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
Dubbo
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
*
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
*
* *
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
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
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
Nil Low Moderate Heavy
Beer .
* * ns
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
Survival function by predominant alcohol type
Months of follow-up
Wine/spirits Beer
Nil
Low
Moderate
Heavy
Moderate
Low
Heavy
Nil
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
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
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
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
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
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
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
*
Survival free of dementia by alcohol intake
Months of follow-up
Moderate
Nil Low
Heavy
Other Australian studies looking at alcohol intake and survival?
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
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)
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)
• 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