Department of Epidemiology, Columbia University, New York, New York.
Robert N. Butler Columbia Aging Center, Columbia University, New York, New York.
Alcohol Clin Exp Res. 2019 Aug;43(8):1734-1746. doi: 10.1111/acer.14125. Epub 2019 Jul 5.
Alcohol consumption in later life has increased in the past decade, and the relationship between alcohol consumption and mortality is controversial. Recent studies suggest little, if any, health benefit to alcohol. Yet most rely on single-time point consumption assessments and minimal confounder adjustments.
We report on 16 years of follow-up from the Health and Retirement Study (HRS) cohorts born 1931 to 1941 (N = 7,904, baseline mean age = 61, SD = 3.18). Respondents were queried about drinking frequency/quantity. Mortality was established via exit interviews and confirmed with the national death index. Time-varying confounders included but were not limited to household assets, smoking, body mass index, health/functioning, depression, chronic disease; time-invariant confounders included baseline age, education, sex, and race.
After adjustment, current abstainers had the highest risk of subsequent mortality, consistent with sick quitters, and moderate (men: HR = 0.74, 95% CI: 0.60 to 0.91; women: HR = 0.82, 95% CI: 0.63 to 1.07) drinking was associated with a lower mortality rate compared with occasional drinking, though smokers and men evidenced less of an inverse association. Quantitative bias analyses indicated that omitted confounders would need to be associated with ~4-fold increases in mortality rates for men and ~9-fold increases for women to change the results.
There are consistent associations between moderate/occasional drinking and lower mortality, though residual confounding remains a threat to validity. Continued efforts to conduct large-scale observational studies of alcohol consumption and mortality are needed to characterize the changing patterns of consumption in older age.
在过去的十年中，老年人的饮酒量有所增加，而饮酒与死亡率之间的关系仍存在争议。最近的研究表明，饮酒几乎没有任何健康益处。然而，大多数研究依赖于单次饮酒量评估和最小的混杂因素调整。
我们报告了健康与退休研究（HRS）队列中 1931 年至 1941 年出生的人群（N=7904，基线平均年龄为 61 岁，标准差为 3.18）16 年的随访结果。受访者被询问饮酒频率和饮酒量。通过离职访谈确定死亡率，并与国家死亡指数确认。时变混杂因素包括但不限于家庭资产、吸烟、体重指数、健康/功能、抑郁、慢性疾病；时不变混杂因素包括基线年龄、教育、性别和种族。
调整后，当前戒酒者的后续死亡率风险最高，与因病戒酒者一致，而适度饮酒（男性：HR=0.74，95%CI：0.60 至 0.91；女性：HR=0.82，95%CI：0.63 至 1.07）与较低的死亡率相关，尽管吸烟者和男性的反比关系较弱。定量偏差分析表明，对于男性，需要有大约 4 倍的死亡率增加和女性有大约 9 倍的死亡率增加的混杂因素才会改变结果。
适度/偶尔饮酒与较低的死亡率之间存在一致的关联，但仍存在残留混杂的威胁。需要继续努力开展关于饮酒和死亡率的大规模观察性研究，以描述老年人群饮酒模式的变化。
