Alcohol Use, Comorbidity, and Mortality

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Abstract
OBJECTIVES:To examine the combined influence of alcohol use and comorbidity on 20‐year mortality in older adults (average age 66 at the time of the baseline survey).DESIGN:Longitudinal analysis of a national probability sample–based cohort study.SETTING:Data sources were the National Health and Nutrition Examination Survey I (NHANES I), 1971–1974, and the NHANES Epidemiologic Followup Survey, 1992.PARTICIPANTS:Four thousand six hundred ninety‐one adults aged 60 and older who provided data on alcohol use.MEASUREMENTS:The prevalence of at‐risk drinking in older adults in the United States and the 20‐year all‐cause mortality risk associated with it. At‐risk drinking status was determined from amount of alcohol consumed and comorbidities, using a previously validated method.RESULTS:The prevalence of at‐risk drinking in the United States between 1971 and 1974 in older adults was 10% (18% of men, 5% of women). The majority of at‐risk drinkers were identified as such because of their use of alcohol in amounts deemed risky in the presence of relevant comorbidities (69%) (e.g., drinking 2–3 drinks per day and having gout or anxiety or taking a medication for pain). In men, at‐risk drinking was associated with higher mortality rates than not‐at‐risk drinking (hazard ratio=1.20, 95% confidence interval=1.01–1.41); abstinence was not associated with greater mortality. In women, neither abstinence nor at‐risk drinking was associated with greater mortality rates.CONCLUSION:In this first, large population‐based study of older adults examining the mortality risks of alcohol use and comorbidity, at‐risk drinking was associated with greater mortality rates in men. These findings suggest that a lower threshold of alcohol use should be recommended for older adults with specific comorbidities to reduce mortality risks.