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Abdul-Rahman AK, Card TR, Grainge MJ, Fleming KM. All-cause and cause-specific mortality rates of patients treated for alcohol use disorders: A meta-analysis. Subst Abus 2018; 39:509-517. [PMID: 29958085 DOI: 10.1080/08897077.2018.1475318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although alcohol use disorders (AUDs) are known to increase the relative risk of all-cause and some cause-specific mortality, the absolute mortality rates of the AUD population are unknown. Such knowledge would benefit planners of the provision of services for this population, including in prioritizing the identification and/or treatment of diseases likely to cause their death. METHODS We conducted a systematic review of studies in English, reporting the cause-specific mortality rates among people treated for AUDs. Number of deaths by cause and total person-years of follow-up were extracted. All-cause and cause-specific mortality rates per 1000 person-years were meta-analyzed assuming random effects. RESULTS Thirty-one studies were included. Participants were mainly middle-aged males. The quality of studies was generally good. A total of 6768 all-cause deaths in 276,990.7 person-years of follow-up (36,375 patients) were recorded, and the pooled all-cause mortality rate was 27.67/1000 person-years (py) (95% confidence interval [CI]: 23.9, 32.04). The most common cause of death in the AUD population was cardiovascular disease (CVD) (6.9/1000 py; 95% CI: 5.61, 8.49), followed by gastrointestinal deaths (5.63/1000 py; 95% CI: 4.1, 7.74), unnatural deaths (4.95/1000 py; 95% CI: 4.01, 6.09)), neoplasms, respiratory diseases, and substance use disorders. CONCLUSIONS Patients with AUDs have increased rates of all-cause and cause-specific mortality compared with the general population. Like the general population, they are most likely to die of CVD. In contrast to the general population, gastrointestinal and unnatural deaths are the next most common causes of death. We believe these facts should be considered when planning health care services for patients with AUDs.
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Affiliation(s)
- Abdul-Kareem Abdul-Rahman
- a Division of Epidemiology and Public Health, School of Medicine , University of Nottingham, Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom.,b UK Centre for Tobacco and Alcohol Studies , Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom
| | - Timothy R Card
- a Division of Epidemiology and Public Health, School of Medicine , University of Nottingham, Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom.,c Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and the University of Nottingham, Queens Medical Centre , Nottingham , United Kingdom
| | - Matthew J Grainge
- a Division of Epidemiology and Public Health, School of Medicine , University of Nottingham, Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom
| | - Kate M Fleming
- d Department of Public Health and Policy , University of Liverpool , Liverpool , United Kingdom
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Laramée P, Leonard S, Buchanan-Hughes A, Warnakula S, Daeppen JB, Rehm J. Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis. EBioMedicine 2015; 2:1394-404. [PMID: 26629534 PMCID: PMC4634361 DOI: 10.1016/j.ebiom.2015.08.040] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/26/2015] [Accepted: 08/29/2015] [Indexed: 01/08/2023] Open
Abstract
Background Alcohol dependence (AD) carries a high mortality burden, which may be mitigated by reduced alcohol consumption. We conducted a systematic literature review and meta-analysis investigating the risk of all-cause mortality in alcohol-dependent subjects. Methods MEDLINE, MEDLINE In-Process, Embase and PsycINFO were searched from database conception through 26th June 2014. Eligible studies reported all-cause mortality in both alcohol-dependent subjects and a comparator population of interest. Two individuals independently reviewed studies. Of 4540 records identified, 39 observational studies were included in meta-analyses. Findings We identified a significant increase in mortality for alcohol-dependent subjects compared with the general population (27 studies; relative risk [RR] = 3.45; 95% CI [2.96, 4.02]; p < 0.0001). The mortality increase was also significant compared to subjects qualifying for a diagnosis of alcohol abuse or subjects without alcohol use disorders (AUDs). Alcohol-dependent subjects continuing to drink heavily had significantly greater mortality than alcohol-dependent subjects who reduced alcohol intake, even if abstainers were excluded (p < 0.05). Interpretation AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption. A systematic review and meta-analysis were performed to investigate mortality risk in alcohol-dependent individuals. Alcohol dependence was associated with significantly higher mortality risk vs the general population, and vs alcohol abuse. Alcohol-dependent people with reduced alcohol consumption lowered their mortality risk, even if abstinence was not reached.
Individuals with alcohol dependence have a high risk of disease, disability or death. Treatment has traditionally focused on promoting abstinence, although some alcohol-dependent individuals would prefer to continue drinking in a controlled manner. By statistically combining results from previously published studies identified in a systematic literature review, we have shown that mortality among alcohol-dependent individuals is three to four times higher than in the general population. We have also found that individuals with alcohol dependence can reduce their risk of death by reducing alcohol consumption, even if they do not achieve abstinence.
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Affiliation(s)
- Philippe Laramée
- Université Claude Bernard Lyon I, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France ; Lundbeck SAS, 37-45, Quai du Président Roosevelt, Issy-les-Moulineaux, 92445 Paris, France
| | - Saoirse Leonard
- Costello Medical Consulting, City House, 126-130 Hills Road, Cambridge, CB2 1RE, UK
| | - Amy Buchanan-Hughes
- Costello Medical Consulting, City House, 126-130 Hills Road, Cambridge, CB2 1RE, UK
| | - Samantha Warnakula
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, UK
| | - Jean-Bernard Daeppen
- University Alcohol Treatment Centre, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada ; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada ; Klinische Psychologie und Psychotherapie, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
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Roerecke M, Rehm J. Alcohol use disorders and mortality: a systematic review and meta-analysis. Addiction 2013; 108:1562-78. [PMID: 23627868 DOI: 10.1111/add.12231] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/26/2013] [Accepted: 04/23/2013] [Indexed: 01/16/2023]
Abstract
AIMS To conduct a systematic review and meta-analysis on all-cause mortality in people with alcohol use disorders. METHODS Using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, studies were identified through MEDLINE, EMBASE, and Web of Science up to August, 2012. Prospective and historical cohort studies including a comparison of alcohol use disorder with a control group investigating all-cause mortality risk were included. RESULTS This meta-analysis included 81 observational studies with 221 683 observed deaths among 853 722 people with alcohol use disorder. In men, the relative risk (RR) among clinical samples was 3.38 (95% confidence interval [CI]: 2.98-3.84); in women it was 4.57 (95% CI: 3.86-5.42). Alcohol use disorders identified in general population surveys showed a twofold higher risk compared with no alcohol use disorder in men; no data were available for women. RRs were markedly higher for those ≤40 years old (ninefold in men, 13-fold in women) while still being at least twofold among those aged 60 years or older. CONCLUSIONS Mortality in people with alcohol use disorders is markedly higher than thought previously. Women have generally higher mortality risks than men. Among all people with alcohol use disorders, people in younger age groups and people in treatment show substantially higher mortality risk than others in that group.
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Affiliation(s)
- Michael Roerecke
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, Canada.
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Hall AE. Adult Children of Alcoholics: Are They at Greater Risk for Negative Health Behaviors? ACTA ACUST UNITED AC 2013. [DOI: 10.1080/10556699.1995.10603104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Arlene E. Hall
- a College of Health and Human Development , The Pennsylvania State University , New Kensington , PA , 15068 , USA
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5
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Park S, Hong JP, Choi SH, Ahn MH. Clinical and Laboratory Predictors of All Causes Deaths and Alcohol-Attributable Deaths Among Discharged Alcohol-Dependent Patients. Alcohol Clin Exp Res 2012; 37:270-5. [DOI: 10.1111/j.1530-0277.2012.01943.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 07/05/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Subin Park
- Department of Neuropsychiatry ; Seoul National University Hospital; Seoul; South Korea
| | - Jin Pyo Hong
- Department of Psychiatry ; Asan Medical Center; Ulsan University College of Medicine; Seoul; South Korea
| | - Soon Ho Choi
- Department of Psychiatry ; Asan Medical Center; Ulsan University College of Medicine; Seoul; South Korea
| | - Myung Hee Ahn
- Department of Psychiatry ; Asan Medical Center; Ulsan University College of Medicine; Seoul; South Korea
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Saieva C, Bardazzi G, Masala G, Quartini A, Ceroti M, Iozzi A, Gelain E, Querci A, Allamani A, Palli D. General and Cancer Mortality in a Large Cohort of Italian Alcoholics. Alcohol Clin Exp Res 2011; 36:342-50. [DOI: 10.1111/j.1530-0277.2011.01626.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Saitz R, Gaeta J, Cheng DM, Richardson JM, Larson MJ, Samet JH. Risk of mortality during four years after substance detoxification in urban adults. J Urban Health 2007; 84:272-82. [PMID: 17221296 PMCID: PMC2231626 DOI: 10.1007/s11524-006-9149-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this analysis was to assess the mortality rate and risk factors in adults, with substance dependence, who are not receiving primary medical care (PC). Date and cause of death were identified using the National Death Index data and death certificates for 470 adults without PC over a period of almost 4 years after detailed clinical assessment after detoxification. Factors associated with risk of mortality were determined using stepwise Cox proportional hazards models. Subjects were 76% male, 47% homeless, and 47% with chronic medical illness; 40% reported alcohol, 27% heroin, and 33% cocaine as substance of choice. Median age was 35. During a period of up to 4 years, 27 (6%) subjects died. Median age at death was 39. Causes included: poisoning by any substance (40.9% of deaths), trauma (13%), cardiovascular disease (13.6%), and exposure to cold (9.1%). The age adjusted mortality rate was 4.4 times that of the general population in the same city. Among these individuals without PC in a detoxification unit, risk factors associated with death were the following: drug of choice [heroin: hazard ratio (HR) 6.9 (95% confidence interval (CI) 1.6-31.1]; alcohol: HR 3.7 (95% CI 0.79-16.9) compared to cocaine); past suicide attempt (HR 2.1, 95% CI 0.96-4.5); persistent homelessness (HR 2.4, 95% CI 1.1-5.3); and history of any chronic medical illness (HR 2.1, 95% CI 0.93-4.7). Receipt of primary care was not significantly associated with death (HR 0.85, 95% CI 0.34-2.1). Risk of mortality is high in patients with addictions and risk factors identifiable when these patients seek help from the health care system (i.e., for detoxification) may help identify those at highest risk for whom interventions could be targeted.
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Affiliation(s)
- Richard Saitz
- Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, 91 East Concord Street, Boston, MA 02118, USA.
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Timko C, Debenedetti A, Moos BS, Moos RH. Predictors of 16-Year Mortality Among Individuals Initiating Help-Seeking for an Alcoholic Use Disorder. Alcohol Clin Exp Res 2006; 30:1711-20. [PMID: 17010138 DOI: 10.1111/j.1530-0277.2006.00206.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND METHODS We examined rates and predictors of mortality in individuals (47% women) who had just initiated help-seeking for their alcohol use disorders (AUDs) at the start of the study (n=628) and were followed for 16 years. RESULTS For both women and men, the observed-to-expected mortality ratio (1.4) was lower than rates found in samples of treated individuals with AUDs, suggesting that those initiating help-seeking careers have better chances of long-term survival. Of the individuals for whom cause of death was known, 68% died of alcohol-related causes. Men were more likely to die than were women. When gender was controlled, individuals who were older and unmarried and had more alcohol dependence symptoms at baseline were more likely to die over the 16-year period. When these baseline characteristics were controlled, better drinking outcomes at 1 year were associated with a lower likelihood of subsequent death. The combination of a shorter duration of inpatient/residential care and better drinking outcomes at 1 year was related to a lower probability of death, as was the combination of a longer duration of outpatient care or Alcoholics Anonymous attendance and better drinking outcomes at 1 year. CONCLUSIONS Efforts should be made to help providers identify individuals who are not responding positively to inpatient or residential treatment and intervene to motivate participation in continuing outpatient care and community 12-step self-help groups to reduce the likelihood of a chronic and fatal AUD course.
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Affiliation(s)
- Christine Timko
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Menlo Park, California 94025, USA.
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Wilcox HC, Conner KR, Caine ED. Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend 2004; 76 Suppl:S11-9. [PMID: 15555812 DOI: 10.1016/j.drugalcdep.2004.08.003] [Citation(s) in RCA: 401] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 08/04/2004] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study updated and expanded upon Harris and Barraclough's empirical review [Harris, E.C., Barraclough, B., 1997. Suicide as an outcome for mental disorders. A meta-analysis, Br. J. Psychiatry 170, 205-228] of retrospective and prospective cohort studies of alcohol and drug use disorders and suicide. METHOD Studies presenting data on alcohol and drug use disorders and suicide originally identified by Harris and Barraclough were used in this study. To find additional studies, (1) the location of English language reports on MEDLINE (1994-2002) were identified with the search terms 'substance-disorders' with 'mortality' and 'follow-up', (2) read throughs were conducted of four prominent alcohol and drug specialty journals from 1966 through 2002, and (3) the reference sections of studies that met criteria were searched for additional reports. This strategy yielded 42 new studies meeting eligibility criteria. RESULTS The estimated standardized mortality ratios (SMR; 95% confidence interval) for suicide were as follows: alcohol use disorder (979; 95% CI 898-1065; p < 0.001), opioid use disorder (1351; 95% CI 1047-1715; p < 0.001), intravenous drug use (1373; 95% CI 1029-1796; p < 0.001), mixed drug use (1685; 95% CI 1473-1920; p < 0.001), heavy drinking (351; 95% CI 251-478; p < 0.001). SMR estimates stratified by sex were also calculated. CONCLUSIONS Additional studies on the association of suicide and mixed drug use, heavy drinking, and alcohol use disorders in women augmented the findings of Harris and Barraclough, along with a novel estimate for intravenous drug use, a byproduct of intensive research on HIV in the past decade. There is a large empirical literature on alcohol use disorders and suicide and a moderate literature on suicide and opioid use disorders and IV drug use. There remains limited prospective data on the association of suicide and other drug use disorders (e.g., cocaine, cannabis).
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Affiliation(s)
- Holly C Wilcox
- Department of Psychiatry and Behavioral Sciences, Center for Family Research, George Washington University, Washington DC 20037, USA.
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Masudomi I, Isse K, Uchiyama M, Watanabe H. Self-help groups reduce mortality risk: a 5-year follow-up study of alcoholics in the Tokyo metropolitan area. Psychiatry Clin Neurosci 2004; 58:551-7. [PMID: 15482588 DOI: 10.1111/j.1440-1819.2004.01299.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The present study aimed to determine whether alcoholics who attend self-help groups experience fewer deaths than those who do not. Subjects were patients from the Alcoholism Treatment Program (ATP) of Matsuzawa hospital. A cohort of alcoholic patients recruited into a prospective study was followed from April 1994 to March 1999. A total of 469 alcoholic patients met the International Classification of Diseases (10th edition) criteria for alcohol dependency. Of these, 94 patients refused to participate in the study, leaving a total of 375 participants. After discharge from the ATP and a complete explanation of the present study, subjects decided whether to attend a self-help group (SHG) or not. The SHG comprised 208 subjects, and the non-self-help group (NSHG) comprised 167 subjects. Outcomes were evaluated with regard to death during follow-up for a mean of 2.4 years. Death was ascertained through the records of the Setagaya Department of Health and Welfare center, Matsuzawa hospital and other hospitals, and through personal contact with informants, relatives, and significant others of subjects. Deaths were confirmed for 47 NSHG subjects and only five SHG subjects. NSHG displayed a significantly decreased cumulative survival compared with SHG (P < 0.0001). Cox proportion hazard analysis was used to examine variables that may help to predict mortality among alcoholics. Alcoholics who attended self-help groups differed from those who did not, with regard to mortality experience. Attending a self-help group represented the most important predictor of prognosis for alcoholics.
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Affiliation(s)
- Ichiro Masudomi
- Section of Psychiatry and Behavioral Science, Tokyo Medical and Dental University, Tokyo, Japan.
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12
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Neeleman J. A continuum of premature death. Meta-analysis of competing mortality in the psychosocially vulnerable. Int J Epidemiol 2001; 30:154-62. [PMID: 11171878 DOI: 10.1093/ije/30.1.154] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Suicide may be an extreme expression of liability to death of any type. If true, suicide risk factors should also increase other mortality, and, given exposure, excess risk should be higher for suicide than for other mortality. METHODS Of 304 publications identified in Index Medicus (1966-June 1988) by the string (suicide) and (mortality or death) and (accidental or natural), 24 reported total and cause-specific mortality associated with exposure to 16 established suicide risk factors; reference scanning yielded 122 more. These 146 publications reported on 163 cohorts (total subjects = 1179 126) mortality. Meta-analysis gave random effects standardized mortality ratios (SMR) for natural, accidental and suicidal death, stratified over the 16 risk groups. RESULTS Overall, SMR were 8.6 (95% CI : 7.1-10.4) for suicide, 3.4 (95% CI : 2.9-4.0) for accidental and 2.1 (95% CI : 1.9-2.3) for natural death. Compatible with the first hypothesis, in most groups, mortality of any type was raised. Supporting the second hypothesis, excesses increased from lowest for natural death to highest for suicide. This trend was most pronounced following deliberate self-harm, intermediate in substance abusers, and weakest, but present, in bereaved and low social class cohorts and reversed in smokers and epileptic people. CONCLUSIONS Many suicide risks apply to any type of premature death, whilst also retaining some specificity for suicide. Primary prevention, targeting such generic risk factors, will not only reduce rates of suicide but also of other types of death. Conversely, when prevention focuses on specific outcomes-such as suicide-only, other types of mortality may increase.
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Affiliation(s)
- J Neeleman
- Department of Social Psychiatry, University of Groningen, PO Box 30001, 9700 RB Groningen, Netherlands.
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Abstract
The mortality rate from alcoholism and related comorbidities is high. Studies show multiple causes of premature death from alcoholism. Several studies showed that abstinence had a positive effective on the overall survival of alcoholics. Alcoholics who abstained from alcohol, particularly continuously, showed reduced mortality rates and increased years of longevity than alcoholics who relapsed to alcohol consumption. The sources of the findings tend to be derived from treatment populations, in which abstinence is expected to occur in higher rates than in the general population.
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Affiliation(s)
- N S Miller
- Department of Psychiatry, Michigan State University, East Lansing, USA
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14
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Abstract
A group of alcoholic men were followed-up 8 years after discharge from hospital. The interview included items on sleep, anxiety, and depression. The sample was divided into abstinent and drinking subjects. Sleep data were factor analyzed. Only the Alcohol-Abstinence Sleep Factor significantly correlated with drinking status. The Alcohol-Abstinence Sleep Factor was also the primary correlate of anxiety and depression. Fewer abstinent subjects reported anxiety and depression. Sleep variables, anxiety, and depression are considered as possible markers of relapse in persons treated for alcoholism.
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Affiliation(s)
- A Mackenzie
- Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205, USA
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Abstract
BACKGROUND We describe the increased risk of premature death from natural and from unnatural causes for the common mental disorders. METHOD With a Medline search (1966-1995) we found 152 English language reports on the mortality of mental disorder which met our inclusion criteria. From these reports, covering 27 mental disorder categories and eight treatment categories, we calculated standardised mortality ratios (SMRs) and 95% confidence intervals (CIs) for all causes of death, all natural causes and all unnatural causes; and for most, SMRs for suicide, other violent causes and specific natural causes. RESULTS Highest risks of premature death, from both natural and unnatural causes, are for substance abuse and eating disorders. Risk of death from unnatural causes is especially high for the functional disorders, particularly schizophrenia and major depression. Deaths from natural causes are markedly increased for organic mental disorders, mental retardation and epilepsy. CONCLUSION All mental disorders have an increased risk of premature death.
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Affiliation(s)
- E C Harris
- Mental Health Group, University of Southampton
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Abstract
The close association of nicotine addiction and alcoholism is well established. As many as 80% of alcoholics smoke, and 30% of smokers are alcoholics. The mortality from cigarette smoking and alcoholism individually is very high, as an estimated 400,000 deaths from tobacco and 100,000 deaths from alcoholism are reported annually. Cigarettes and alcohol interact to cause certain cancers, e.g., head and neck. Only recently has attention been focused on the role of tobacco in abstinent alcoholics. An important study found high rates of mortality from tobacco in abstinent alcoholics in recovery. However, the mortality rates from alcoholism were high and predominant. Of great importance is that studies show that abstinence from alcohol essentially eliminates the premature deaths or increased mortality rates from active alcoholism. Similar studies showing a reduction in mortality from abstinence in nicotine addiction have not been forthcoming. The importance of treating nicotine addiction, however, is clear to reduce the high mortality rates from tobacco smoking in active or abstinent alcoholics.
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Affiliation(s)
- N S Miller
- Department of Psychiatry, University of Illinois at Chicago 60612, USA
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Lewis CE, Smith E, Kercher C, Spitznagel E. Assessing gender interactions in the prediction of mortality in alcoholic men and women: a 20-year follow-up study. Alcohol Clin Exp Res 1995; 19:1162-72. [PMID: 8561286 DOI: 10.1111/j.1530-0277.1995.tb01596.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study investigates the predictors of mortality in 259 male and female alcoholics who were psychiatrically hospitalized between 1967 and 1968 and followed for > 20 years. The findings showed that, in addition to age, marital status, medical complications, and non-antisocial personality comorbidity were important independent predictors of time to death. Data pointed to gender interactions, in that marital disruption tended to be a stronger predictor of mortality in men, and delirium tremens tended to be a stronger predictor of mortality in women. Knowing and understanding that certain events and processes may differentially affect the survival of male and female alcoholics will allow for the development of more individualized and gender-specific therapeutic interventions.
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Affiliation(s)
- C E Lewis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Lewis CE, Smith E, Kercher C, Spitznagel E. Predictors of mortality in alcoholic men: a 20-year follow-up study. Alcohol Clin Exp Res 1995; 19:984-91. [PMID: 7485850 DOI: 10.1111/j.1530-0277.1995.tb00978.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study investigates the predictors of mortality in 156 male alcoholics who were psychiatrically hospitalized between 1967 and 1968 and followed for > 20 years. The findings showed that an older age, liver cirrhosis, and separation or divorce at intake were all associated with a shorter time to death. These results corroborate those of other follow-up studies that have identified age, health, and social support as independent correlates of mortality in alcoholics. From a therapeutic standpoint, the most alterable predictor is social support. Thus, the establishment of a salutary social network and social support system should be an integral part of the alcoholic's treatment plan.
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Affiliation(s)
- C E Lewis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Abstract
This study presents mortality data from a 20-year follow-up of 99 married men with drinking problems. Forty-four of the sample had died and death certificates were obtained on 43. Cause of death was classified according to the Ninth Revision of the International Classification of Diseases. Most of the mortality excess was in the 45-54 year age group. The observed/expected mortality ratio was 3.64 for the group as a whole, 2.93 for the moderately dependent group and 4.41 for the severely dependent group. The commonest causes of death were carcinoma of the bronchus and diseases of the circulatory system. Cause of death was analysed in terms of years of life lost. The number of years of life lost per death was highest for injury and poisoning. Only four of the 43 death certificates obtained mentioned "chronic alcoholism".
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Mackenzie A, Funderburk FR, Allen RP. Controlled drinking and abstinence in alcoholic men: beliefs influence actions. THE INTERNATIONAL JOURNAL OF THE ADDICTIONS 1994; 29:1377-92. [PMID: 7829276 DOI: 10.3109/10826089409048715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A group of alcoholic men were asked 8 years postdischarge from hospital if they could drink alcohol with control. Subjects who said "no" (the NCD group) were compared to those who said "yes" (the CD group). A majority of the NCD group had been abstinent during the year preceding the 8-year evaluation, whereas none of the CD group had been. In the model developed, troubles resulting from drinking are seen as instrumental in changes from a CD to a NCD belief. The clinical relevance of our results is discussed.
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Affiliation(s)
- A Mackenzie
- Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
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Ojehagen A, Berglund M, Moberg AL. A 6-year follow-up of alcoholics after long-term outpatient treatment. Alcohol Clin Exp Res 1994; 18:720-5. [PMID: 7943682 DOI: 10.1111/j.1530-0277.1994.tb00937.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The predictors of the long-term outcome in alcoholics (n = 50) who had been treated in a 2-year outpatient treatment program were investigated. Previously, the sample had been followed up personally 2 years after the termination of treatment. This study is a repeated, independent follow-up of the same sample over a 4-year period, 3-6 years after termination of treatment. Outcome could be categorized in 38 subjects. Patients with a favorable outcome during at least 2 years of the 4-year follow-up period (n = 21), who were categorized as a positive outcome group, were compared with the other patients (n = 17). There was no significant correlation between initial patient characteristics and outcome 3-6 years after treatment. Drinking outcome during the 1st half-year of treatment had no correlation to positive drinking outcome in years 3-6, whereas there was a positive correlation for later phases of treatment and outcome reaching a significant level during the 2nd and 4th half-year of treatment. A favorable drinking outcome during years 1-2 after treatment had a positive significant correlation to outcome in years 3-6 after treatment [i.e., 80% of the patients with a favorable outcome during the 1st follow-up period also had a positive outcome during the 2nd follow-up period, and 72% of those who had an unfavorable outcome during the 1st follow-up period had an unfavorable outcome also during the 2nd follow-up period (chi 2 test = 10.4, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Ojehagen
- Department of Psychiatry, University of Lund, Sweden
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22
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Moos RH, Brennan PL, Mertens JR. Mortality rates and predictors of mortality among late-middle-aged and older substance abuse patients. Alcohol Clin Exp Res 1994; 18:187-95. [PMID: 8198219 DOI: 10.1111/j.1530-0277.1994.tb00902.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study describes mortality rates and predictors of mortality among late-middle-aged and older (55+) substance abuse inpatients (n = 21,139) in Department of Veterans Affairs (VA) Medical Centers in the 4 years after an index episode of care. A total of 24% of the patients died; this mortality rate was 2.64 times higher than expected. Predictors of earlier mortality included older age and nonmarried status, alcohol psychosis and organic brain disorder diagnoses, and several medical diagnoses, including neoplasms, liver cirrhosis, respiratory, endocrine and metabolic, and blood system disorders. Three proxy indicators of illness severity also predicted mortality: more prior inpatient and outpatient medical care and an index episode in an extended care unit. In contrast, more prior outpatient mental health care and remitted status predicted lower mortality. These diagnostic and treatment indicators can be used to identify patients at heightened risk for premature mortality. Moreover, they show that intensive mental health aftercare and remission of substance abuse may delay mortality, even among older patients who have longstanding substance abuse problems.
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Affiliation(s)
- R H Moos
- Center for Health Care Evaluation (152), Department of Veterans Affairs Medical Center, Palo Alto, CA 94304
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23
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Abstract
This study examines the importance of Subjective Staff Ratings as predictors of the 3- and 12- month outcomes in 375 male primary alcoholic inpatients. For short-term outcome, while combinations of more usual predictors including two aspects of the pretreatment drinking history, evidence of a stable personal relationship, prior alcoholic hospitalizations, employment status, and posttreatment recovery home placement explained up to 5% of the variance on three measures of short-term outcome, Subjective Ratings alone explained up to 6%. The combination of Subjective Ratings and objective historical data explained up to 9% of the variance. The data indicate that it is difficult to accurately predict short term outcome among primary alcoholics, that the Subjective Ratings of prognosis by the treatment staff are important predictors of short-term outcome which do not overlap greatly with more traditional predictors, but that these ratings appear to add little to the longer term outcome prediction.
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Affiliation(s)
- M A Schuckit
- School of Medicine, University of California, San Diego
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24
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Mackenzie A, Funderburk FR, Allen RP, Stefan RL. Locating and interviewing alcoholics 8 years after discharge from hospital. THE INTERNATIONAL JOURNAL OF THE ADDICTIONS 1988; 23:379-86. [PMID: 3384508 DOI: 10.3109/10826088809039204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An 8-year follow-up of 85 alcoholic men resulted in 93% interviewed or confirmed deceased. The location and interview techniques used to achieve this high completion rate are reported and the "location" of deceased subjects is discussed. A list of the agencies that might have information on the whereabouts of subjects is provided. The time course of data collection is analyzed. The characteristics of subjects lost under specific follow-up inadequacies or constraints are considered. Our findings can be used by program evaluators as a basis for decisions concerning the best use of their follow-up resources.
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Affiliation(s)
- A Mackenzie
- Francis Scott Key Medical Center, Baltimore, Maryland 21224
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