Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.
Center for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.
JAMA Netw Open. 2024 Aug 1;7(8):e2424495. doi: 10.1001/jamanetworkopen.2024.24495.
Alcohol consumption is a leading cause of morbidity and mortality that may be more important in older adults with socioeconomic or health-related risk factors.
To examine the association of alcohol consumption patterns with 12-year mortality and its modification by health-related or socioeconomic risk factors.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from the UK Biobank, a population-based cohort. Participants were current drinkers aged 60 years or older. Data were analyzed from September 2023 to May 2024.
According to their mean alcohol intake in grams per day, participants' drinking patterns were classified as occasional: ≤2.86 g/d), low risk (men: >2.86-20.00 g/d; women: >2.86-10.00 g/d), moderate risk (men: >20.00-40.00 g/d; women: >10.00-20.00 g/d) and high risk (men: >40.00 g/d; women: >20.00 g/d).
Health-related risk factors were assessed with the frailty index, and socioeconomic risk factors were assessed with the Townsend deprivation index. All-cause and cause-specific mortality were obtained from death certificates held by the national registries. Analyses excluded deaths in the first 2 years of follow-up and adjusted for potential confounders, including drinking patterns and preferences.
A total of 135 103 participants (median [IQR] age, 64.0 [62.0-67.0] years; 67 693 [50.1%] women) were included. In the total analytical sample, compared with occasional drinking, high-risk drinking was associated with higher all-cause (hazard ratio [HR], 1.33; 95% CI, 1.24-1.42), cancer (HR, 1.39; 95% CI, 1.26-1.53), and cardiovascular (HR, 1.21; 95% CI, 1.04-1.41) mortality; moderate-risk drinking was associated with higher all-cause (HR, 1.10; 95% CI, 1.03-1.18) and cancer (HR, 1.15; 95% CI, 1.05-1.27) mortality, and low-risk drinking was associated with higher cancer mortality (HR, 1.11; 95% CI, 1.01-1.22). While no associations were found for low- or moderate-risk drinking patterns vs occasional drinking among individuals without socioeconomic or health-related risk factors, low-risk drinking was associated with higher cancer mortality (HR, 1.15; 95% CI, 1.01-1.30) and moderate-risk drinking with higher all-cause (HR, 1.10; 95% CI, 1.01-1.19) and cancer (HR, 1.19; 95% CI, 1.05-1.35) mortality among those with health-related risk factors; low-risk and moderate-risk drinking patterns were associated with higher mortality from all causes (low risk: HR, 1.14; 95% CI, 1.01-1.28; moderate risk: HR, 1.17; 95% CI, 1.03-1.32) and cancer (low risk: HR, 1.25; 95% CI, 1.04-1.50; moderate risk: HR, 1.36; 95% CI, 1.13-1.63) among those with socioeconomic risk factors. Wine preference (>80% of alcohol from wine) and drinking with meals showed small protective associations with mortality, especially from cancer, but only in drinkers with socioeconomic or health-related risk factors and was associated with attenuating the excess mortality associated with high-, moderate- and even low-risk drinking.
In this cohort study of older drinkers from the UK, even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. The attenuation of mortality observed for wine preference and drinking only during meals requires further investigation, as it may mostly reflect the effect of healthier lifestyles, slower alcohol absorption, or nonalcoholic components of beverages.
饮酒是导致发病和死亡的主要原因之一,对于具有社会经济或健康相关风险因素的老年人来说,其影响可能更为重要。
研究饮酒模式与 12 年死亡率的关联,并探讨健康相关或社会经济风险因素对此关联的影响。
设计、地点和参与者:本前瞻性队列研究使用了英国生物库的数据,这是一项基于人群的队列研究。参与者为年龄在 60 岁及以上的当前饮酒者。数据分析于 2023 年 9 月至 2024 年 5 月进行。
根据参与者每天的平均酒精摄入量,他们的饮酒模式被分为以下几类:偶尔饮酒(≤2.86 克/天)、低风险(男性:>2.86-20.00 克/天;女性:>2.86-10.00 克/天)、中风险(男性:>20.00-40.00 克/天;女性:>10.00-20.00 克/天)和高风险(男性:>40.00 克/天;女性:>20.00 克/天)。
健康相关风险因素通过衰弱指数进行评估,社会经济风险因素通过汤森剥夺指数进行评估。所有原因和特定原因的死亡率均通过国家登记处的死亡证明获得。分析排除了随访前 2 年内的死亡,并对潜在混杂因素进行了调整,包括饮酒模式和偏好。
共纳入 135103 名参与者(中位年龄[四分位距],64.0[62.0-67.0]岁;67693 名[50.1%]女性)。在总分析样本中,与偶尔饮酒相比,高风险饮酒与全因(风险比[HR],1.33;95%CI,1.24-1.42)、癌症(HR,1.39;95%CI,1.26-1.53)和心血管疾病(HR,1.21;95%CI,1.04-1.41)死亡率升高相关;中风险饮酒与全因(HR,1.10;95%CI,1.03-1.18)和癌症(HR,1.15;95%CI,1.05-1.27)死亡率升高相关;低风险饮酒与癌症死亡率升高相关(HR,1.11;95%CI,1.01-1.22)。在没有社会经济或健康相关风险因素的个体中,低风险或中风险饮酒模式与偶尔饮酒相比,没有发现关联,但低风险饮酒与癌症死亡率升高相关(HR,1.15;95%CI,1.01-1.30),中风险饮酒与全因(HR,1.10;95%CI,1.01-1.19)和癌症(HR,1.19;95%CI,1.05-1.35)死亡率升高相关。在有健康相关风险因素的个体中,低风险和中风险饮酒模式与全因(低风险:HR,1.14;95%CI,1.01-1.28;中风险:HR,1.17;95%CI,1.03-1.32)和癌症(低风险:HR,1.25;95%CI,1.04-1.50;中风险:HR,1.36;95%CI,1.13-1.63)死亡率升高相关;在有社会经济风险因素的个体中,偏好葡萄酒(>80%的酒精来自葡萄酒)和进餐时饮酒与死亡率呈轻度保护关联,尤其是癌症死亡率,但这种关联仅见于有社会经济或健康相关风险因素的饮酒者,并且与降低与高、中、甚至低风险饮酒相关的过高死亡率有关。
在这项来自英国的老年饮酒者的队列研究中,即使是低风险饮酒也与有健康相关或社会经济风险因素的老年人的死亡率升高有关。对于葡萄酒偏好和仅在进餐时饮酒观察到的死亡率降低作用,需要进一步研究,因为这可能主要反映了更健康的生活方式、酒精吸收更慢或饮料中非酒精成分的影响。