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Alcohol consumption and all-cause mortality in older adults in Spain: an analysis accounting for the main methodological issues

Ortola, Rosario; Garcia-Esquinas, Esther; Lopez-Garcia, Esther; Leon-Munoz, Luz M.; Banegas, Jose R.; Rodriguez-Artalejo, Fernando

ADDICTION
2019
VL / 114 - BP / 59 - EP / 68
abstract
Background and aims Observational evidence that light-to-moderate alcohol consumption lowers mortality is questioned because of potential selection biases and residual confounding. We assess the association between alcohol intake and all-cause death in older adults after accounting for those methodological issues. Methods Data came from 3045 individuals representative of the non-institutionalized population aged >= 60 years in Spain. Participants were recruited in 2008-10, when they reported current and life-time alcohol intake; drinkers were classified as occasional (< 1.43 g/day), light (>= 1.43 but < 20 g/day for men and >= 1.43 but < 10 g/day for women), moderate (>= 20 but < 40 g/day for men and >= 10 but < 20 g/day for women) or heavy (>= 40 g/day for men and >= 24 g/day for women)/binge. Participants were followed-up to 2017 to assess vital status. In analyses, ex-drinkers were removed from the abstainer group and were classified according to their life-time intake to address the 'abstainer bias'. Moreover, analyses were replicated in individuals without functional limitations, and excluded deaths in the first year of follow-up, to address reverse causation. Also, occasional drinkers were used as reference in some analyses to reduce the 'healthy drinker/survivor' bias. Results were adjusted for many covariates to minimize residual confounding. Results Compared with never-drinkers, the hazard ratio (95% confidence interval) of mortality for light drinkers was 1.05 (0.71-1.56) and 1.20 (0.72-2.02) in those without functional limitations. Corresponding values for moderate drinkers were 1.28 (0.81-2.02) and 1.55 (0.87-2.75) and for heavy/binge drinkers 1.85 (1.07-3.23) and 2.15 (1.09-4.22). Results were consistent when occasional drinkers were used as reference. Among drinkers without functional limitations, the hazard ratio (95% confidence interval) of mortality per 10 g/day of alcohol was 1.12 (1.02-1.23). Conclusion After accounting for potential biases, light-to-moderate drinking among people 60+ years of age appears to have no statistically significant benefit on mortality compared with abstention from alcohol. By contrast, heavy/binge drinking shows a higher death risk compared with abstention from alcohol. Alcohol intake appears to have a positive dose-response with mortality among drinkers.

AccesS level

Green published

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