Functional Limitations, Socioeconomic Status, and All-Cause Mortality in Moderate Alcohol Drinkers

Authors

  • Sei J. Lee MD, MAS,

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of Geriatrics, University of California at San Francisco, San Francisco, California.
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  • Rebecca L. Sudore MD,

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of Geriatrics, University of California at San Francisco, San Francisco, California.
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  • Brie A. Williams MD,

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of Geriatrics, University of California at San Francisco, San Francisco, California.
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  • Karla Lindquist MS,

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of Geriatrics, University of California at San Francisco, San Francisco, California.
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  • Helen L. Chen MD,

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of Geriatrics, University of California at San Francisco, San Francisco, California.
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  • Kenneth E. Covinsky MD, MPH

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of Geriatrics, University of California at San Francisco, San Francisco, California.
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Address correspondence to Sei J. Lee, San Francisco VA Medical Center, Division of Geriatrics, Bldg 1, Room 306, Box 181G, 4150 Clement Street, San Francisco, CA 94121. E-mail: seijlee@gmail.com

Abstract

OBJECTIVES: To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations.

DESIGN: Prospective cohort.

SETTING: The Health and Retirement Study (HRS), a nationally representative study of U.S. adults aged 55 and older.

PARTICIPANTS: Twelve thousand five hundred nineteen participants were enrolled in the 2002 wave of the HRS.

MEASUREMENTS: Participants were asked about their alcohol use, functional limitations (activities of daily living, instrumental activities of daily living, and mobility), SES (education, income, and wealth), psychosocial factors (depressive symptoms, social support, and the importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbidities. Death by December 31, 2006, was the outcome measure.

RESULTS: Moderate drinkers (1 drink/d) had a markedly more-favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking (vs no drinking) was strongly associated with less mortality (odds ratio (OR)=0.50, 95% confidence interval (CI)=0.40–0.62). When traditional risk factors (smoking, obesity, and comorbidities) were also adjusted for, the protective effect was slightly attenuated (OR=0.57, 95% CI=0.46–0.72). When all risk factors including functional status and SES were adjusted for, the protective effect was markedly attenuated but still statistically significant (OR=0.72, 95% CI=0.57–0.91).

CONCLUSION: Moderate drinkers have better risk factor profiles than nondrinkers, including higher SES and fewer functional limitations. Although these factors explain much of the survival advantage associated with moderate alcohol use, moderate drinkers maintain their survival advantage even after adjustment for these factors.

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