good (OR: 0.54, 95% CI: 0.39-0.76).

CONCLUSION

Only 30.7% of older men in this cohort were moderate drinkers throughout the follow-up. Many older men may benefit from brief counseling on the risks and benefits of drinking.

Negative effect of smoking on the performance of the QuantiFERON TB gold in tube test

Background

False negative and indeterminate Interferon Gamma Release Assay (IGRA) results are a well documented problem. Cigarette smoking is known to increase the risk of tuberculosis (TB) and to impair Interferon-gamma (IFN-γ) responses to antigenic challenge, but the impact of smoking on IGRA performance is not known. The aim of this study was to evaluate the effect of smoking on IGRA performance in TB patients in a low and high TB prevalence setting respectively.

Methods

Patients with confirmed TB from Denmark (DK, n = 34; 20 smokers) and Tanzania (TZ, n = 172; 23 smokers) were tested with the QuantiFERON-TB Gold In tube (QFT). Median IFN-γ level in smokers and non smokers were compared and smoking was analysed as a risk factor for false negative and indeterminate QFT results.

Results

Smokers from both DK and TZ had lower IFN-γ antigen responses (median 0.9 vs. 4.2 IU/ml, p = 0.04 and 0.4 vs. 1.6, p < 0.01), less positive (50 vs. 86%, p = 0.03 and 48 vs. 75%, p < 0.01) and more false negative (45 vs. 0%, p < 0.01 and 26 vs. 11%, p = 0.04) QFT results. In Tanzanian patients, logistic regression analysis adjusted for sex, age, HIV and alcohol consumption showed an association of smoking with false negative (OR 17.1, CI: 3.0-99.1, p < 0.01) and indeterminate QFT results (OR 5.1, CI: 1.2-21.3, p = 0.02).

Conclusions

Cigarette smoking was associated with false negative and indeterminate IGRA results in both a high and a low TB endemic setting independent of HIV status.

A prospective cohort study of health behavior profiles after age 50 and mortality risk

Background

This study examines the mortality risk associated with distinct combinations of multiple risk behaviors in middle-aged and older adults, and assesses whether the mortality risks of certain health behaviors are moderated by the presence of other risk behaviors.

Methods

Data for this prospective cohort study are from the Health and Retirement Study (HRS), a nationwide sample of adults older than 50 years. Baseline data are from respondents (n = 19,662) to the 1998 wave of the HRS. Twelve distinct health behavior profiles were created, based on each respondent’s smoking, physical activity, and alcohol use status in 1998. Mortality risk was estimated through 2008 using Cox regression.

Results

Smoking was associated with elevated risk for mortality within all behavioral profiles, but risk was greatest when combined with heavy drinking, both for middle-aged (ages 51–65) and older (ages 66+) adults. Profiles that included physical inactivity were also associated with increased mortality risk in both age groups. However, the impact of inactivity was clearly evident only among non-smokers; among smokers, the risk of inactivity was less evident, and seemingly overshadowed by the risk of smoking. Moderate drinking was protective relative to abstinence among non-smokers, and relative to heavy drinking among smokers.

Conclusions

In both middle-aged and older adults, multiple unhealthy behaviors increase mortality risk. However, the level of risk varies across unique combinations of unhealthy behaviors. These findings highlight the role that lifestyle improvements could play in promoting healthy aging, and provide insight into which behavioral combinations should receive top priority for intervention.

Is it merely a myth that alcoholic beverages such as red wine can be cardioprotective?

It has been suggested that although the negative impact of alcohol consumption varies from person to person, on a global level the adverse effect of alcohol on cardiovascular disease outweighs any protective effect by between two- and three-fold. This is inaccurate. There is a proven positive relationship between alcohol consumption and cardiovascular disease that is acknowledged by the World Health Organization. For example, moderate alcohol consumption reduces the risk of cardiovascular disease by approximately 25%, such that alcohol consumption per se accounts for -4.7% of the total cardiovascular disease burden in Australia. Correspondingly, cardiovascular disease accounted for 34% of the total number of deaths in Australia in 2008, and 18% of the overall burden of disease in Australia in 2003, with coronary heart disease and stroke contributing over 80% of this burden. Australia is not substantially different from other developed countries having similar demographics to, and the same leading causes of burden as, other high-income developed countries. This article examines the suggestions and evidence surrounding the relationship between light-to-moderate alcohol consumption and benefits to human health.

Potential health benefits of moderate alcohol consumption: current perspectives in research

The benefits of moderate amounts of alcohol for a better health and longer life expectancy compared with abstinence have been suggested by the findings of numerous studies. However, controversies have emerged regarding the influence of confounding factors and the systematic errors that might have been inadvertently disregarded in the early studies. This review includes a description of the findings of those research studies published in the last 5 years on the effects of moderate alcohol consumption on all-cause mortality, CVD and inflammation, the immune system, insulin sensitivity, non-alcoholic fatty liver disease (NAFLD) and cancer. Promising evidences exist from both animal studies and human clinical trials regarding intermediate end-points of CHD and insulin sensitivity, such as HDL, adiponectin or fibrinogen. However, controversies and inconsistent findings exist regarding many of these diseases and related functions and biomarkers. Further research and human randomised-controlled trials with adequate standardisation of the study conditions are necessary in order to draw a comparison between studies, establish the causal effect of moderate alcohol intake on disease protection and reach consensus on the circumstances that allow the recommendation of moderate alcohol habitual intakes as a strategy for health maintenance.

Moderate ethanol ingestion and cardiovascular protection: from epidemiologic associations to cellular mechanisms

While ethanol intake at high levels (3-4 or more drinks), either in acute (occasional binge drinking) or chronic (daily) settings, increases the risk for myocardial infarction and stroke, an inverse relationship between regular consumption of alcoholic beverages at light to moderate levels (1-2 drinks per day) and cardiovascular risk has been consistently noted in a large number of epidemiologic studies. Although initially attributed to polyphenolic antioxidants in red wine, subsequent work has established that the ethanol component contributes to the beneficial effects associated with moderate intake of alcoholic beverages regardless of type (red versus white wine, beer, spirits). Concerns have been raised with regard to interpretation of epidemiologic evidence for this association including heterogeneity of the reference groups examined in many studies, different lifestyles of moderate drinkers versus abstainers, and favorable risk profiles in moderate drinkers. However, better controlled epidemiologic studies and especially work conducted in animal models and cell culture systems have substantiated this association and clearly established a cause and effect relationship between alcohol consumption and reductions in tissue injury induced by ischemia/reperfusion (I/R), respectively. The aims of this review are to summarize the epidemiologic evidence supporting the effectiveness of ethanol ingestion in reducing the likelihood of adverse cardiovascular events such as myocardial infarction and ischemic stroke, even in patients with co-existing risk factors, to discuss the ideal quantities, drinking patterns, and types of alcoholic beverages that confer protective effects in the cardiovascular system, and to review the findings of recent experimental studies directed at uncovering the mechanisms that underlie the cardiovascular protective effects of antecedent ethanol ingestion. Mechanistic interrogation of the signaling pathways invoked by antecedent ethanol ingestion may point the way towards development of new therapeutic approaches that mimic the powerful protective effects of socially relevant alcohol intake to limit I/R injury, but minimize the negative psychosocial impact and pathologic outcomes that also accompany consumption of ethanol.

Effect of alcohol and tobacco use on vascular dementia: a matched case control study

BACKGROUND

Vascular dementia is the second most common type of dementia in the United States. The underlying association of tobacco and alcohol with vascular dementia is not completely understood.

PURPOSE

Determine the relationship of tobacco and alcohol use with the development of vascular dementia (VaD).

METHODS

This was a matched case-control study of subjects living in Olmsted County, MN. Cases of VaD were identified through medical record abstraction using conventionally accepted definitions of VaD, using the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Ensignement en Neurosicences ( NINDS-AIRENS) criteria and were matched to controls by gender and age within 3 years among persons free of dementia on the index date. Exposure data for alcohol and tobacco use were abstracted by trained nurses, along with demographic, lifestyle, cerebrovascular, cardiovascular, and vascular comorbid disease characteristics. Matched conditional logistic regression for univariate and multivariate evaluation of the association of tobacco and alcohol use with VaD was utilized.

RESULTS

Current alcohol exposure was associated with a decreased risk of VaD with an odds ratio of 0.48 (95% confidence interval: 0.31-0.74). This protective effect of alcohol was seen in men, women, and subjects under 80 years of age. Tobacco use was not associated with VaD in univariate and multivariate analysis, and stratified analysis did not reveal any subgroup-specific associations between tobacco use and VaD in the study population.

CONCLUSION

Current alcohol use appears to have protective effects against the development of vascular dementia. The effects are more pronounced in subjects under age 80. This may reflect the direct vascular effects of alcohol on the vascular system or may represent a surrogate for better social or functional status. Previous alcohol use was not protective. Tobacco use was not a risk factor for VaD status, which was possibly an indication of survivorship bias in the cohort.

Limitations to functioning and independent living after the onset of coronary heart disease: what is the role of lifestyle factors and obesity?

Background: People with coronary disease have a higher risk of functional limitations than their same-age counterparts without disease. This study examined prospectively the extent to which functioning and independent living among individuals with coronary disease in early old age are associated with lifestyle factors before and after disease onset. Methods: Participants were 986 British civil servants (657 men and 329 women aged 35–55 years), who were free of coronary disease at study entry in 1985–88 but developed disease during 21 years follow-up (the Whitehall II study). Lifestyle factors (obesity, smoking, alcohol, diet and physical activity) were measured at baseline and follow-up in 2007–09. Post-disease limitations to functioning were measured in 2006–09 at mean age is 68 years using activities of daily living scales. Results: Low physical activity and being overweight [body mass index (BMI) ≥25] before and after disease onset were associated with having one or more limitations in activities of daily living among coronary patients [age-, sex- and socio-economic position adjusted odds ratios for pre-disease inactivity and obesity 1.53 [95% confidence interval (95% CI) 0.99–2.35] and 2.53 (95% CI 1.53–4.18), respectively]. A decrease in physical activity [odds ratio (OR): 2.42, 95% CI 1.59–3.68] and an increase of >5 U in BMI (OR: 2.05, 95% CI 1.34–3.13) were also related to limitations in activities of daily living after disease onset. These relationships were not accounted for by measured co-morbidities. No robust associations were observed for smoking, alcohol use and diet. Conclusion: Physical activity and weight control across the adult life course are associated with fewer limitations to functioning and independent living after the onset of coronary disease.

Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed ≥ 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3% of sample), "Decreasing Drinkers" (5.9%), "Stable Drinkers" (24.2%), and "Non/Infrequent Drinkers" (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.

Drinking patterns and the development of functional limitations in older adults: longitudinal analyses of the health and retirement survey

OBJECTIVE

To examine whether consistent low-risk drinking is associated with lower risk of developing functional limitations among older adults.

METHOD

Data were obtained from five waves of the Health and Retirement Study. Function was assessed by questions measuring four physical abilities and five instrumental activities of daily living. Five different drinking patterns were determined using data over two consecutive survey periods.

RESULTS

Over the follow-up periods, 38.6% of older adults developed functional limitations. Consistent low-risk drinkers had lower odds of developing functional limitations compared with consistent abstainers, and the effect of consistent low-risk drinking was greater among those aged 50 to 64 years compared with those aged ≥65 years. Other drinking patterns were not associated with lower odds of incident functional limitation.

DISCUSSION

Consistent low-risk drinking was associated with lower odds of developing functional limitations, and this association was greater among older middle-aged adults aged 50 to 64 years.

Inverse relationship between moderate alcohol intake and rectal cancer: analysis of the North Carolina Colon Cancer Study

BACKGROUND

The relationship between alcohol intake and rectal cancer is uncertain.

OBJECTIVE

We sought to evaluate whether alcohol consumption is associated with distal colorectal cancer and rectal cancer specifically.

DESIGN

Data on alcohol intake were examined from the North Carolina Colon Cancer Study, a population-based case-control study of distal colorectal cancer.

SETTING

This study encompassed 33 counties in the central and eastern part of North Carolina.

PATIENTS

Cases had adenocarcinoma of the rectum, rectosigmoid, and sigmoid colon. Controls were frequency-matched on age, race, and sex.

INTERVENTIONS

Demographic and dietary intake data were collected with use of a validated questionnaire.

MAIN OUTCOME MEASURES

Logistic regression was used to estimate odds ratios for the relationship between alcohol consumption and distal colorectal cancer.

RESULTS

Included in the study were 1033 cases and 1011 controls. The odds ratio for rectal cancer comparing any vs no alcohol intake was 0.73 (95% CI 0.60, 0.90), adjusted for age, sex, race, smoking status, obesity, education, red meat intake, use of nonsteroidal anti-inflammatory medications, and family history of colorectal cancer. The odds ratio for moderate alcohol (≤14 g/day) was 0.66 (95% CI 0.53, 0.82), whereas the odds ratio for heavy alcohol (>14 g/day) was 0.93 (95% CI 0.70, 1.23). Moderate beer and wine intakes were also inversely associated with distal colorectal cancer: odds ratios 0.76 (95% CI 0.60, 0.96) and 0.69 (95% CI 0.56, 0.86).

LIMITATIONS

This was a retrospective, observational study. Residual confounding is possible.

CONCLUSIONS

In this study, moderate alcohol intake (especially wine) was inversely associated with distal colorectal cancer.

Severity of alcohol-related problems and mortality: results from a 20-year prospective epidemiological community study

There is evidence that high alcohol use is associated with an increase in mortality. Little is known about long-term effects of problematic alcohol consumption in non-clinical (community) populations. The aim of our study was to obtain data on this and related issues in a representative rural community sample assessed longitudinally over a period of 20 years. Assessments focused on a baseline survey from 1980 to 1984 and 20-year follow-up from 2001 to 2004. Based on expert interviews and standardized self-rating scales (e.g. MALT; Munich Alcoholism Test), the following three groups were defined (a) severe alcohol problems, (b) moderate alcohol problems, and (c) no alcohol problems. Mortality and hazard rates were analyzed with logistic and Cox regression adjusted for several health risk factors. From an original community sample of 1,465 individuals, 448 were deceased at 20-year follow-up. Participation rates were high. Baseline prevalence according to the MALT was 1.6% for severe alcohol problems and 4.0% for moderate alcohol problems. Over the 20-year time span, individuals with severe alcohol problems had a significantly elevated risk for dying earlier than the group with no alcohol problems (2.4 times higher). Mortality for those with moderate alcohol problems at baseline had a non-significantly elevated 20-year mortality risk (1.5 times higher) compared to those with no alcohol problems. Cox survival analyses corroborate these findings from multiple sequential logistic regression analyses. In discussing the mortality risk of persons with alcohol problems, the severity of the alcohol problems must be taken into account.

Alcohol consumption and health status in very old veterans

Previous research has linked drinking with health, but has yet to address alcohol consumption and the relationship between drinking and health among very old veterans. To help fill this gap, the authors present a cross-sectional self-report study on 1105 veterans age 90 and older who completed the national Veteran's Affairs (VA) Survey of the Health Experiences of Patients (SHEP) for fiscal year (FY) 2005. Alcohol consumption was measured using Alcohol Use Disorders Identification Test scores (AUDIT-C). Health status was measured using the Veterans Rand Health Survey: VR-12. Among men (n = 1063), 60% were abstainers. No significant differences in mental health component (MCS; F(3,1040) = 1.80, P = .15) or physical health component (PCS; F(3,1040) = 1.48, P = .22) scores were detected across consumption categories. Among women (n = 42), 47% were abstainers. These results suggest many very old veterans abstain from alcohol and, among men, the associations between health status and drinking observed in younger groups may not be present in very old age.

Socioeconomic and living conditions are determinants of hip fracture incidence and age occurrence among community-dwelling elderly

In this prospective, 10-year study in community-dwelling elderly aged 50 years and over, hip fracture incidence and accordingly age at hip fracture were inversely associated with the area-level income, independently of the geographical area. Age at hip fracture also depended of marital status but in a gender-specific way.

PURPOSE

The purpose of this study is to investigate the impact of socioeconomic and living conditions on hip fracture incidence and age occurrence among community-dwelling elderly.

METHOD

Between January 1991 and December 2000, 2,454 hip fractures were recorded in community-dwelling adults aged 50 years and over in the Geneva University Hospital, State of Geneva, Switzerland. Median annual household income by postal code of residence (referred to as area-level income) based on the 1990 Census was used as a measure of socioeconomic condition and was stratified into tertiles (< 53,170; 53,170-58,678; and ≥ 58,678 CHF). Hip fracture incidence and age occurrence were calculated according to area-level income categories and adjusted for confounding factors among community-dwelling elderly.

RESULTS

Independently of the geographical area (urban versus rural), community-dwelling persons residing in areas with the medium income category presented a lower hip fracture incidence [OR 0.91 (0.82-0.99), p = 0.049] compared to those from the lowest income category. Those in the highest income category had a hip fracture at a significant older age [+1.58 (0.55-2.61) year, p = 0.003] as compared to those in the lowest income category. Age at hip fracture also depended on marital status but in a gender-specific way, with married women fracturing earlier.

CONCLUSIONS

These results indicate that incidence and age occurrence of hip fracture are influenced by area-level income and living conditions among community-dwelling elderly. Prevention programs may be encouraged in priority in communities with low income.

Assessing alternative measures of wealth in health research

OBJECTIVES

We assessed whether it would be feasible to replace the standard measure of net worth with simpler measures of wealth in population-based studies examining associations between wealth and health.

METHODS

We used data from the 2004 Survey of Consumer Finances (respondents aged 25-64 years) and the 2004 Health and Retirement Survey (respondents aged 50 years or older) to construct logistic regression models relating wealth to health status and smoking. For our wealth measure, we used the standard measure of net worth as well as 9 simpler measures of wealth, and we compared results among the 10 models.

RESULTS

In both data sets and for both health indicators, models using simpler wealth measures generated conclusions about the association between wealth and health that were similar to the conclusions generated by models using net worth. The magnitude and significance of the odds ratios were similar for the covariates in multivariate models, and the model-fit statistics for models using these simpler measures were similar to those for models using net worth.

CONCLUSIONS

Our findings suggest that simpler measures of wealth may be acceptable in population-based studies of health.

Should Red Wine Be Considered a Functional Food?

  Functional foods may be regarded as foods that have nutritional value, but in particular, they also have beneficial effects on one or more body functions. Thus, functional foods may improve health and/or reduce the risk of developing certain diseases when taken in amounts that can be consumed in a normal diet. Based on nearly 2 decades of research since the term "French paradox" was first coined in 1992, wine would appear to fit this definition. Yet there seems to be reluctance to consider wine as a functional food. In this review, we present an overview of the accumulated evidence for the health benefits of wine-and its key phenolic components such as resveratrol, quercetin, catechin-and show that these alone are not enough to firmly establish wine as a functional food. What is required is to create clearly defined products based on wine that are targeted to consumers' needs and expectations when it comes to purchasing functional foods. Moreover, the crucial question of alcohol and health also needs to be addressed by the functional food industry. Suggestions are presented for working through this issue, but in many regards, wine is like any other food-it should be consumed sensibly and in amounts that are beneficial to health. Overindulgence of any kind does not promote good health.

Alcohol use among older adults

Alcohol use is common in older adults and is associated with numerous health and social problems. Recent evidence suggests that in addition to level of alcohol consumption, drinking pattern may also be important. Moderate alcohol intake may confer some cardiac benefits, while heavy episodic drinking seems particularly problematic. Detecting alcohol misuse in older adults is difficult since clinical acumen is often poor, screening questionnaires have serious limitations and laboratory tests are not diagnostic. Brief alcohol interventions to reduce alcohol consumption appear useful in younger populations, but are less studied in older adults. While there is increasing research into the issue of alcohol use among older adults, clinicians and policy-makers must rely on limited evidence when making clinical decisions.

Low to moderate alcohol intake is not associated with increased mortality after breast cancer

BACKGROUND

Both alcohol consumption and obesity have been linked with breast cancer morbidity and mortality. An inverse association between alcohol intake and obesity suggests possible confounding between these variables (and perhaps other factors) with breast cancer outcomes.

METHODS

Alcohol intake (beer, wine, spirits, and total) was examined in 3,088 women previously diagnosed and treated for breast cancer within an intervention trial that targeted vegetables, fiber, and fat but not alcohol or weight loss. Factors associated with baseline alcohol intake were included in Cox proportional hazards models for recurrence and mortality.

RESULTS

Alcohol intake was significantly associated with higher education and physical activity levels. Neither light alcohol intake nor obesity was significantly associated with breast cancer recurrence, but moderate alcohol intake >300 g/mo was protective against all-cause mortality (hazard ratio, 0.69; 95% confidence intervals, 0.49-0.97) in a proportional hazards model adjusted for obesity. Obese women were 61% more likely to be nondrinkers than drinkers, and 76% more likely to be light drinkers than moderate/heavy drinkers. In nonobese women, alcohol intake >10 g/mo was associated with lower risk of all-cause mortality (hazard ratio, 0.68; 95% confidence intervals, 0.51-0.91).

CONCLUSION

Light alcohol intake, regardless of body weight, did not increase the risk of breast cancer recurrence or all-cause mortality in this cohort of middle-aged women previously diagnosed with breast cancer. Alcohol intake was associated with other favorable prognostic indicators, which may explain its apparent protective effect in nonobese women.

Socioeconomic gradients in mortality in the oldest old: a review

This review aims at identifying gaps in knowledge on socioeconomic gradients in mortality in the oldest old. The authors review literature on oldest old population with a focus on unanswered questions: do socioeconomic status (SES) gradients in mortality persist after 80; does the magnitude of the gradient change as compared with younger populations; which socioeconomic/socio-demographic determinants should be used in this population with specific characteristics (e.g., with respect to sex ratio and household type)? Results are often inconsistent while conclusions drawn by selected studies are generally limited by the difficulty of disentangling the effects of age and cohort, and of generalizing results observed in preponderantly small, selected samples (which typically exclude institutionalized persons). Future research should explore the effects of socio-demographic indicators other than education and social class (e.g., marital status, loss of the partner) and adequately differentiate the social position of oldest old women. The authors recommend that research applies a life-course perspective combined with an interdisciplinary perspective to improve our understanding of the SES gradients in later life. Research is needed to elucidate which causal pathways depending on SES in younger age impact on mortality in higher ages up to oldest old.