Analysis

Does moderate alcohol consumption in later life reduce the risk of mortality? - International Scientific Forum on Alcohol Research Critique 232

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There are well-known problems inherent in most observational studies of alcohol and health. As well as having to rely on self-reporting of intake, these include single-time point consumption assessments, inadequate confounder adjustments, accounting for reverse causation, selection bias, short follow-up, residual confounding and lacking information on chronic health conditions that may mediate the association between alcohol consumption and mortality.

The latest critique from The ISFAR looks at recent research into the effects of alcohol consumption on the chances of mortality in older consumers

The latest critique from The ISFAR looks at recent research into the effects of alcohol consumption on the chances of mortality in older consumers

Further, there have been a lot of assumptions expounded about the generic fragility of older individuals in terms of alcohol consumption; they are generally without supportive clinical or experimental evidence. For light to moderate intake, the elderly tend to have similar benefits associated with alcohol as younger people, and they are at an age when the risk of mortality is at its peak.

A recent study was able to adjust for many of these factors. It describes the risk of total mortality among a large group of older subjects, who were 56 years old at the start of a 16-year follow-up.

The subjects were participants in a nationally-representative cohort of men and women in the US, the Health & Retirement Study. Its strengths, in addition to its large size, is the fact that there were repeated assessments of alcohol so that changes of intake could be evaluated. The authors were also able to judge the potential importance of residual confounding.

The authors conclude that occasional and moderate drinking among older subjects are associated with a lower risk of total mortality. The usual argument that light or moderate drinkers tend to have less severe or fewer common diseases and to enjoy better health and socioeconomic status is addressed in this study, which accounted for time-varying confounders that included smoking, body mass index, income, health/functioning, depression, and chronic diseases.

From quantitative-bias analysis studies, they were able to estimate the effects of residual confounding on their results. The authors conclude that it is very unlikely that residual confounding by unrecorded variables would be the cause of the reduction in mortality associated with moderate drinking. Survival analyses supported notably-decreased mortality for moderate drinkers.

ISFAR members considered that this study adds important information about the effects on mortality of moderate drinking in the elderly.

Despite many decades of observational data, animal experiments and limited clinical trials showing beneficial effects on many diseases and mortality from moderate drinking, it is noted that some researchers appear to be loath to admit to any positive health effects of alcohol. We all appreciate the serious adverse effects of heavy drinking and alcohol use disorders, both on the health of consumers and on the community. However, when well-done analyses provide reliable data for light-to-moderate drinkers who do not binge drink, it is disturbing that, even then, some scientists question the observed beneficial results and appear to focus only on warnings about abuse. 

There is evidence of a preference not to admit to any beneficial effects of alcohol in many papers, including this one, which throughout the text seems to accentuate the negative aspects of alcohol. Such statements detract from an otherwise-clear report suggesting, as one reviewer stated, that this paper is part research results, part polemic.

In the opinion of the ISFAR, this paper provides strong evidence indicating that elderly people who are light-to-moderate drinkers tend to have a lower risk of mortality.

To read the full critique, click here.

These critiques are published with the permission of The International Scientific Forum on Alcohol Research.

Click here for all of the critiques from the International Scientific Forum on Alcohol Research


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