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Title: Changes in health status predict changes in alcohol consumption in older adults: the Seniors-ENRICA cohort

Author
item ORTOLA, ROSARIO - Autonomous University Of Madrid
item GARCIA-ESQUINAS, ESTHER - Autonomous University Of Madrid
item SOLER-VILA, HOSANNA - Autonomous University Of Madrid
item ORDOVAS, JOSE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item LOPEZ-GARCIA, ESTHER - Autonomous University Of Madrid
item RODRIGUEZ-ARTALEJO, FERNANDO - Autonomous University Of Madrid

Submitted to: Journal of Epidemiology and Community Health
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/17/2018
Publication Date: 10/30/2018
Citation: Ortola, R., Garcia-Esquinas, E., Soler-Vila, H., Ordovas, J.M., Lopez-Garcia, E., Rodriguez-Artalejo, F. 2018. Changes in health status predict changes in alcohol consumption in older adults: the Seniors-ENRICA cohort. Journal of Epidemiology and Community Health. 73(2):123-129. https://doi.org/10.1136/jech-2018-211104.
DOI: https://doi.org/10.1136/jech-2018-211104

Interpretive Summary: Moderate alcohol consumption has been associated with positive health outcomes; however, it is possible that a healthy status may influence moderate consumption rather than the opposite. Our objective was to examine whether health status changes influence changes in alcohol consumption, cessation included. We used data from 571 current drinkers aged 60 years or older participating in the Seniors-ENRICA cohort. Participants were recruited in 2008-2010 and followed-up for 8.2 years, with four waves of data collection. Health status was assessed using a deficit accumulation index. To minimize reverse causation, we examined how changes in health status over a 3-year period (wave 0-wave 1) influenced changes in alcohol consumption over the subsequent 5 years (waves 1-3). Our data shows that, compared with participants in the lowest tertile of deficit accumulation change, those in the highest tertile showed a reduction in alcohol intake and were more likely to quit alcohol. The main contributors to decreasing drinking were increased functional impairment and poorer self-rated health, whereas worsening self-rated health, onset of diabetes or stroke and increased prevalence of hospitalization influenced cessation. In conclusion, health deterioration is related to a subsequent reduction and cessation of alcohol consumption contributing to the growing evidence challenging the protective health effect previously attributed to low-to-moderate alcohol consumption.

Technical Abstract: BACKGROUND: Some of the previously reported health benefits of low-to-moderate alcohol consumption may derive from health status influencing alcohol consumption rather than the opposite. We examined whether health status changes influence changes in alcohol consumption, cessation included. METHODS: Data came from 571 current drinkers aged 60 years or older participating in the Seniors-ENRICA cohort in Spain. Participants were recruited in 2008-2010 and followed-up for 8.2 years, with four waves of data collection. We assessed health status using a 52-item deficit accumulation (DA) index with four domains: functional, self-rated health and vitality, mental health, and morbidity and health services use. To minimise reverse causation, we examined how changes in health status over a 3-year period (wave 0-wave 1) influenced changes in alcohol consumption over the subsequent 5 years (waves 1-3) using linear/logistic regression, as appropriate. RESULTS: Compared with participants in the lowest tertile of DA change (mean absolute 4.3% health improvement), those in the highest tertile (7.8% worsening) showed a reduction in alcohol intake (beta: -4.32 grams per day; 95% CI -7.00 to -1.62; p trend=0.002) and were more likely to quit alcohol (OR: 2.80; 95% CI 1.54 to 5.08; p trend=0.001). The main contributors to decreasing drinking were increased functional impairment and poorer self-rated health, whereas worsening self-rated health, onset of diabetes or stroke and increased prevalence of hospitalization influenced cessation. CONCLUSIONS: Health deterioration is related to a subsequent reduction and cessation of alcohol consumption contributing to the growing evidence challenging the protective health effect previously attributed to low-to-moderate alcohol consumption.