Alcohol abstinence and mortality in a general population sample of adults in Germany: A cohort study
Evidence suggests that people who abstain from alcohol have a higher mortality rate than those who consume low to moderate amounts of alcohol. However, little is known about factors that might be causal for this finding.
The objective of this study was to analyze former alcohol or other drug use disorders, high-risk alcohol use, tobacco smoking, and fair to poor health among persons who reported abstinence from alcohol use in the last 12 months before baseline in relation to total, cardiovascular, and cancer mortality 20 years later.
A sample of residents aged 18 to 64 years had been drawn at random among the general population in northern Germany and a standardized interview conducted in the years 1996 to 1997. The baseline assessment included 4,093 persons (70.2% of those who had been eligible). Vital status and death certificate data were retrieved in the years 2017 and 2018.
The researchers found that among the alcohol-abstinent study participants at baseline (447), there were 405 (90.60%) former alcohol consumers.
- Of the abstainers, 322 (72.04%) had met one or more criteria for former alcohol or other drug dependence or abuse, alcohol high-risk consumption, or had tried to cut down or to stop consuming alcohol, were daily smokers, or self-rated their health as fair to poor.
- Among the abstainers with one or more of these risk factors, 114 (35.40%) had an alcohol use disorder or high-risk alcohol consumption in their history.
- Another 161 (50.00%) did not have such an alcohol-related risk but were daily smokers.
The 322 alcohol-abstinent study participants with one or more of the risk factors had a shorter time to death than those with low to moderate alcohol consumption.
The Cox proportional hazard ratio (HR) was 2.44 for persons who had one or more criteria for an alcohol or other drug use disorder fulfilled in their history and after adjustment for age and sex.
The 125 alcohol-abstinent persons without these risk factors (27.96% of the abstainers) did not show a statistically significant difference from low to moderate alcohol consumers in total, cardiovascular, and cancer mortality.
Those who had stayed alcohol abstinent throughout their life before (42; 9.40% of the alcohol-abstinent study participants at baseline) had an HR 1.64 compared to low to moderate alcohol consumers after adjustment for age, sex, and tobacco smoking.
Main limitations of this study include its reliance on self-reported data at baseline and the fact that only tobacco smoking was analyzed as a risky behavior alongside alcohol consumption.
The majority of the alcohol abstainers at baseline were former alcohol consumers and had risk factors that increased the likelihood of early death. Former alcohol use disorders, high-risk alcohol consumption, ever having smoked tobacco daily, and fair to poor health were associated with early death among alcohol abstainers.
Those without an obvious history of these risk factors had a life expectancy similar to that of low to moderate alcohol consumers.
The findings speak against recommendations to drink alcohol for health reasons.
- According to evidence, alcohol abstinence seems to be associated with a lower life expectancy than low to moderate alcohol consumption.
- Individuals who abstain from alcohol might include those who have risk factors that can be reasons for the shorter life expectancy compared to low to moderate alcohol consumers.
What do these findings mean?
- Former alcohol use disorders, high-risk consumption, efforts to cut down on alcohol intake, ever daily tobacco smoking, and fair to poor health may predict early death among alcohol abstainers.
- Healthy alcohol abstainers who have no alcohol- or tobacco-related risk factors may not have a higher mortality than low to moderate alcohol consumers.
- The findings speak against recommendations to consume alcohol for health reasons.
- 91% of the alcohol abstainers at first contact had consumed alcohol in life before.
- 72% of the alcohol abstainers had a history of one or more criteria of a former alcohol or other drug use disorder, former high-risk alcohol consumption, efforts to cut down or to stop consuming alcohol, daily tobacco smoking, or fair to poor health.
- In terms of mortality rate, no statistically significant difference was apparent between alcohol abstinent persons without these risk factors and who had self-rated their health as good to excellent and persons who consumed low to moderate amounts of alcohol.
The results support the view that people in the general population who currently are abstinent from alcohol do not necessarily have a shorter survival time than the population with low to moderate alcohol consumption. Increased mortality risks among abstainers might largely be explained by previous alcohol or drug problems, risky drinking, daily smoking, and self-rated health as fair to poor. The findings speak against recommendations to drink alcohol for health reasons.”John U, Rumpf H-J, Hanke M, Meyer C (2021) Alcohol abstinence and mortality in a general population sample of adults in Germany: A cohort study. PLoS Med 18(11): e1003819. https://doi.org/10.1371/journal.pmed.1003819
Ultimately, the problem in previous studies was in the definition of abstainers. Previous studies grouped all abstainers together, but there are subgroups within abstainers as well. This mistake is what has led to previous findings showing health protective factors of low-dose alcohol use. New research which adjusts for confounders show that there are no health protection or longevity from low-dose alcohol use.
This new study found that abstainers who previously had an alcohol use disorder or other risk factors such as tobacco use, and fair to poor health had a shorter lifespan comparative to those who had low-dose alcohol use. However, when lifetime abstainers with no previous risk factors and good health are compared with those who had low-dose alcohol use there was no significant difference in mortality. Meaning low-dose alcohol use offers no health protection and has nothing to do with longevity.
Our findings add one piece to the growing evidence that low to moderate alcohol drinking should not be recommended for health reasons,” said Prof. Dr. Ulrich John, lead author of the study, as per Medical News Today.
Prof. Dr. Ulrich John, lead author of the study
U.S. News: “Think a Little Alcohol Might Be Healthy? Think Again“
Medical News Today: “Moderate alcohol consumption ‘should not be recommended for health reasons’”