Gabriela suggests that perhaps alcohol is not the only

Gabriela Hernandez

Psychology M140

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24 November 2017

Annotated Bibliography –
Alcohol and Mortality

            According to the
life course perspective of aging, our risk of dying increases every single
second that we are alive. There are plenty of factors that can have an impact
on our death risk, such as sociodemographic factors, habits and behaviors. One
of these behvaioral factors is diet, specifically alcohol consumption.

            Alcohol consumption
is associated with multiple side effects including: liver damage, cancer, brain
damage, injuries among many others. However, in older people moderate alcohol
consumption has shown an inverse relationship with mortality risk. This
relationship is such that with moderate alcohol consumption is associated with
decreased death risk. Current research shows benefits of moderate alcohol
consumption in relation to cardiovascular health, all-cause death, and life
expectancy. There is presence of a U-shaped relationship, in which those who
abstain from alcohol have a greater mortality risk than those who are moderate
drinkers, and heavy drinkers have the greatest mortality risk. The benefits seem
to be confounded to specific sociodemographic factors in certain studies. This
suggests that perhaps alcohol is not the only factor contributing to a better
well being in the elderly and warrants further research. Most research suggests
to interpret results with much scrutiny as there are situations in which
alcohol consumption may present negative effects, such as in the presence of
comorbidity. Therefore, there must be further research on comorbidity and
sociodemographic factors and their interaction with alcohol consumption in the
elderly. Whether the benefits outweigh the consequences of alcohol is still in


1. Colditz, G. A., Branch, L. G., Lipnick, R. J., Willett, W. C.,
Rosner, B., Posner, B., & Hennekens, C. H. (1985). Moderate alcohol and
decreased cardiovascular mortality in an elderly cohort. American Heart
Journal, 109(4), 886-889.

            This study
studied the relationship between alcohol and CHD in older populations. It
focuses on the relationships between alcohol and CHD and all-cause mortality.
In this longitudinal study, they interviewed 1271 elders, ages 66 and older and
categorized them as light moderate or heavy drinkers (calculated gm/day). They followed
up with participants ~4.75 years later… Results show that when compared to
non-drinkers, those classified as moderate drinkers (9-34 gm/day) had an
overall lower relative risk for all cause mortality, light drinkers (0.1 – 8.9
gm/day) also had lower relative risk of all-cause mortality and CHD mortality.
However, heavy drinkers (>34 gm/day) had the highest RR for CHD mortality.
Although this study shows an inverse relationship between alcohol and
mortalityin moderate drinkers (all cause and CHD), we cannot ignore the
consequences/impact of alcohol consumption, such as impaired judgment, liver
damage, cancer risk. Further research has to be done to see if alcohol does
indeed present benefits.

2. Grønbæk, M., Deis, A., Becker, U., Hein, H. O., Schnohr, P.,
Jensen, G., . . . Sørensen, T. I. (1998). Alcohol and mortality: is there a
U-shaped relation in elderly people? Age and Ageing,27(6), 739-744.

This study further
investigates the relationship between alcohol, gender and mortality (all-
cause) in middle age and old age. Middle age group was 50-64 years of age. Old
age group was older than 64 years and up. They were classified on number of
drinks per week. Smoking, education and BMI were all taken into account for
proper analysis. Follow up was done ~11 years after initial survey. There is a
U-shaped pattern in both the middle and old age groups, meaning that abstainers
have higher RR of mortality when compared to light or moderate drinkers, but
then RR goes up again with heavy drinking. Overall (regardless of gender or
age), there is a lower RR for light drinkers (1-6 drinks a week) when compared
to non-drinkers. This U shaped pattern is also seen in Colditz et al. (1985).
This study also suggests that we cannot assume major benefits of alcohol and
that people should not be encouraged to start consuming alcohol based on these


3. Paganini-Hill, A., Kawas, C. H., & Corrada, M. M. (2007).
Type of alcohol consumed, changes in intake over time and mortality: the
Leisure World Cohort Study. Age and Ageing, 36(2), 203-209.

This observational study
examined  the impact of alcohol consumption on mortality (all cause) in
elderly populations over a longer period of time (23 year follow up). The
median age in this cohort was ~ 74 years, and the sample was from a retirement
community. Data was collected through surveys, in which they asked # of drinks
(separated by drink type)  and calculated a total amount of alcohol per
week. During the span of 23 years, participants were surveyed about alcohol
consumption twice; information gathered in these surveys established whether
participants were in the non-drinking, stable drinking, started drinking, or
stopped drinking groups. Results show an overall decrease in risk of mortality
in all who consumed alcohol (regardless of quantity) and that drinkers (2 or
more drinks weekly) showed a decreased death risk by 14-16% ( compared to
non-drinking group). Like many other studies (#1 & #2), this study supports
research that shows lowered death risks in drinking individuals. It also
presents an interesting result of women who stopped drinking actually increased
their risk of death… Potential for further research in women or those who stop
drinking in old age.


4. Thun, M. J., Peto, R., Lopez, A. D., Monaco, J. H., Henley, S.
J., Heath, C. W., & Doll, R. (1997). Alcohol Consumption and Mortality
among Middle-Aged and Elderly U.S. Adults. New England Journal of Medicine,
337(24), 1705-1714.

Since previous research has
shown benefits of alcohol on all cause mortality and CHD in elderly, this study
researched the effect of alcohol on specific causes of death in both elderly
and middle aged individuals. Data was collected through surveys of people over
the age of 30  (mean age 56) and were followed for about ~10 years.
Participants were grouped into 3 categories: non-drinkers, >3 drinks a week,
1-6 drinks daily. Results showed that those who consume alcohol have higher
risks of dying from cancers (cancers associated with alcoholism – mouth,
esophagus, liver etc) and cirrhosis than non-drinkers. However, results were
consistent with previous studies indicating benefits of alcohol on
cardiovascular health, such that participants who had 1+ drink daily had a
30% decrease in risk of cardio-related death. They found a lowered risk of
all-cause death in people who drank 1 drink daily; But since moderate alcohol
consumption decreased risk of non-alcoholic death, Thun et al. (1997) suggests
the impact of age and history/background on the ultimate impact of alcohol on
death risk. This warrants more research on alcohol’s impact on other causes of
death and other cancer related deaths. (possible gender differences as well – breast
cancer risks and physical injury)  


5. Streppel, M. T., Ocke, M. C., Boshuizen, H. C., Kok, F. J.,
& Kromhout, D. (2009). Long-term wine consumption is related to
cardiovascular mortality and life expectancy independently of moderate alcohol
intake: the Zutphen Study. Journal of Epidemiology & Community Health,63(7),

This longitudinal study
followed ~1000 men (ages 40-60) in the Netherlands for about 40 years. The goal
was to determine the long term effect of alcohol consumption and effect of type
of alcohol on different types of mortality and life expectancy. Results also
show a U shaped pattern of alcohol consumption and all-cause mortality. It
showed that long term drinkers (consuming both >20g/day or <20g/day) had decreased risk of cardiovascular, cerebrovascular and all cause mortality. However, those who consumed less alcohol (> 20 g/day) had even greater
reduction in mortality risks. Longer life expectancy was seen in men who
consumed alcohol moderately. Wine showed the biggest decrease in mortality risk
(cardiovascular, cerebrovascular, CHD, and all cause mortality) and longer life
expectancy, such that those consuming wine (½ glass) had an additional ~ 5
years when compared to non drinkers. There is need for more research on
protective effect of wine (perhaps because of Polyphenolic compounds in red
wine). This study further supported that low intake of alcohol decreases risk
of mortality, but also provided results about increased life expectancy. It
suggests that some types of alcohol are more beneficial than others.  


6. Holahan,
C. J., Schutte, K. K., Brennan, P. L., North, R. J., Holahan, C. K., Moos, B.
S., & Moos, R. H. (2012). Wine Consumption and 20-Year Mortality Among
Late-Life Moderate Drinkers. Journal of Studies on Alcohol and Drugs, 73(1),

This article further
explores the effect of alcohol on total mortality in the elderly, but isolates
levels of wine consumption and accounts for sociodemographic factors. Sample of
~800 individuals ages 55-65, followed up for 20 years. Participants were placed
into 3 categories: non-drinkers, High wine – moderate (1- 3 drinks per day),
low wine moderate (1-3 drinks per day). High wine consumption = intake of wine
was more than ? of their daily intake. Low wine consumption = wine is less than
? of total alcohol intake. Results showed that more people died in the
abstainer group (69% died) than the wine drinking groups (low wine = 50%
and high wine = 32%). It also showed a reduced risk of death for both high (.59)
and low wine (.67) drinkers compared to non drinkers (high wine groups have a lessened
mortality risk than those who consume less wine). This study further supported
the inverse relationship between moderate drinking and lower mortality risk,
but presents further examination of confounding factors. Those who drank more
wine were confounded to other sociodemographic factors that might explain the
decreased mortality rates in wine drinkers. Further research regarding the
effect of wine compared to other types of alcohol should done.


7.  Holahan, C. J., Schutte, K. K., Brennan, P. L.,
Holahan, C. K., Moos, B. S., & Moos, R. H. (2010). Late-Life Alcohol
Consumption and 20-Year Mortality. Alcoholism: Clinical and Experimental
Research, 34(11), 1961-1971.

This study’s main purpose
was to include possible confounding variables. They specifically addressed the idea
that abstainers might include people who have a history of heavy drinking and
may be influenced by sociodemographic factors. They took a sample of about
1,800 subjects age 55-65 and followed them for 20 years. Initial results
support the U relationship: abstainers and heavy drinkers had the highest
mortality rate and light/moderate drinkers had the lowest mortality rate. However,
when they controlled for other health and social factors this relationship was
much less exaggerated. More closely, abstainers were shown to have more health
problems that are related to increased risk of mortality including: smoking,
obesity, prior drinking history, depression, lower SES. This study therefore
supports the overall consensus that light drinking has an inverse relationship
with mortality risk (moderate drinking = lower risk), but states that the
shocking difference in mortality rates between abstainers and drinkers can be
explained by other variables.


8.  Moore, A. A., Giuli, L., Gould, R., Hu, P., Zhou, K.,
Reuben, D., . . . Karlamangla, A. (2006). Alcohol Use, Comorbidity, and
Mortality. Journal of the American Geriatrics Society, 54(5),

This studies the effect of alcohol
in combination with other illnesses. This is important research because of the
increased health problems and medications in the elderly (Moore et al., 2006). The
study followed ~4600 participants ages 60 + for 20 years. It placed drinking
participants in at-risk or not at risk categories using the Comorbidity–Alcohol
Risk Evaluation Tool, which indicates # of drinks in combination with certain
comorbidities will put a person at an increased risk of death. Results showed
that not-at-risk drinkers had a lower death rate than abstainers, which indicates
the U pattern between alcohol and death risks. However, results showed
different when alcohol was combined with comorbidities Those who were
abstainers and at-risk (those exceeding the drink recommendation for a specific
comorbidity) had much higher death rates than not-at-risk drinkers. This indicates
that alcohol consumption along with presence of health issues can be a deadly
mix, in which death rates can increase due to increase in alcohol intake. Further
research should consider other factors contributing to at-risk drinking in