Key takeaways:
- People who previously drank alcohol face a higher mortality risk until they have stopped drinking for 20 years.
- Two researchers told Healio about their findings and what primary care clinicians should know.
New research has challenged the idea that alcohol consumption confers health benefits, instead suggesting it may be worse for overall health.
Additionally, findings suggest that a higher mortality risk associated with alcohol use will continue until one has stopped drinking for 20 years.
Previous studies have suggested a J-shaped association between health outcomes and alcohol consumption, suggesting that light-to-moderate drinking possibly reduces the risk for mortality and cardiovascular diseases. But researchers pointed to a growing body of evidence that contradicts that hypothesis and instead indicates that no amount of alcohol consumption improves health outcomes.
Researchers wrote in the American Journal of Preventive Medicine that “it is critical to investigate whether people who drank alcohol in the past are indeed at higher risk of healthy disadvantages.”
To explore the issue further, they analyzed data from a longitudinal study of 31,999 older adults who drank alcohol in the past with varying durations of alcohol abstention.
Healio spoke with two of the researchers — Ziqiong Wang, MD, PhD, and Sen He, MD, PhD, both affiliated with West China Hospital of Sichuan University — to learn more about the study’s implications, what primary care providers should take away from the findings and more.
Healio: Will you briefly describe your study’s findings and their importance?
He: The findings of our study showed, in older people, the risk of all-cause mortality significantly increased in former drinkers when compared with current drinkers or lifetime abstainers, and the increased risk was sustained for 20 years post abstention, at which point it disappears. Therefore, misclassification of former drinkers might cause the divergent conclusions about the beneficial effects of light-to-moderate alcohol drinking in older people, which could have inappropriate implications for global public health policymaking about alcohol intake.
Healio: What are the implications of your study?
He: To avoid false conclusions about drinking, former drinkers should be classified accurately in future cohort studies that explore the net health benefits of alcohol drinking. The duration of alcohol abstention, ie, 20 years, may be an important cut-point for accurate classification of former drinkers. Whether this is a chance finding or not needs further exploration.
Healio: What is the take-home message for primary care clinicians?
He: One important explanation for the association between alcohol abstention and mortality is that former drinkers have often stopped drinking due to health concerns, which increases mortality risk. Indeed, the present study suggested the prevalence of multiple diseases were relatively higher in former drinkers than both current drinkers and lifetime abstainers, which is in agreement with some previous studies. Therefore, former drinkers are potential sick quitters, who have a higher risk of adverse health outcomes.
Because alcohol abstention was associated with increased mortality risk within 20 years of abstention, primary care clinicians should focus on a detailed reassessment of physical conditions for those recent abstainers, further performing appropriate interventions to avoid the increased risk of adverse health outcomes.
In addition, we should be cautious about the idea that light-to moderate alcohol drinking contributes to health benefits. If individuals are lifetime abstainers, there is no need to advocate light-to-moderate alcohol drinking. Also, if individuals with a healthy status plan to quit drinking alcohol voluntarily, clinicians should not discourage this behavior.
Healio: Is there anything else you would like to add?
Wang: The present study also found that there were no significant differences regarding the mortality risk between current drinkers and lifetime abstainers, which might underestimate the risks associated with drinking alcohol. Unfortunately, different levels of alcohol consumption among the study participants were not available. Comparing the mortality risk between subjects with different levels of alcohol consumption and lifetime abstainers would provide additional useful information, while acknowledging the adverse effects of heavy alcohol consumption have been well recognized. Furthermore, ‘healthy drinker/survivor’ bias might also partially explain this phenomenon, especially for older participants. That is, current drinkers in the present study cohort tend to be healthier and attain a longer lifespan by virtue of avoiding premature death due to the adverse impact of alcohol consumption.
