Drinking Level, Drinking Pattern, and Twenty-Year Total Mortality Among Late-Life Drinkers

Abstract

ABSTRACT. Objective: Research on moderate drinking has focused on the average level of drinking. Recently, however, investigators have begun to consider the role of the pattern of drinking, particularly heavy episodic drinking, in mortality. The present study examined the combined roles of average drinking level (moderate vs. high) and drinking pattern (regular vs. heavy episodic) in 20-year total mortality among late-life drinkers. Method: The sample comprised 1,121 adults ages 55-65 years. Alcohol consumption was assessed at baseline, and total mortality was indexed across 20 years. We used multiple logistic regression analyses controlling for a broad set of sociodemographic, behavioral, and health status covariates. Results: Among individuals whose high level of drinking placed them at risk, a heavy episodic drinking pattern did not increase mortality odds compared with a regular drinking pattern. Conversely, among individuals who engage in a moderate level of drinking, prior findings showed that a heavy episodic drinking pattern did increase mortality risk compared with a regular drinking pattern. Correspondingly, a high compared with a moderate drinking level increased mortality risk among individuals maintaining a regular drinking pattern, but not among individuals engaging in a heavy episodic drinking pattern, whose pattern of consumption had already placed them at risk. Conclusions: Findings highlight that low-risk drinking requires that older adults drink low to moderate average levels of alcohol and avoid heavy episodic drinking. Heavy episodic drinking is frequent among late-middle-aged and older adults and needs to be addressed along with average consumption in understanding the health risks of late-life drinkers. (J. Stud. Alcohol Drugs, 76, 552-558, 2015) Received: January 15, 2015. Revision: March 12, 2015. This work was supported by National Institute on Alcohol Abuse and Alcoholism Grant AA15685 and by Department of Veterans Affairs Health Services Research and Development Service funds. The opinions expressed here are the authors' and do not necessarily represent the opinions of the Department of Veterans Affairs. *Correspondence may be sent to Charles J. Holahan at the Department of Psychology (A8000), University of Texas at Austin, Austin, TX 78712, or via email at: holahan@utexas.edu. E XCESSIVE ALCOHOL CONSUMPTION is a major risk factor for chronic disease and injury (Rehm et al., 2009), but moderate alcohol consumption has been associated with reduced total mortality (Di Castelnuovo et al., 2006). However, research on moderate drinking has focused on the average level of drinking, masking diverse underlying patterns of drinking (Naimi et al., 2013). Among individuals whose average consumption is moderate, drinking may vary from a regular pattern to occasions of heavy episodic drinking. Recently, investigators have begun to consider the role of drinking pattern in mortality (Roerecke et al., 2011;Wannamethee, 2013). Heavy episodic drinking and mortalityHeavy episodic drinking is linked t...

Late-Life Drinking Problems: The Predictive Roles of Drinking Level vs. Drinking Pattern

“…Information based only on average consumption underestimates the risk for drinking problems among older drinkers (Dawson et al, 2008;Wannamethee, 2013). Along with our earlier findings (Holahan et al, 2014(Holahan et al, , 2015, the results of this investigation highlight the importance of drinking pattern, in addition to average level TABLE 3. Results of negative binomial regression analyses with drinking level and drinking pattern at baseline prospectively predicting the number of drinking problems at the 4-, 10-, and 20-year follow-ups Notes: All analyses controlled for drinking problems at baseline as well as for age, sex, socioeconomic status, marital status, and medical conditions.…”

“…However, low-risk drinking guidelines historically have been based more on experts' judgment than on research data (Greenfield et al, 2014). In conjunction with our recent work on the significant role of both high-level drinking and episodic heavy drinking in mortality (Holahan et al, 2014(Holahan et al, , 2015, these findings provide empirical support for current NIAAA guidelines for older adults (Gunzerath et al, 2004;NIAAA, 2007). Low-risk drinking requires avoiding both high average consumption and an episodic heavy drinking pattern.…”

“…Descriptive and psychometric information on the measures is available in the Health and Daily Living Form (Moos et al, 1992) for the measures of alcohol consumption and demographic and health factors, and in the Drinking Problems Index (Finney et al, 1991) for the measure of drinking problems. Following Holahan et al (2014Holahan et al ( , 2015, we applied NIAAA guidelines in defining both level and pattern of drinking.…”

“…Correspondingly, high drinking (score = 1) was defined as an average daily level of drinking that was greater than one drink per day for women and two drinks per day for men. Following Holahan et al (2014Holahan et al ( , 2015, very light drinkers (>0 to <half of a drink on average per day) were excluded because it was statistically unlikely that they would be episodic heavy drinkers.…”

One size should not fit all, so use the right tool for the job

“…Even in the absence of self‐reported psychosocial problems, heavy drinking can have an adverse effect on health. The 4+/5+ criterion may also be useful in identifying individuals at risk for a range of other health behaviors, including risky sexual activity, tobacco and illicit drug use, non‐compliance with recommended health screenings, adverse cardiovascular events, cancer and mortality . Therefore, the 4+/5+ threshold may be useful as a screening tool to identify individuals who may benefit from brief advice or health interventions.…”