Alcohol Drinking and Mortality
Critique 017. Moderate alcohol intake is associated with a lower risk of total mortality than are either abstinence or heavy drinking. 5 September 2010
Reference: Holahan CJ, Schutte KK, Brennan PL, Holahan CK, Moos BS, Moos RH. Late-Life Alcohol Consumption and 20-Year Mortality. Alcoholism: Clinical and Experimental Research 2010;34:in press, November 2010.
In a study based on data from 1,824 predominantly Caucasian Americans from the Western part of the United States, alcohol consumption at baseline was related to mortality risk during a 20-year follow-up period. Subjects were recruited into a longitudinal project that has examined late-life patterns of alcohol consumption and drinking problems. Lifetime abstainers were not included in the study, which focused on stress and coping processes among problem drinkers and non-problem drinkers. The sample at baseline included only subjects aged 55 to 65 years who had had outpatient contact with a health care facility in the previous 3 years.
The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social-behavioral factors. Subjects who were not lifetime abstainers but did not report drinking at the time of the baseline examination were classified as “abstainers.” Data on potential changes in alcohol consumption during the course of the study were not collected. Death during follow up was confirmed primarily by death certificate.
The key results of the paper are that even when adjusting for sociodemographic factors, former problem drinking status, health factors, and social-behavioral factors, moderate drinking was associated with considerably lower risk of all-cause mortality. In comparison with “moderate drinkers” (subjects reporting up to 3 drinks/day), abstainers had 51% higher mortality risk and heavy drinkers had 45% higher risk. The study supports most previous scientific studies showing that moderate drinking, in comparison with both abstinence and heavy drinking, is associated with lower risk of total mortality.
Critique 012. Moderate drinking in the elderly is associated with lower total mortality. 23 July 2010
Reference: McCaul KA, Almeida OP, Hankey GJ, Jamrozik K, Byles JE, Flicker L. Alcohol use and mortality in older men and women. Addiction 2010. On-line prior to publication: doi:10.1111/j.1360-0443.2010.02972.x
The effects of alcohol consumption in the elderly may be modified by a decreased ability to metabolize alcohol, an altered volume of distribution due to reduced lean body mass and total body water, and an increased prevalence of co-morbid conditions. These factors make this study of the net effects of drinking among a large number of community-dwelling elderly men and women especially important.
In large prospective studies from Australia of men aged 60-79 and women aged 70-75 years of age, men consuming up to 4 drinks/day and women up to 2 drinks/day had considerably lower risk of dying (total mortality) than did non-drinkers. For subjects reporting 1-2 drinks/day, their total mortality risk was about 20-30% lower than that of abstainers.
While the authors concluded that not consuming alcohol on 1 or 2 days per week was associated with better outcomes, this conclusion is not in accordance with their own data. The benefit of one or two “alcohol-free” days per week has never been substantiated with solid evidence from any large epidemiological study.
Our Forum review concludes that in terms of total mortality risk, recommendations for very low levels of drinking among the elderly may be overly restrictive, as this study showed lower total mortality for up to 4 drinks/day for elderly men and 2 drinks/day for elderly women. Further, this study does not provide support for the conclusion that mortality is lower for people who have 1 or 2 “alcohol-free” days per week.