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Alcohol
Alcohol consumption and the U-shape relationship with mortality: 8-year follow-up of more than 6000 older men in the Whitehall study
  1. N. Bhala,
  2. J. Emberson,
  3. R. Clarke
  1. Clinical Trial Service Unit, University of Oxford, Oxford, UK

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    Objective

    To assess the relevance of alcohol consumption for cause-specific mortality in old age.

    Design

    Prospective cohort study of 6157 older men (mean age: 77 yrs) followed for cause-specific mortality for an average of 8 years.

    Methods

    Current and past alcohol consumption were collected by means of a postal questionnaire in 1997/98 among surviving participants in the 1970 Whitehall study of London Civil Servants. Mortality rates in each of six alcohol consumption groups (including a group for reduced or ex-drinking due to ill-health) were estimated after standardisation for age, smoking and employment grade. Cox proportional hazards models were used to estimate hazard ratios.

    Results

    Of the 6157 men, 1578 men (26%) with a prior history of vascular disease (myocardial infarction, angina or stroke) were excluded. About one quarter of the remaining men reported drinking less than they had done 5 years earlier, with half of these having reduced or given up alcohol for health reasons (“sick quitters”). Alcohol consumption was strongly related to plasma HDL cholesterol concentrations (1% (0.01 mmol/L) higher concentration per unit per week), and also with higher levels of blood pressure and rates of cigarette smoking. During follow-up, 2220 men died (annual rate: 56/1000/yr), including 825 from a vascular cause (21/1000/yr) and 1395 from a non-vascular cause (35/1000/yr). There was a U-shaped relation between alcohol consumption and mortality from all-causes and vascular causes, with the highest mortality observed among sick quitters and men who drank more than 28 units a week. Compared with men who drank 1–7 units a week (standardised death rate: 48/1000/yr), the adjusted HR (95% CI) for all-cause mortality was 1.45 (1.26 to 1.66) for sick quitters, 1.25 (1.11 to 1.41) for non-drinkers, and 1.32 (1.11 to 1.57) for those who drank more than 28 units a week. The risks associated with heavy drinking were even more extreme for vascular mortality (HR 1.48, 95% CI 1.13 to 1.95).

    Conclusion

    While the excess mortality among non-drinkers may not be causal, as is very likely for sick quitters, the excess mortality for heavy drinkers may well be causal. If so, some of this 50% excess vascular mortality among the 1 in 10 older men who drank more than 28 units per week could have been avoided.

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