title: Alcohol use, comorbidity, and mortality.
abstract: OBJECTIVE
  To examine the combined influence of alcohol use and comorbidity on 20-year mortality in older adults (average age 66 at the time of the baseline survey).
  
  
  METHODS
  Longitudinal analysis of a national probability sample-based cohort study.
  
  
  METHODS
  Data sources were the National Health and Nutrition Examination Survey I (NHANES I), 1971-1974, and the NHANES Epidemiologic Followup Survey, 1992.
  
  
  METHODS
  Four thousand six hundred ninety-one adults aged 60 and older who provided data on alcohol use.
  
  
  METHODS
  The prevalence of at-risk drinking in older adults in the United States and the 20-year all-cause mortality risk associated with it. At-risk drinking status was determined from amount of alcohol consumed and comorbidities, using a previously validated method.
  
  
  RESULTS
  The prevalence of at-risk drinking in the United States between 1971 and 1974 in older adults was 10% (18% of men, 5% of women). The majority of at-risk drinkers were identified as such because of their use of alcohol in amounts deemed risky in the presence of relevant comorbidities (69%) (e.g., drinking 2-3 drinks per day and having gout or anxiety or taking a medication for pain). In men, at-risk drinking was associated with higher mortality rates than not-at-risk drinking (hazard ratio=1.20, 95% confidence interval=1.01-1.41); abstinence was not associated with greater mortality. In women, neither abstinence nor at-risk drinking was associated with greater mortality rates.
  
  
  CONCLUSIONS
  In this first, large population-based study of older adults examining the mortality risks of alcohol use and comorbidity, at-risk drinking was associated with greater mortality rates in men. These findings suggest that a lower threshold of alcohol use should be recommended for older adults with specific comorbidities to reduce mortality risks.
authors.affiliation: Department of Medicine, Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, 10945 Le Conte Avenue, Los Angeles, CA 90095, USA. aamoore@mednet.ucla.edu
authors.forename: Alison A
authors.initials: AA
authors.lastname: Moore
authors.forename: Lisa
authors.initials: L
authors.lastname: Giuli
authors.forename: Robert
authors.initials: R
authors.lastname: Gould
authors.forename: Peifeng
authors.initials: P
authors.lastname: Hu
authors.forename: Kefei
authors.initials: K
authors.lastname: Zhou
authors.forename: David
authors.initials: D
authors.lastname: Reuben
authors.forename: Gail
authors.initials: G
authors.lastname: Greendale
authors.forename: Arun
authors.initials: A
authors.lastname: Karlamangla
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012309:Risk-Taking; D012959:Socioeconomic Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology