alcohol intake and survival in australian seniors

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In July 2013 A/Prof Leon Simons, Director of the Dubbo Study, presented a plenary lecture at a conference in Sydney entitled “Winehealth 2013”. The presentation was entitled “Alcohol intake and survival in Australian seniors”. This is the slide presentation.

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  • 1.Alcohol intake and survival in Australian seniors: the Dubbo Study www.dubbostudy.org

2. 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 3. Dubbo 4. 22 57 13 8 78 87 13 2.4 4.4 1.8 2.8 52 44 56 0 20 40 60 80 100 Percentageofpopulation Men Women Alcohol questionnaire, based on NHF surveys 5. 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 6. 78 73 17 10 87 13 0 20 40 60 80 100 Any Low Moderate Heavy Beer Wine/spirits Percentageofpopulation 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 7. 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 Percentageofpopulation 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 8. Died 41% vs 47% Bed-days/person 42.8 vs 48.5 Hospitalised 94% vs 93% Hostel 4.7%vs 8.9% Nursing home 6.5%vs 12.6% Any Alcohol n=1779 No Alcohol n=1011 1988-2002 9. Died 41% vs 47% Hospitalised 94% vs 93% Hostel 4.7% vs 8.9% Nursing home 6.5% vs 12.6% Any Alcohol n=1779 No Alcohol n=1011 1988-2002 By 2008: Men 64% vs 72% Women 46% vs 60% 10. 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 * 11. Hazard ratios for death by alcohol intake in Cox models 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 Nil Low Moderate Heavy Men Women . * ns * * * 12. Hazard ratios for death by alcohol intake in Cox models 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 Nil Low Moderate Heavy Men Women All * * ns 13. Hazard ratios for death by alcohol intake in Cox models controlling for predictors or potential confounders 1 0.8 0.72 0.89 0.6 0.7 0.8 0.9 1 1.1 Nil Low Moderate Heavy Variablesin models include: age, sex, marital status,smoking, BMI, diabetes,prior CVD, hypertension,atrial fibrillation,peak exp flow, self-ratedhealth and physical disability * * ns 14. Survival function by alcohol intake (Cox model) Months of follow-up Nil Moderate Heavy Low 15. 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 Nil Low Moderate Heavy Beer . * * ns 16. 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 1 0.85 0.62 0.6 0.7 0.8 0.9 1 1.1 Nil Low Moderate Heavy Beer Wine/spirits * * * * ns ns 17. Survival function by predominant alcohol type Months of follow-up Wine/spiritsBeer Nil Low Moderate Heavy Moderate Low Heavy Nil 18. Nil Low Moderate Heavy 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 Hazard ratios for death by alcohol intake in Cox models controlling for predictors or potential confounders, but adding potential mediators stepwise 19. Nil Low Moderate Heavy 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 Hazard ratios for death by alcohol intake in Cox models controlling for predictors or potential confounders, but adding potential mediators stepwise 20. Nil Low Moderate Heavy 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 Hazard ratios for death by alcohol intake in Cox models controlling for predictors or potential confounders, but adding potential mediators stepwise 21. Nil Low Moderate Heavy 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 Hazard ratios for death by alcohol intake in Cox models controlling for predictors or potential confounders, but adding potential mediators stepwise 22. Nil Low Moderate Heavy 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) Hazard ratios for death by alcohol intake in Cox models controlling for predictors or potential confounders, but adding potential mediators stepwise 23. Survival differences over 20 years (Cox models) 12 12 -50 -40 -30 -20 -10 0 10 20 Alcohol Monthsofsurvival Men Women Simons LA et al. Intern Med J 2011;41:555-560 24. 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 Monthsofsurvival Men Women Simons LA et al. Intern Med J 2011;41:555-560 25. Hazard ratios for DEMENTIA by alcohol intake in Cox models controlling for predictors or potential confounders 1 0.69 0.4 0.67 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Nil Low Moderate Heavy Dementia * ns * 26. Survival free of dementia by alcohol intake Months of follow-up Moderate Nil Low Heavy 27. Other Australian studies looking at alcohol intake and survival? 28. Hazard ratios for death by alcohol intake in Cox models 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 Nil Low Moderate Heavy M+W n=2066 * ns Cullen KJ et al. Am J Epidemiol 1993;137:242-248 n=2066, 40 yrs, mean 57 yrs 29. Hazard ratios for death by alcohol intake in Cox models 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 Nil Low Moderate Heavy Men Men * ns * McCaul KA et al. Addiction 2010;105:1391-1400 (n=11727) 30. Hazard ratios for death by alcohol intake in Cox models 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 Nil Low Moderate Heavy Women Women * ns * McCaul KA et al. Addiction 2010;105:1391-1400 (n=12432) 31. 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 .. 32. 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 33. 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 34. Dubbo Study co-investigators Leon Simons Uni of NSW Australia John McCallum NHMRC & Victoria Uni Judith Simons St Vincents Hosp Australia Yechiel Friedlander Hebrew Uni Israel 2 35. www.dubbostudy.org

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