Health-associated changes in drinking: a period prevalence study of the Atherosclerosis Risk In Communities (ARIC) cohort (1987-1995)

Changes in Alcohol Use and Associations With Disease Activity, Health Status, and Mortality in Rheumatoid Arthritis

OBJECTIVE

Better disease activity and quality of life have been observed among patients with rheumatoid arthritis (RA) who drink alcohol. This association might be explained by reverse causality. We undertook this study to identify predictors of change in alcohol use and to evaluate independent associations between alcohol use and RA activity and mortality.

METHODS

Participants in Forward, The National Databank for Rheumatic Diseases, were asked about alcohol use (any versus none), and disease activity was collected through the Patient Activity Scale-II (PAS-II) on semiannual surveys. We identified factors associated with changes in alcohol use and determined associations between alcohol use and disease activity and mortality using linear and logistic regression models, Cox proportional hazards models, and marginal structural models.

RESULTS

A total of 121,280 observations were studied among 16,762 unique participants. Discontinuation and initiation of alcohol were common among drinkers and abstainers (8.2% and 9.2% of observations, respectively). Greater discontinuation and less initiation were observed with greater disease activity, older age, female sex, nonwhite race, obesity, greater comorbidity, low quality of life, low educational level, low income, and work disability. While alcohol users had lower PAS-II (β = -0.15 [95% confidence interval (95% CI) -0.18, -0.11], P < 0.001) and a lower mortality (odds ratio 0.87 [95% CI 0.76, 0.98], P = 0.03) in traditional models, associations were not seen in marginal structural models.

CONCLUSION

Higher disease activity, disability, comorbidity, and poor quality of life contribute to reductions in alcohol use. Active use and changes in use were not associated with disease activity or mortality when adjusting for confounding, suggesting no clear benefit of alcohol consumption in RA.

Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview

BACKGROUND

Although alcohol consumption has long been considered as a risk factor for chronic disease, the relationship to cardiovascular disease (CVD) is complex and involves at least two dimensions: average volume of alcohol consumption and patterns of drinking. The objective of this contribution was to estimate the burden of CVD mortality caused by alcohol consumption.

METHODS

Risk assessment modelling with alcohol-attributable CVD mortality as primary outcome. The mortality burden of ischaemic heart disease (IHD) and ischaemic stroke (IS) attributable to alcohol consumption was estimated using attributable-fraction methodology. Relative Risk (RR) data for IHD and IS were obtained from the most comprehensive meta-analyses (except for Russia and surrounding countries where alcohol RR data were obtained from a large cohort study). Age-group specific RRs were calculated, based on large studies. Data on mortality were obtained from the World Health Organization's Global Health Estimates and alcohol consumption data were obtained from the Global Information System on Alcohol and Health. Risk of former drinkers was modelled taking into account global differences in the prevalence of sick quitters among former drinkers. Alcohol-attributable mortality estimates for all other CVD causes except IHD and IS were obtained from the 2014 Global Status Report on Alcohol and Health.

RESULTS

An estimated 780,381 CVD deaths (441,893 and 338,490 CVD deaths among men and women respectively) were attributable to alcohol consumption globally in 2012, accounting for 1.4 % of all deaths and 26.6 % of all alcohol-attributable deaths. This is in contrast to the previously estimated 1,128,273 CVD deaths attributable to alcohol consumption globally, and represents a decrease of 30.8 % in alcohol-attributable CVD mortality and of 10.6 % in the global burden of all alcohol-attributable deaths.

CONCLUSIONS

When the most comprehensive and recent systematic reviews and meta-analyses are taken as bases, the net impact of alcohol consumption on CVD is lower than previously estimated.

Hospital outcomes in major depression among older adults: differences by alcohol comorbidity

OBJECTIVE

The prevalence of depression in older adults has been increasing over the last 20 years and is associated with economic costs in the form of treatment utilization and caregiving, including inpatient hospitalization. Comorbid alcohol diagnoses may serve as a complicating factor in inpatient admissions and may lead to overutilization of care and greater economic cost. This study sought to isolate the comorbidity effect of alcohol among older adult hospital admissions for depression.

METHODS

We analyzed a subsample (N = 8,480) of older adults (65+) from the 2010 Nationwide Inpatient Sample who were hospitalized with primary depression diagnoses, 7,741 of whom had depression only and 739 of whom also had a comorbid alcohol disorder. To address potential selection bias based on drinking and health status, propensity score matching was used to compare length of stay, total costs, and disposition between the two groups.

RESULTS

Bivariate analyses showed that older persons with depression and alcohol comorbidities were more often male (59.9% versus 34.0%, p <.001) and younger (70.9 versus 75.9 years, p <.001) than those with depression only. In terms of medical comorbidities, those with depression and alcohol disorders experienced more medical issues related to substance use (e.g., drug use diagnoses, liver disease, and suicidality; all p <.001), while those with depression only experienced more general medical problems (e.g., diabetes, renal failure, hypothyroid, and dementia; all p <.001). Propensity score matched models found that alcohol comorbidity was associated with shorter lengths of stay (on average 1.08 days, p <.02) and lower likelihood of post-hospitalization placement in a nursing home or other care facility (OR = 0.64, p <.001). No significant differences were found in overall costs or likelihood of discharge to a psychiatric hospital.

CONCLUSIONS

In older adults, depression with alcohol comorbidity does not lead to increased costs or higher levels of care after discharge. Comorbidity may lead to inpatient hospitalization at lower levels of severity, and depression with alcohol comorbidity may be qualitatively different than non-comorbid depression. Additionally, increased costs and negative outcomes in this population may occur at other levels of care such as outpatient services or emergency department visits.

Changes in alcohol intake and their relationship with health status over a 24-year follow-up period in community-dwelling older adults

OBJECTIVES

To determine whether alcohol use changes over time in older adults and whether alcohol intake is associated with common chronic diseases.

DESIGN

Twenty-four-year longitudinal study.

SETTING

Southern California community.

PARTICIPANTS

One thousand seventy-six members of the Rancho Bernardo cohort aged 50 to 89 at baseline.

MEASUREMENTS

Participants completed two to six research visits at approximately 4-year intervals between 1984 and 2009. At each visit, participants completed standard questionnaires on alcohol use, chronic diseases, and behaviors. Mixed-effects linear models were used to examine changes in average weekly alcohol intake over time and in relationship to health status.

RESULTS

Prevalence and frequency of alcohol use was high throughout the study, with more than 60% of participants reporting weekly alcohol intake. The average amount consumed declined with advancing age, regardless of the presence of any of the eight most common chronic diseases. Prevalence of drinking in excess of age- and sex-specific low-risk guidelines was high across all visits and did not vary according to disease burden. At the final visit, 29% of participants drank in excess of low-risk drinking guidelines, including 28% of those with hypertension and 31% with diabetes mellitus.

CONCLUSION

Prevalence and frequency of alcohol intake remained stable over a 24 year follow-up in this cohort of educated, white, middle-class, older adults, although average amount consumed decreased with advancing age. Despite this decrease, a high proportion of older adults, including those with common chronic health conditions, drank in excess of current guidelines. Clinicians should provide more education on the importance of older adults moderating alcohol intake.

Heavy drinking and use of sedative or anxiolytic drugs among aging men: an 11-year follow-up of the FinDrink study

BACKGROUND

Most studies on heavy drinking and sedative/anxiolytic drug use have been cross-sectional, and evidence for a possible temporal association is lacking.

OBJECTIVE

To prospectively investigate whether heavy drinking predicts initiation, continuation, or discontinuation of sedative/anxiolytic drugs at 4 and 11 years and, conversely, whether sedative/anxiolytic drug use predicts heavy drinking.

METHOD

This was a longitudinal population-based study conducted in Kuopio, Finland. An age-stratified random sample of 1516 men aged 42, 48, 54, and 60 years received a structured clinical examination at baseline (August 1986-December 1989). Follow-up clinical examinations were conducted at 4 (n = 1038) and 11 (n = 854) years. Multinomial logistic regression was used to compute odds ratios and 95% confidence intervals for the association between sedative/anxiolytic drug use and initiation, continuation, and discontinuation of heavy drinking (≥ 14 drinks/wk). The reverse association between heavy drinking and sedative/anxiolytic drug use was also investigated. Regression models were adjusted for age, working status, smoking, and depressive symptoms.

RESULTS

At baseline 12.9% (134/1038) of participants were heavy drinkers and 4.0% (41/1030) used sedative/anxiolytic drugs. In multivariate analyses, baseline heavy drinking predicted initiation of sedative/anxiolytic drug use at 4 years (OR 2.96; 95% CI 1.23 to 7.15). Conversely, baseline sedative/anxiolytic drug use predicted continuation of heavy drinking at 11 years in unadjusted analysis (OR 3.30; 95% CI 1.19 to 8.44). However, the association was not statistically significant in adjusted analyses (OR 2.69; 95% CI 0.86 to 8.44).

CONCLUSIONS

The main finding of this study was the association between heavy drinking and subsequent initiation of sedative/anxiolytic drugs that was not fully explained by baseline depressive symptoms. This may inform strategies to optimize the use of sedative/anxiolytic drugs, and assist in the early identification of patients at risk of heavy drinking. Clinicians should consider a patient's alcohol consumption prior to prescribing or dispensing sedative/anxiolytic drugs. Clinicians should also monitor patients prescribed sedative/anxiolytic drugs for subsequent heavy drinking.

Drinking Patterns, Gender and Health III: Avoiding vs. Seeking Healthcare

BACKGROUND

Inability to predict most health services use and costs using demographics and health status suggests that other factors affect use, including attitudes and practices that influence health and willingness to seek care. Alcohol consumption has generated interest because heavy, chronic consumption causes adverse health consequences, acute consumption increases injury, and moderate drinking is linked to better health while hazardous drinking and alcohol-related problems are stigmatized and may affect willingness to seek care.

METHODS

A stratified random sample of health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). We linked survey data to 24 months of health-plan records to examine relationships between alcohol use, gender, health-related attitudes, practices, health, and service use. In-depth interviews with a stratified 150-respondent subsample explored individuals' reasons for seeking or avoiding care.

RESULTS

Quantitative results suggest health-related practices and attitudes predict subsequent service use. Consistent predictors of care were having quit drinking, current at-risk consumption, cigarette smoking, higher BMI, disliking visiting doctors, and strong religious/spiritual beliefs. Qualitative analyses suggest embarrassment and shame are strong motivators for avoiding care.

CONCLUSIONS

Although models included numerous health, functional status, attitudinal and behavioral predictors, variance explained was similar to previous reports, suggesting more complex relationships than expected. Qualitative analyses suggest several potential predictive factors not typically measured in service-use studies: embarrassment and shame, fear, faith that the body will heal, expectations about likelihood of becoming seriously ill, disliking the care process, the need to understand health problems, and the effects of self-assessments of health-related functional limitations.

A profile of concurrent alcohol and alcohol-interactive prescription drug use in the US population

BACKGROUND

The risk of adverse events among alcohol-interactive medication users can occur with one standard alcoholic drink. Research on the extent to which this occurs is scant.

OBJECTIVE

To examine the prevalence and correlates of concurrent alcohol and alcohol-interactive (AI) medication use across different levels of risk for an alcohol-related adverse event in a nationally representative sample of American adults.

METHODS

Cross-sectional analysis of past year, self-reported drinking history as well as past month, self-reported and visually inspected prescription drug use data from the 1999-2000 and 2001-2002 NHANES questionnaire section (n = 8,246). Medications were considered AI if concurrent use of alcohol and the prescription drug could intensify the effects of alcohol, resulting in increased sedation, drowsiness, or dizziness. Weighted prevalence estimates and polytomous logistic regression accounted for the complex survey design.

RESULTS

Overall, 13.5% took prescription AI medications, of which 5.6% reported alcohol consumption of three or more drinks on each drinking occasion. Correlates of such use were being a man [adjusted odds ratio (AOR): 4.37; 95% confidence interval (CI): 1.84-10.35], between the ages of 20 and 54 (AOR=12.28; 95% CI: 3.12-48.25), and currently smoking (AOR: 2.61; 95% CI: 1.28-5.29), with alcohol-abstaining AI users as the referent group.

CONCLUSIONS

Combining alcohol and AI medications is a common phenomenon, and the risk of alcohol-related adverse drug events may be nontrivial. Screening for alcohol use before prescribing AI medications would be prudent. Better communication regarding the dangers of mixing alcohol with AI medications is warranted.

The role of medication use and health on the decision to quit drinking among older adults

OBJECTIVE

To determine the extent to which changes in medication use and health influence the decision to quit drinking among older adults.

METHOD

The sample consisted of 8,883 elderly enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PA-PACE) program who completed surveys in 2000 and 2002. Survey data were linked with prescription claims to examine medication and health factors associated with drinking cessation between baseline and follow-up.

RESULTS

Overall, 3.9% of those using alcohol at baseline quit drinking during the study period. Logistic regression results showed that individuals who initiated antipsychotic (OR = 2.92) and antineoplastic therapies (OR = 2.67) were the most likely to quit drinking.

DISCUSSION

These findings support the hypothesis that elderly quit drinking in response to ill health. Results have implications for alcohol interventions in older adults and underscore the importance of separating former drinkers from lifetime abstainers in the study of alcohol-health relationships.

Changing drinking pattern does not influence health perception: a longitudinal study of the atherosclerosis risk in communities study

OBJECTIVE

To investigate if dynamic changes in the pattern of alcoholic beverages consumption are associated with modifications in health perception.

DESIGN, SETTING, AND PARTICIPANTS

This study investigated 12 332 middle aged men and women from the atherosclerosis risk in communities study who reported drinking status and perceived health triennially from 1987 to 1995. Crude and adjusted risks for change in health perception between visits two and three by change in drinking status between visits one and two were computed. In the multivariate analysis the sample was restricted to participants with stable drinking status between visit two and three and stable health perception between visits one and two, to assure that exposure and outcome were not temporary. Covariates included age, sex, race, income, smoking status, educational level, and obesity.

RESULTS

Health for persons who stopped or started drinking, or continued to abstain was more likely to decline than was health for persons who continued to drink even after adjustment and restrictions (drinking cessation: OR = 1.6, 95% CI = 1.1, 2.3; started drinking; OR = 1.4, 95% CI = 0.9, 2.2; continued abstaining from alcohol: OR = 1.5, 95% CI = 1.3, 1.9). Among participants with poor perceived health, starting, stopping, or continuing to abstain from alcohol did not improve health in relation to participants that continued to drink.

CONCLUSION

Increasing and decreasing drinking patterns and continuous abstinence were associated with declining health perception in comparison with continuous drinking, while starting or stopping drinking did not improve health perception of persons with poor perceived health. These findings suggest that change in health perception was not biologically related to alcohol consumption.

Smoking and Drinking Habits Five Years after Baseline in the JACC Study

BACKGROUND

Observing longitudinal changes in smoking and drinking habits is important for evaluating the risk of incidence and death from cancer or other diseases in a cohort study.

METHODS

Smoking and drinking habits at baseline and about five years later among 18,312 males and 28,338 females were obtained from the baseline and interim surveys in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) sponsored by Monbusho (Ministry of Education, Science, Sports and Culture of Japan). Changes in smoking and drinking habits between the two surveys were observed. Odds ratios for quitting these habits at interim survey were estimated.

RESULTS

Percentages of current smokers at baseline and interim surveys were 51.0% and 45.5% in males, and 5.2% and 4.8% in females, respectively. Percentages of current drinkers at baseline and interim surveys were 78.0% and 73.2% in males, and 29.5% and 23.5% in females, respectively. The number of cigarettes per day among male current smokers and the usual amount of alcohol consumed on each occasion among current drinkers decreased between the two surveys. Odds ratios for smoking cessation increased with age at baseline and decreased with the number of cigarettes per day at baseline. Odds ratios for drinking cessation increased with age at baseline and decreased with the usual amount of alcohol consumed on each occasion at baseline.

CONCLUSION

The decrease in smoking and drinking habits was observed during the five-year follow-up period. Higher age and lower levels of exposure were associated with quitting smoking or drinking.

Risk factors for cardiovascular disease in a Brazilian population-based cohort study

OBJECTIVE

Our aim was to investigate risk factors for cardiovascular disease (CVD) in a population-based Brazilian cohort.

DESIGN AND METHODS

A cohort study was conducted with 1091 individuals identified through multi-stage probability sampling in Porto Alegre, Brazil. Risk factors were investigated among demographic and anthropometric characteristics, including education, smoking habits, income, alcoholic beverage consumption, and blood pressure. A fatal or non-fatal episode of myocardial infarction, stroke, or heart failure, and cases of sudden death comprised the composite endpoint.

RESULTS

Vital status was determined in 982 (90.0%) of the participants of the original cohort after 6.0+/-1.7 years of follow-up. A total of 52 individuals presented a cardiovascular event. Male gender (hazard ratio (HR) 2.01, 95% CI 1.03-3.91), systolic blood pressure (mmHg) (HR 1.03, 95% CI 1.01-1.04) and alcohol consumption (g/day) (HR 1.001, 95% CI 1.00-1.003) were associated with the incidence of CVD after controlling for confounding. Body mass index (HR 1.05, 95% CI 0.99-1.11) and current or previous smoking (HR 1.65, 95% CI 0.83-3.26) showed a trend for a positive association.

CONCLUSIONS

We confirmed that male gender, systolic blood pressure, obesity and smoking are risk factors for cardiovascular disease in a Brazilian population. The positive association between alcohol consumption and incident CVD was unexpected and deserves replication.

Structural models of gender, alcohol consumption, and health

BACKGROUND

Gender differences exist in patterns of alcohol consumption and in the health and social effects of alcohol use, but little is known about gender differences in how alcohol use is affected by mental and physical health conditions.

METHODS

We used structural equation modeling techniques to examine gender differences in the relationships among alcohol consumption, physical and mental health, functional status, and social and demographic characteristics. Data were obtained from a random sample of the adult membership of a health maintenance organization in the U.S. Pacific Northwest. Simultaneous models evaluated gender differences in predictors of drinking vs. nondrinking status and, among drinkers, amount of alcohol consumed.

RESULTS

Physical health was twice as strong a predictor of drinker/nondrinker status among women compared with men, but among drinkers, there were no gender differences in predictors of amount of alcohol consumed. Mental health predicted drinking status and alcohol consumption among drinkers, but these relationships did not differ by gender. Overall, sociodemographic characteristics and physical health were stronger predictors of alcohol use among women than among men.

CONCLUSIONS

Women may be more amenable than men to alcohol-related preventive messages that target physical health concerns. Treating mental health conditions may be an important method for reducing alcohol consumption.