Background Some of the previously reported health benefits of low-to-moderate alcohol consumption may derive from health status influencing alcohol consumption rather than the opposite. We examined whether health status changes influence changes in alcohol consumption, cessation included.
Methods Data came from 571 current drinkers aged ≥60 years participating in the Seniors-ENRICA cohort in Spain. Participants were recruited in 2008–2010 and followed-up for 8.2 years, with four waves of data collection. We assessed health status using a 52-item deficit accumulation (DA) index with four domains: functional, self-rated health and vitality, mental health, and morbidity and health services use. To minimise reverse causation, we examined how changes in health status over a 3-year period (wave 0–wave 1) influenced changes in alcohol consumption over the subsequent 5 years (waves 1–3) using linear/logistic regression, as appropriate.
Results Compared with participants in the lowest tertile of DA change (mean absolute 4.3% health improvement), those in the highest tertile (7.8% worsening) showed a reduction in alcohol intake (β: –4.32 g/day; 95% CI –7.00 to –1.62; p trend=0.002) and were more likely to quit alcohol (OR: 2.80; 95% CI 1.54 to 5.08; p trend=0.001). The main contributors to decreasing drinking were increased functional impairment and poorer self-rated health, whereas worsening self-rated health, onset of diabetes or stroke and increased prevalence of hospitalisation influenced cessation.
Conclusions Health deterioration is related to a subsequent reduction and cessation of alcohol consumption contributing to the growing evidence challenging the protective health effect previously attributed to low-to-moderate alcohol consumption.
- health status
- cohort study
- older adults
- reverse causation
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Contributors FR-A and E-LG conceived the study; RO and EG-E performed the statistical analyses; RO and FR-A drafted the manuscript; all authors reviewed the manuscript for important intellectual content; RO and FR-A had primary responsibility for final content. All authors read and approved the final manuscript.
Funding This work was mainly supported by grant no. 02/2014 from the Plan Nacional sobre Drogas (Ministry of Health of Spain). Additional funding was obtained from FIS grants 12/1166, 16/609 and 16/1512 (Instituto de Salud Carlos III, State Secretary of R+D+I and FEDER/FSE), CIBERESP, and the Salamander Project (JPI-A Healthy Diet for a Healthy Life, State Secretary of R+D+I PCIN-2016-145).
Disclaimer The funding agencies had no role in study design, data collection and analysis, interpretation of results, manuscript preparation or in the decision to submit this manuscript for publication.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The Clinical Research Ethics Committee of ‘La Paz’ University Hospital in Madrid approved the study.
Provenance and peer review Not commissioned; externally peer reviewed.