Alcohol intake and survival in Australian seniors

Alcohol intake and survival

in Australian seniors:

the Dubbo Study

www.dubbostudy.org

• Longitudinal cohort study of healthy

ageing

• 2805 non-institutionalised senior citizens

60+ years, born before 1930, mean age 69

years

• There were 1233 men and 1572 women,

73% of the eligible population in the LGA

• 66% of men & 53% of women died during

20 years of follow-up from 1988

Dubbo 1905

22

57

13 8

78 87

13

2.4 4.4 1.8 2.8

52 44

56

0

20

40

60

80

100

Perc

enta

ge o

f p

op

ula

tio

n Men Women

Alcohol questionnaire, based on NHF surveys

Derived alcohol intake

Low Moderate Heavy

Men 1-14/w 15-24/w 25+/w

Women 1-7/w 8-14/w 15+/w

Nil or …

78 73

17 10

87

13

0

20

40

60

80

100

Any Low Moderate Heavy Beer Wine/spirits

Perc

en

tage

of

po

pu

lati

on

Men Column1

Low Moderate Heavy Men 1-14/w 15-24/w 25+/w Women 1-7/w 8-14/w 15+/w

Pattern of alcohol intake

78 73

17 10

87

13

52

71

25

4

44

56

0

20

40

60

80

100

Any Low Moderate Heavy Beer Wine/spirits

Perc

en

tage

of

po

pu

lati

on

Men Women

Low Moderate Heavy Men 1-14/w 15-24/w 25+/w Women 1-7/w 8-14/w 15+/w

Pattern of alcohol intake

Died41% vs 47%

Bed-days/person42.8 vs 48.5

Hospitalised94% vs 93%

Hostel4.7% vs 8.9%

Nursing home6.5% vs 12.6%

Any Alcoholn=1779

No Alcoholn=1011

1988-2002

Died41% vs 47%

Hospitalised94% vs 93%

Hostel4.7% vs 8.9%

Nursing home6.5% vs 12.6%

Any Alcoholn=1779

No Alcoholn=1011

1988-2002

By 2008:

Men 64% vs 72%

Women 46% vs 60%

Hazard ratios for death by alcohol intake in Cox models

controlling for age

1

0.82

0.88

1.08

0.6

0.7

0.8

0.9

1

1.1

Nil Low Moderate Heavy

Men . .2

*

ns

*


controlling for age

1

0.82

0.88

1.08

1

0.73

0.66

1.1

0.6

0.7

0.8

0.9

1

1.1


Men Women .

*

ns

*

* *


controlling for age (and sex in “all subjects" model)

1

0.82

0.88

1.08

1

0.73

0.66

1.1

1

0.76 0.75

1.06

0.6

0.7

0.8

0.9

1

1.1


Men Women All

* *

ns


controlling for predictors or potential confounders

1

0.8

0.72

0.89

0.6

0.7

0.8

0.9

1

1.1


Variables in models include: age, sex, marital status, smoking, BMI, diabetes, prior CVD, hypertension, atrial fibrillation, peak exp flow, self-rated health and physical disability

* * ns

Survival function by alcohol intake (Cox model)

Months of follow-up

Nil

Moderate

Heavy

Low

Hazard ratios for death by alcohol intake and type in Cox

models controlling for predictors or potential confounders

1

0.77 0.77

0.84

0.6

0.7

0.8

0.9

1

1.1


Beer .

* * ns

Hazard ratios for death by alcohol intake and type in Cox


1

0.77 0.77

0.84

1

0.85

0.62

0.6

0.7

0.8

0.9

1

1.1


Beer Wine/spirits

* * *

* ns

ns

Survival function by predominant alcohol type

Months of follow-up

Wine/spirits Beer

Nil

Low

Moderate

Heavy

Moderate

Low

Heavy

Nil


Base model 1.00 0.79(0.70-0.89) 0.71(0.60-0.85) 0.91(0.71-1.15)

Diabetes

Hypertension

Body Mass Index

HDL-Cholesterol


controlling for predictors or potential confounders, but

adding potential mediators stepwise


Base model 1.00 0.79(0.70-0.89) 0.71(0.60-0.85) 0.91(0.71-1.15)

Diabetes 1.00 0.81(0.72-0.90) 0.73(0.61-0.86) 0.92(0.72-1.17)

Hypertension

Body Mass Index

HDL-Cholesterol





Base model 1.00 0.79(0.70-0.89) 0.71(0.60-0.85) 0.91(0.71-1.15)

Diabetes 1.00 0.81(0.72-0.90) 0.73(0.61-0.86) 0.92(0.72-1.17)

Hypertension 1.00 0.80(0.71-0.90) 0.72(0.61-0.85) 0.90(0.71-1.14)

Body Mass Index

HDL-Cholesterol





Base model 1.00 0.79(0.70-0.89) 0.71(0.60-0.85) 0.91(0.71-1.15)

Diabetes 1.00 0.81(0.72-0.90) 0.73(0.61-0.86) 0.92(0.72-1.17)

Hypertension 1.00 0.80(0.71-0.90) 0.72(0.61-0.85) 0.90(0.71-1.14)

Body Mass Index 1.00 0.80(0.72-0.90) 0.72(0.61-0.85) 0.89(0.70-1.14)

HDL-Cholesterol





Base model 1.00 0.79(0.70-0.89) 0.71(0.60-0.85) 0.91(0.71-1.15)

Diabetes 1.00 0.81(0.72-0.90) 0.73(0.61-0.86) 0.92(0.72-1.17)

Hypertension 1.00 0.80(0.71-0.90) 0.72(0.61-0.85) 0.90(0.71-1.14)

Body Mass Index 1.00 0.80(0.72-0.90) 0.72(0.61-0.85) 0.89(0.70-1.14)

HDL-Cholesterol 1.00 0.80(0.72-0.90) 0.73(0.61-0.87) 0.91(0.71-1.16)




Survival differences over 20 years (Cox models)

12 12

-50

-40

-30

-20

-10

0

10

20

Alcohol

Mo

nth

s o

f s

urv

iva

l

Men Women

Simons LA et al. Intern Med J 2011;41:555-560

Survival differences over 20 years (Cox models)

12

-41

-20 -20 -20

12

-25

-17

-30

-25

-50

-40

-30

-20

-10

0

10

20

Alcohol Smoking HiBP Diabetes AF

Mo

nth

s o

f s

urv

iva

l

Men Women

Simons LA et al. Intern Med J 2011;41:555-560

Hazard ratios for DEMENTIA by alcohol intake in Cox


1

0.69

0.4

0.67

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1


Dementia

* ns

*

Survival free of dementia by alcohol intake

Months of follow-up

Moderate

Nil Low

Heavy

Other Australian studies looking at alcohol intake and survival?


controlling for standard CVD risk factors in men and women

of Busselton, WA: 23 years follow-up to 1989

1

0.91

0.76

0.6

0.7

0.8

0.9

1

1.1


M+W n=2066

* ns

Cullen KJ et al. Am J Epidemiol 1993;137:242-248

n=2066, ≥40 yrs, mean 57 yrs


controlling for age and smoking – HIMS cohort 65-79 years:

10 years follow-up to 2006

1

0.78 0.83

1.3

0.6

0.7

0.8

0.9

1

1.1

1.2

1.3


Men

Men

*

ns

*

McCaul KA et al. Addiction 2010;105:1391-1400

(n=11727)


controlling for smoking – ALSWH cohort 70-75 years:

10 years follow-up to 2006

1

0.78 0.78

0.86

0.4

0.5

0.6

0.7

0.8

0.9

1

1.1


Women

Women

* ns

*

McCaul KA et al. Addiction 2010;105:1391-1400

(n=12432)

• Amongst Australian senior citizens in 1988, 78% of

men and 52% of women reported some alcohol intake

• Most men reported an intake of 1-14 drinks/week,

most women 1-7 drinks/week

• 87% of male drinkers predominantly consumed beer,

44% of female drinkers predominantly consumed beer

(the balances consumed wine or spirits)

To sum up …..

• Over 20 years to 2008, 64% of male drinkers died vs

72% of non-drinkers; 46% of female drinkers died vs

60% of non-drinkers

• This relationship did not appear to be

impacted/mediated by diabetes, hypertension,

obesity or HDL-cholesterol

• Any alcohol intake (vs nil) added 12 months survival

time in men and women over 20 years follow-up

• All-cause mortality was related to the quantity of alcohol

intake in the usual “U-shaped” relationship. This

relationship was similar with all drink types

• Alcohol intake offered strong protection against dementia

in a “U-shaped” relationship

• The Dubbo survival experience re alcohol intake is not

unique, but our findings are applicable to a group of non-

institutionalised senior citizens, 60+ years at study entry,

and a “healthy survivor” effect may be partially operating

Dubbo Study co-investigators

Leon Simons

Uni of NSW

Australia

John McCallum

NHMRC &

Victoria Uni

Judith Simons

St Vincent’s Hosp

Australia

Yechiel Friedlander

Hebrew Uni

Israel

2

www.dubbostudy.org

Alcohol intake and survival in Australian seniors

Health & Medicine

Transcript of Alcohol intake and survival in Australian seniors