Skip to main content

Moderate Alcohol Consumption and the Risk of Mortality

Abstract

There has been a growing consensus that moderate consumption of alcohol is associated with a lower risk of mortality and that this association is probably causal. However, a recent review article has raised a serious challenge to this consensus. In short, it determined that most prior research in this area committed serious misclassification errors; furthermore, among those studies that were free of these misclassification errors, no support for a protective role of alcohol consumption was found. This article reexamines the issue using prospective data for more than 124,000 persons interviewed in the U.S. National Health Interview Surveys of 1997 through 2000 with mortality follow-up through 2002 using the Linked Mortality File. The study involves about 488,000 person-years. Controlling for a variety of covariates, this study finds that compared with nondrinkers, those who consume a moderate amount of alcohol have lower all-cause and CHD mortality. The fact that the current study has taken care to avoid the pitfalls of some earlier studies and still finds that those who consume a moderate amount of alcohol have lower all-cause mortality and CHD mortality lends credence to the argument that the relationship is causal.

This is a preview of subscription content, access via your institution.

Notes

  1. I use the restricted-use data set. There is a corresponding public-use data set. With the public-use data set, an analyst can obtain the data set to be analyzed at his or her own institution. Owing to confidentiality concerns, however, there are some disadvantages to using the public-use data set. First, the NCHS used “standard data perturbation techniques that introduce statistical noise into the data set” (Lochner et al. 2007:2). Second, “synthetic data were substituted for the actual date and underlying cause-of-death data for selected decedent records” (Lochner et al. 2007:2). Third, while the restricted-use data set reports date of death, the public-use data set reports quarter of death. Given the limitations of the public-use data set, I opted to use the restricted-use data set. For more details, see Lochner et al. (2007).

  2. Not all families reported their income. To deal with missing data, the National Center for Health Statistics (NCHS) used multiple-imputation methodology to create five imputed estimates of family income for each family. As recommended in NCHS documentation, each of the analyses reported in this article was replicated five times, once using each imputation of family income, and the results were then combined. More details are provided by NCHS at http://www.cdc.gov/nchs/about/major/nhis/2000imputedincome.htm and the Technical Documentation linked to that site.

  3. These are found in the document titled “Underlying and Multiple Causes of Death September 2006” located at http://www.cdc.gov/nchs/data/datalinkage/h1_underlying_and_multiple_causes_of_death.pdf.

  4. Former drinkers who rarely binge drink are the same group as all former drinkers; however, the comparison groups are different (i.e., occasional moderate who rarely binge drink versus all occasional moderate binge drinkers).

References

  • Agarwal, D. P. (2002). Cardioprotective effects of light-moderate consumption of alcohol: A review of putative mechanisms. Alcohol & Alcoholism, 37, 409–415.

    Article  Google Scholar 

  • Benjamins, M. R., Hummer, R. A., Eberstein, I. W., & Nam, C. B. (2004). Self-reported health and adult mortality: An analysis of cause-specific mortality. Social Science and Medicine, 59, 1297–1306.

    Article  Google Scholar 

  • Bovet, P., & Paccaud, F. (2001). Commentary: Alcohol, coronary heart disease and public health: Which evidence-based policy? International Journal of Epidemiology, 30, 734–737.

    Article  Google Scholar 

  • Emberson, J. R., Shaper, A. G., Wannamethee, S. G., Morris, R. W., & Whincup, P. H. (2005). Alcohol intake in middle age and risk of cardiovascular disease and mortality: Accounting for intake variation over time. American Journal of Epidemiology, 161, 856–863.

    Article  Google Scholar 

  • Fillmore, K. M., Kerr, W. C., Stockwell, T., Chikritzhs, T., & Bostrom, A. (2006). Moderate alcohol use and reduced mortality risk: Systematic error in prospective studies. Addiction Research and Theory, 14, 101–132.

    Article  Google Scholar 

  • Fraser, G. E. (1999). Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. American Journal of Clinical Nutrition, 70(Suppl), 532S–538S.

    Google Scholar 

  • Hines, L. M., Stamper, M. J., Ma, J., Gaziano, J. M., Ridker, P. M., Hankinson, S. E.… Hunter, D. J. (2001). Genetic variation in alcohol dehydrogenase and the beneficial effect of moderate alcohol consumption on myocardial infarction. New England Journal of Medicine, 344, 549–555.

    Google Scholar 

  • Idler, E. L., & Benyamani, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21–37.

    Article  Google Scholar 

  • Kent, L. M., & Worsley, A. (2008). Does the prescriptive lifestyle of Seventh-day Adventists provide “immunity” from the secular effects of changes in BMI? Public Health Nutrition, 12(4), 472–480.

    Article  Google Scholar 

  • Klatsky, A. L. (2001). Commentary: Could abstinence from alcohol be hazardous to your health? International Journal of Epidemiology, 30, 739–742.

    Article  Google Scholar 

  • Lang, I., Guralnik, J., Wallace, R. B., & Melzer, D. (2006). What level of alcohol consumption is hazardous for older people? Functioning and mortality in U.S. and English national cohorts. Journal of the American Geriatric Society, 55, 49–57.

    Article  Google Scholar 

  • Liao, Y., McGee, D. L., Cao, G., & Cooper, R. S. (2000). Alcohol intake and mortality: Findings from the National Health Interview Surveys (1988 and 1990). American Journal of Epidemiology, 151, 651–659.

    Google Scholar 

  • Lochner, K. A., Hummer, R. A., & Cox, C. S. (2007). Comparative analysis of the public-use and restricted-use NHIS linked mortality files. Hyattsville, MD: National Center for Health Statistics.

    Google Scholar 

  • Marmot, M. G. (1984). Alcohol and coronary heart disease. International Journal of Epidemiology, 13, 160–167.

    Article  Google Scholar 

  • Marmot, M. G. (2001). Commentary: Reflections on alcohol and coronary heart disease. International Journal of Epidemiology, 30, 729–734.

    Article  Google Scholar 

  • Marmot, M. G., Rose, G., Shipley, M. J., & Thomas, B. J. (1981). Alcohol and mortality: The U-shaped curve. Lancet, 1, 580–583.

    Article  Google Scholar 

  • Minugh, P. A. (1998). Gender, health beliefs, health behaviors, and alcohol consumption. American Journal of Drug and Alcohol Abuse, 24, 483–497.

    Article  Google Scholar 

  • Mokdad, M. J., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. Journal of the American Medical Association, 291, 1238–1245.

    Article  Google Scholar 

  • Mossey, J. M., & Shapiro, E. (1982). Self-rated health: A predictor of mortality among the elderly. American Journal of Public Health, 72, 800–808.

    Article  Google Scholar 

  • National Center for Health Statistics (NCHS). (2003). 2002 National Health Interview Survey (NHIS). NHIS Survey Description. Hyattsville, MD: NCHS.

    Google Scholar 

  • 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, 203–209.

    Article  Google Scholar 

  • Pearl, R. (1926). Alcohol and longevity. New York: Alfred A Knopf.

    Google Scholar 

  • Rimm, E. (2001). Commentary: Alcohol and coronary heart disease–laying the foundation for future work. International Journal of Epidemiology, 30, 738–739.

    Article  Google Scholar 

  • Rimm, E. B., Klatsky, A., Grobbee, D., & Stampfer, M. J. (1996). Review of moderate alcohol consumption and reduced risk of coronary heart disease: Is the effect due to beer, wine or spirits. British Medical Journal, 312, 731–736.

    Google Scholar 

  • Rogers, R. G., Hummer, R. A., & Nam, C. B. (2000). Living and dying in the USA. New York: Academic Press.

    Google Scholar 

  • Shaper, A. G., Wannamethee, G., & Walker, M. (1988). Alcohol and mortality in British men: Explaining the U-shaped curve. Lancet, 2, 1267–1273.

    Article  Google Scholar 

  • Thun, M. J., Peto, R., Lopez, A. D., Monaco, J. H., Henley, S. J., Clark, J.… Doll, R. (1997). Alcohol consumption and mortality among middle-aged and elderly U.S. adults. New England Journal of Medicine, 337\, 1705–1714

    Google Scholar 

  • Yamaguchi, K. (1991). Event history analysis. Newbury Park, CA: Sage.

    Google Scholar 

Download references

Acknowledgment

I would like to thank Margaret Gaines for computational assistance on this paper.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Theodore D. Fuller.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fuller, T.D. Moderate Alcohol Consumption and the Risk of Mortality. Demography 48, 1105–1125 (2011). https://doi.org/10.1007/s13524-011-0035-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13524-011-0035-2

Keywords

  • Alcohol consumption
  • Mortality
  • Coronary heart disease mortality
  • Sex differences