Dawson D A
Division of Biometry and Epidemiology, National Institute on Alcohol Abuse & Alcoholism, National Institutes of Health, Bethesda, Maryland 20892-7003, USA.
Alcohol Clin Exp Res. 2000 Jan;24(1):72-81.
This study examined the effects of alcohol consumption and DSM-IV alcohol dependence on the risk of mortality.
Data from the 1988 National Health Interview Survey Alcohol Supplement were matched to the National Death Index for the years 1988 to 1995 (baseline n = 37,682 U.S. adults age > or =25 linked to 3,586 deaths). All mortality analyses were based on proportional hazards models that adjusted for age, sex, race/ethnicity, marital status, education, income, labor force status, body mass index, smoking status, and poor health indicators at baseline.
When dependence was not considered and all past-year abstainers were used as the reference group, both light and moderate drinkers exhibited a reduced risk of mortality, with hazards ratios of 0.76 (0.68-0.84) and 0.84 (0.74-0.96). Heavy drinkers had about the same risk of dying as did past-year abstainers, and very heavy drinkers had an increased risk that was not significant (OR = 1.17, CI = 0.93-1.47). When lifetime abstainers were used as the reference category, the protective effect of moderate drinking fell short of significance, and there were nearly significant increased risks among former drinkers and very heavy drinkers. When dependence was considered, light and moderate drinkers without dependence had a reduced mortality risk regardless of reference group, and there was no significant effect among heavy or very heavy drinkers without dependence. Among dependent drinkers, there was no protective effect of light or moderate drinking, and very heavy drinkers had a significantly increased risk (OR = 1.56 relative to past-year abstainers and 1.65 relative to lifetime abstainers).
Because alcohol dependence nullifies the protective effect of light and moderate drinking, it is important to understand its role as an independent risk factor for mortality. Differences between dependent and nondependent drinkers who drank comparable amounts suggest that this risk may result from longer and heavier drinking histories before baseline, more severe health problems at baseline, more heavy episodic drinking, and, possibly, differences in beverage preference.
本研究探讨了饮酒及《精神疾病诊断与统计手册》第四版（DSM-IV）中酒精依赖对死亡风险的影响。
将1988年全国健康访谈调查酒精补充调查的数据与1988年至1995年的国家死亡指数进行匹配（基线时n = 37,682名年龄≥25岁的美国成年人，与3,586例死亡相关）。所有死亡率分析均基于比例风险模型，该模型对年龄、性别、种族/族裔、婚姻状况、教育程度、收入、劳动力状况、体重指数、吸烟状况以及基线时的健康不佳指标进行了调整。
当不考虑依赖情况且将所有过去一年戒酒者作为参照组时，轻度和中度饮酒者的死亡风险均降低，风险比分别为0.76（0.68 - 0.84）和0.84（0.74 - 0.96）。重度饮酒者的死亡风险与过去一年戒酒者大致相同，而极重度饮酒者的死亡风险增加但不显著（比值比 = 1.17，置信区间 = 0.93 - 1.47）。当将终生戒酒者作为参照类别时，适度饮酒的保护作用未达显著水平，前饮酒者和极重度饮酒者的风险增加接近显著水平。当考虑依赖情况时，无论参照组如何，无依赖的轻度和中度饮酒者的死亡风险均降低，而无依赖的重度或极重度饮酒者则无显著影响。在依赖饮酒者中，轻度或中度饮酒无保护作用，极重度饮酒者的风险显著增加（相对于过去一年戒酒者的比值比 = 1.56，相对于终生戒酒者的比值比 = 1.65）。
由于酒精依赖会消除轻度和中度饮酒的保护作用，因此了解其作为死亡独立风险因素的作用非常重要。饮酒量相当的依赖饮酒者和非依赖饮酒者之间的差异表明，这种风险可能源于基线前更长且更大量的饮酒史、基线时更严重的健康问题、更多的重度暴饮，以及可能的饮料偏好差异。
