Moderate Alcohol Use, Health Status, and Mortality in a Prospective Chinese Elderly Cohort

PurposeA U-shaped relation between alcohol use and mortality may be due to biological hormesis, differential response (i.e., effect modification) by health status or changes in alcohol use with ill-health and aging (i.e., reverse causality).We examined whether alcohol had the same association with mortality in healthy and unhealthy older people.MethodsWe used Cox regression analysis to examine the association of alcohol with mortality by health status in a population-based cohort of 56,167 people (65+ years), enrolled during July 1998 to December 2000 in Hong Kong.ResultsAfter a mean follow-up of 4.1 years, there were 3,819 deaths in 54,087 subjects. Adjusted for age, socioeconomic position and lifestyle, both occasional and moderate types of alcohol use were associated with lower mortality compared to never-drinkers, relative risk (RR) 0.72 (95% confidence interval [CI] 0.63–0.83) and 0.73 (95% CI 0.59–0.90) in men and 0.77 (95% CI 0.64–0.94) and 0.54 (95% CI 0.29–1.01) in women. However, these associations were not maintained in those with good health status: RR 1.02 (95% CI 0.74–1.39) and 1.09 (95% CI 0.71–1.68) in men and 0.63 (95% CI 0.36–1.12) and 1.27 (95% CI 0.40–4.01) in women.ConclusionsModerate alcohol use may only be beneficial for older adults in poor health.