Ruf Esther, Baumert Jens, Meisinger Christa, Döring Angela, Ladwig Karl-Heinz
Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr, 1, 85764 Neuherberg, Germany.
BMC Public Health. 2014 Apr 4;14:312. doi: 10.1186/1471-2458-14-312.
Several studies have shown a protective association of moderate alcohol intake with mortality. However, it remains unclear whether this relationship could be due to misclassification confounding. As psychosocial stressors are among those factors that have not been sufficiently controlled for, we assessed whether they may confound the relationship between alcohol consumption and all-cause mortality.
Three cross-sectional MONICA surveys (conducted 1984-1995) including 11,282 subjects aged 25-74 years were followed up within the framework of KORA (Cooperative Health Research in the Region of Augsburg), a population-based cohort, until 2002. The prevalences of diseases as well as of lifestyle, clinical and psychosocial variables were compared in different alcohol consumption categories. To assess all-cause mortality risks, hazard ratios (HRs) were estimated by Cox proportional hazards models which included lifestyle, clinical and psychosocial variables.
Diseases were more prevalent among non-drinkers than among drinkers: Moreover, non-drinkers showed a higher percentage of an unfavourable lifestyle and were more affected with psychosocial stressors at baseline. Multivariable-adjusted HRs for moderate alcohol consumption versus no consumption were 0.74 (95% confidence interval (CI): 0.58-0.94) in men and 0.87 (95% CI: 0.66-1.16) in women. In men, moderate drinkers had a significantly lower all-cause mortality risk than non-drinkers or heavy drinkers (p=0.002) even after multivariable adjustment. In women, moderate alcohol consumption was not associated with lowered risk of death from all causes.
The present study confirmed the impact of sick quitters on mortality risk, but failed to show that the association between alcohol consumption and mortality is confounded by psychosocial stressors.
多项研究表明适度饮酒与死亡率之间存在保护性关联。然而，这种关系是否可能归因于错误分类的混杂因素仍不清楚。由于心理社会压力源是尚未得到充分控制的因素之一，我们评估了它们是否可能混淆饮酒与全因死亡率之间的关系。
在基于人群的队列研究——奥格斯堡地区合作健康研究（KORA）的框架内，对三项横断面莫尼卡调查（1984 - 1995年进行）中11282名年龄在25 - 74岁的受试者进行随访，直至2002年。比较了不同饮酒类别中疾病的患病率以及生活方式、临床和心理社会变量。为评估全因死亡风险，通过Cox比例风险模型估计风险比（HRs），该模型纳入了生活方式、临床和心理社会变量。
非饮酒者中的疾病患病率高于饮酒者：此外，非饮酒者在基线时显示出更不利生活方式的比例更高，且受心理社会压力源的影响更大。男性中适度饮酒与不饮酒相比，多变量调整后的HR为0.74（95%置信区间（CI）：0.58 - 0.94），女性为0.87（95%CI：0.66 - 1.16）。在男性中，即使经过多变量调整，适度饮酒者的全因死亡风险仍显著低于非饮酒者或重度饮酒者（p = 0.002）。在女性中，适度饮酒与全因死亡风险降低无关。
本研究证实了因病戒酒者对死亡风险的影响，但未能表明饮酒与死亡率之间的关联受心理社会压力源的混杂影响。
