Alcohol, Other Lifestyle Factors, and Mortality

To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations, researchers analyzed data from 12,519 participants in the Health and Retirement Study, a nationally representative study of US adults aged 55 and older. Participants were asked about their alcohol use, activities of daily living, mobility, SES, psychosocial factors (depressive symptoms, social support, and importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbid conditions. The outcome measure was death during the 4-year follow-up period.

• Moderate drinkers (1 drink per day) had a markedly more favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking versus no drinking was associated with 50% lower mortality (odds ratio [OR], 0.50).

• When smoking, obesity, and comorbidities were also adjusted for, the protective effect was slightly attenuated (OR, 0.57). When all risk factors (including functional status and SES) were adjusted for, the protective effect was markedly attenuated but remained statistically significant (OR, 0.72).

• After calculating a propensity score for alcohol intake to provide more precise estimates of confounding, moderate drinking versus no drinking resulted in an OR for mortality of 0.62.

Comments:

Although nontraditional risk factors explain much of the survival advantage associated with moderate alcohol use, moderate drinkers maintain their survival advantage over abstainers or heavy drinkers even after adjustment for these factors. In this study, the estimated mortality risk for moderate drinkers was 28% lower than that of nondrinkers after traditional multivariable adjustment, and 38% lower after a sophisticated analytic approach was used for better control of confounding. These findings suggest some, but not all, of the beneficial effects of moderate alcohol intake on total mortality may be related to other lifestyle factors.

R. Curtis Ellison, MD

Reference:

Lee SJ, Sudore RL, Williams BA, et al. Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers. J Am Geriatr Soc. 2009;57(6):955–962.