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BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Are psychosocial stressors associated with the relationship of alcohol consumption and all-cause mortality?

Authors: Esther Ruf, Jens Baumert, Christa Meisinger, Angela Döring, Karl-Heinz Ladwig, for the MONICA/KORA investigators

Published in: BMC Public Health | Issue 1/2014

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Abstract

Background

Several studies have shown a protective association of moderate alcohol intake with mortality. However, it remains unclear whether this relationship could be due to misclassification confounding. As psychosocial stressors are among those factors that have not been sufficiently controlled for, we assessed whether they may confound the relationship between alcohol consumption and all-cause mortality.

Methods

Three cross-sectional MONICA surveys (conducted 1984–1995) including 11,282 subjects aged 25–74 years were followed up within the framework of KORA (Cooperative Health Research in the Region of Augsburg), a population-based cohort, until 2002. The prevalences of diseases as well as of lifestyle, clinical and psychosocial variables were compared in different alcohol consumption categories. To assess all-cause mortality risks, hazard ratios (HRs) were estimated by Cox proportional hazards models which included lifestyle, clinical and psychosocial variables.

Results

Diseases were more prevalent among non-drinkers than among drinkers: Moreover, non-drinkers showed a higher percentage of an unfavourable lifestyle and were more affected with psychosocial stressors at baseline. Multivariable-adjusted HRs for moderate alcohol consumption versus no consumption were 0.74 (95% confidence interval (CI): 0.58-0.94) in men and 0.87 (95% CI: 0.66-1.16) in women. In men, moderate drinkers had a significantly lower all-cause mortality risk than non-drinkers or heavy drinkers (p = 0.002) even after multivariable adjustment. In women, moderate alcohol consumption was not associated with lowered risk of death from all causes.

Conclusions

The present study confirmed the impact of sick quitters on mortality risk, but failed to show that the association between alcohol consumption and mortality is confounded by psychosocial stressors.
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Literature
1.
Keil U, Chambless LE, Doring A, Filipiak B, Stieber J: The relation of alcohol intake to coronary heart disease and all-cause mortality in a beer-drinking population. Epidemiology. 1997, 8: 150-156. 10.1097/00001648-199703000-00005.CrossRefPubMed
2.
Rehm J, Baliunas D, Borges GL, Graham K, Irving H, Kehoe T, Parry CD, Patra J, Popova S, Poznyak V, Roerecke M, Room R, Samokhvalov AV, Taylor B: The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction. 2010, 105: 817-843. 10.1111/j.1360-0443.2010.02899.x.CrossRefPubMedPubMedCentral
3.
Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA: Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011, 342: d671-10.1136/bmj.d671.CrossRefPubMedPubMedCentral
4.
Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G: Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006, 166: 2437-2445. 10.1001/archinte.166.22.2437.CrossRefPubMed
5.
Rehm J, Gmel G, Sempos CT, Trevisan M: Alcohol-related morbidity and mortality. Alcohol Res Health. 2003, 27: 39-51.PubMed
6.
Gronbaek M: The positive and negative health effects of alcohol and the public health implications. J Intern Med. 2009, 265: 407-420. 10.1111/j.1365-2796.2009.02082.x.CrossRefPubMed
7.
Kloner RA, Rezkalla SH: To drink or not to drink? That is the question. Circulation. 2007, 116: 1306-1317. 10.1161/CIRCULATIONAHA.106.678375.CrossRefPubMed
8.
Shaper AG, Wannamethee G, Walker M: Alcohol and mortality in British men: explaining the U-shaped curve. Lancet. 1988, 2: 1267-1273.CrossRefPubMed
9.
Strandberg TE, Strandberg AY, Salomaa VV, Pitkala K, Tilvis RS, Miettinen TA: Alcoholic beverage preference, 29-year mortality, and quality of life in men in old age. J Gerontol A Biol Sci Med Sci. 2007, 62: 213-218. 10.1093/gerona/62.2.213.CrossRefPubMed
10.
Andreasson S: Alcohol and J-shaped curves. Alcohol Clin Exp Res. 1998, 22: 359S-364S. 10.1111/j.1530-0277.1998.tb04391.x.CrossRefPubMed
11.
Pulska T, Pahkala K, Laippala P, Kivelä SL: Follow up study of longstanding depression as predictor of mortality in elderly people living in the community. BMJ. 1999, 318: 432-433. 10.1136/bmj.318.7181.432.CrossRefPubMedPubMedCentral
12.
Zheng D, Macera CA, Croft JB, Giles WH, Davis D, Scott WK: Major depression and all-cause mortality among white adults in the United States. Ann Epidemiol. 1997, 7: 213-218. 10.1016/S1047-2797(97)00014-8.CrossRefPubMed
13.
Cuijpers P, Smit F: Excess mortality in depression: a meta-analysis of community studies. J Affect Disord. 2002, 72: 227-236. 10.1016/S0165-0327(01)00413-X.CrossRefPubMed
14.
Kivimaki M, Leino-Arjas P, Luukkonen R, Riihimaki H, Vahtera J, Kirjonen J: Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ. 2002, 325: 857-10.1136/bmj.325.7369.857.CrossRefPubMedPubMedCentral
15.
Kivimaki M, Virtanen M, Elovainio M, Kouvonen A, Vaananen A, Vahtera J: Work stress in the etiology of coronary heart disease - a meta-analysis. Scand J Work Environ Health. 2006, 32: 431-442. 10.5271/sjweh.1049.CrossRefPubMed
16.
Huppert FA, Whittington JE: Symptoms of psychological distress predict 7-year mortality. Psychol Med. 1995, 25: 1073-1086. 10.1017/S0033291700037569.CrossRefPubMed
17.
Kaplan GA, Camacho T: Perceived health and mortality: a nine-year follow-up of the human population laboratory cohort. Am J Epidemiol. 1983, 117: 292-304.PubMed
18.
Eaker ED, Sullivan LM, Kelly-Hayes M, D’Agostino RB, Benjamin EJ: Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fibrillation, and total mortality: the Framingham Offspring Study. Psychosom Med. 2005, 67: 692-696. 10.1097/01.psy.0000174050.87193.96.CrossRefPubMed
19.
Allgulander C, Lavori PW: Excess mortality among 3302 patients with ‘pure’ anxiety neurosis. Arch Gen Psychiatry. 1991, 48: 599-602. 10.1001/archpsyc.1991.01810310017004.CrossRefPubMed
20.
Naimi TS, Brown DW, Brewer RD, Giles WH, Mensah G, Serdula MK, Mokdad AH, Hungerford DW, Lando J, Naimi S, Stroup DF: Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. Am J Prev Med. 2005, 28: 369-373. 10.1016/j.amepre.2005.01.011.CrossRefPubMed
21.
Lipton RI: The effect of moderate alcohol use on the relationship between stress and depression. Am J Public Health. 1994, 84: 1913-1917. 10.2105/AJPH.84.12.1913.CrossRefPubMedPubMedCentral
22.
23.
Power C, Rodgers B, Hope S: U-shaped relation for alcohol consumption and health in early adulthood and implications for mortality. Lancet. 1998, 352: 877-CrossRefPubMed
24.
Rodgers B, Korten AE, Jorm AF, Jacomb PA, Christensen H, Henderson AS: Non-linear relationships in associations of depression and anxiety with alcohol use. Psychol Med. 2000, 30: 421-432. 10.1017/S0033291799001865.CrossRefPubMed
25.
Leifman H, Kuhlhorn E, Allebeck P, Andreasson S, Romelsjo A: Abstinence in late adolescence - antecedents to and covariates of a sober lifestyle and its consequences. Soc Sci Med. 1995, 41: 113-121. 10.1016/0277-9536(94)00298-8.CrossRefPubMed
26.
Peele S, Brodsky A: Exploring psychological benefits associated with moderate alcohol use: a necessary corrective to assessments of drinking outcomes?. Drug Alcohol Depend. 2000, 60: 221-247. 10.1016/S0376-8716(00)00112-5.CrossRefPubMed
27.
Colder CR: Life stress, physiological and subjective indexes of negative emotionality, and coping reasons for drinking: Is there evidence for a self-medication model of alcohol use?. Psychol Addict Behav. 2001, 15: 237-245.CrossRefPubMed
28.
WHO MONICA Project Principal Investigators (prepared by H. Tunstall-Pedoe): Myocardial Infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994, 90: 538-612.
29.
Holle R, Happich M, Lowel H, Wichmann HE, MONICA/KORA Study Group: KORA - a research platform for population based health research. Gesundheitswesen. 2005, 67: S19-S25. 10.1055/s-2005-858235.CrossRefPubMed
30.
WHO MONICA Project Principal Investigators: MONICA Psychosocial Optional Study. Suggested Measurement Instruments. 1989, Copenhagen: WHO Regional Office for Europe
31.
Loewel H, Lewis M, Hoermann A, Keil U: Case finding, data quality aspects and comparability of myocardial infarction registers: results of a south German register study. J Clin Epidemiol. 1991, 44: 249-260. 10.1016/0895-4356(91)90036-9.CrossRef
32.
Wellmann J, Heidrich J, Berger K, Doring A, Heuschmann PU, Keil U: Changes in alcohol intake and risk of coronary heart disease and all-cause mortality in the MONICA/KORA-Augsburg cohort 1987–97. Eur J Cardiovasc Prev Rehabil. 2004, 11: 48-55. 10.1097/01.hjr.0000118174.70522.20.CrossRefPubMed
33.
Seeman TE, Kaplan GA, Knudsen L, Cohen R, Guralnik J: Social network ties and mortality among the elderly in the Alameda County Study. Am J Epidemiol. 1987, 126: 714-723.PubMed
34.
Karasek A: Job demands, job decision latitude, and mental strain: implications for job redesign. Administration Sc Q. 1979, 24: 285-307. 10.2307/2392498.CrossRef
35.
Heidrich J, Liese AD, Lowel H, Keil U: Self-rated health and its relation to all-cause and cardiovascular mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984–1995. Ann Epidemiol. 2002, 12: 338-345. 10.1016/S1047-2797(01)00300-3.CrossRefPubMed
36.
Zerssen D v: Die Beschwerden-Liste. Klinische Selbstbeurteilungsfragebögen aus dem Münchner Psychiatrischen Informationssystem. Psychis - Manuale, Allgemeiner Teil. 1976, Weinheim: Beltz
37.
Ladwig KH, Marten-Mittag B, Baumert J, Doering A, Loewel H: Case-finding for vital exhaustion and depressive mood in the general population: reliability and validity of a symptom driven diagnostic scale. Results from the MONICA-KORA Augsburg Study. Ann Epidemiol. 2004, 14: 332-338. 10.1016/j.annepidem.2003.09.003.CrossRefPubMed
38.
Breslow NE, Day NE: Statistical Methods in Cancer Research. Volume II - The Design and Analysis of Cohort Studies. IARC Sci Publ. Nr. 82. Lyon, France: IARC; 1987
39.
Jackson R, Broad J, Connor J, Wells S: Alcohol and ischaemic heart disease: probably no free lunch. Lancet. 2005, 366: 1911-1912. 10.1016/S0140-6736(05)67770-7.CrossRefPubMed
40.
Huth C, Siegert N, Meisinger C, Konig J, Kaab S, Wichmann HE, Doring A: Individuals with very low alcohol consumption: a heterogeneous group. J Stud Alcohol Drugs. 2007, 68: 6-10.CrossRefPubMed
41.
Thompson PL: J-curve revisited: cardiovascular benefits of moderate alcohol use cannot be dismissed. Med J Aust. 2013, 198: 419-422.CrossRefPubMed
42.
Gmel G, Gutjahr E, Rehm J: How stable is the risk curve between alcohol and all-cause mortality and what factors influence the shape? A precision-weighted hierarchical meta-analysis. Eur J Epidemiol. 2003, 18: 631-642.CrossRefPubMed
43.
Lown ES, Greenfield TK, Rogers JD: Health effects from drinking: type, severity, and associated drinking patterns based on qualitative and qantitative questions in a methodological survey. Subst Use Misuse. 2007, 42: 793-810. 10.1080/10826080701202346.CrossRefPubMed
44.
Camargo CA, Hennekens CH, Gaziano JM, Glynn RJ, Manson JE, Stampfer MJ: Prospective study of moderate alcohol consumption and mortality in US male physicians. Arch Intern Med. 1997, 157: 79-85. 10.1001/archinte.1997.00440220083011.CrossRefPubMed
45.
Gronbaek M, Deis A, Sorensen TI, Becker U, Schnohr P, Jensen G: Mortality associated with moderate intakes of wine, beer, or spirits. BMJ. 1995, 310: 1165-1169. 10.1136/bmj.310.6988.1165.CrossRefPubMedPubMedCentral
46.
Solomon CG, Hu FB, Stampfer MJ, Colditz GA, Speizer FE, Rimm EB, Willett WC, Manson JE: Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus. Circulation. 2000, 102: 494-499. 10.1161/01.CIR.102.5.494.CrossRefPubMed
47.
Kearney J, Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Bleday R, Willett WC: Diet, alcohol, and smoking and the occurrence of hyperplastic polyps of the colon and rectum (United States). Cancer Causes Control. 1995, 6: 45-56. 10.1007/BF00051680.CrossRefPubMed
48.
Barefoot JC, Gronbaek M, Feaganes JR, McPherson RS, Williams RB, Siegler IC: Alcoholic beverage preference, diet, and health habits in the UNC Alumni Heart Study. Am J Clin Nutr. 2002, 76: 466-472.PubMed
49.
Tjonneland A, Gronbaek M, Stripp C, Overvad K: Wine intake and diet in a random sample of 48763 Danish men and women. Am J Clin Nutr. 1999, 69: 49-54.PubMed
50.
Shaw BA, Agahi N: A prospective cohort study of health behavior profiles after age 50 and mortality risk. BMC Public Health. 2012, 12: 803-10.1186/1471-2458-12-803.CrossRefPubMedPubMedCentral
51.
52.
Skog OJ: Public health consequences of the J-curve hypothesis of alcohol problems. Addiction. 1996, 91: 325-337. 10.1111/j.1360-0443.1996.tb02283.x.CrossRefPubMed
53.
Murray RP, Rehm J, Shaten J, Connett JE: Does social integration confound the relation between alcohol consumption and mortality in the Multiple Risk Factor Intervention Trial (MRFIT)?. J Stud Alcohol. 1999, 60: 740-745.CrossRefPubMed
54.
Greenfield TK, Rehm J, Rogers JD: Effects of depression and social integration on the relationship between alcohol consumption and all-cause mortality. Addiction. 2002, 97: 29-38. 10.1046/j.1360-0443.2002.00065.x.CrossRefPubMed
55.
Caldwell TM, Rodgers B, Jorm AF, Christensen H, Jacomb PA, Korten AE: Patterns of association between alcohol consumption and symptoms of depression and anxiety in young adults. Addiction. 2002, 97: 583-594. 10.1046/j.1360-0443.2002.00092.x.CrossRefPubMed
56.
Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WA: Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ. 2011, 342: d636-10.1136/bmj.d636.CrossRefPubMedPubMedCentral
57.
Murray RP, Connett JE, Tyas SL, Bond R, Ekuma O, Silversides CK, Barnes GE: Alcohol volume, drinking pattern, and cardiovascular disease morbidity and mortality: is there a U-shaped function?. Am J Epidemiol. 2002, 155: 242-248. 10.1093/aje/155.3.242.CrossRefPubMed
58.
Bagnardi V, Zatonski W, Scotti L, La Vecchia C, Corrao G: Does drinking pattern modify the effect of alcohol on the risk of coronary heart disease? Evidence from a meta-analysis. J Epidemiol Community Health. 2008, 62: 615-619. 10.1136/jech.2007.065607.CrossRefPubMed
59.
Roerecke M, Rehm J: Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis. Am J Epidemiol. 2010, 171: 633-644. 10.1093/aje/kwp451.CrossRefPubMed
60.
Pernanen K: Validity of survey data on alcohol use. Research advances in alcohol and drug problems. Edited by: Gibbins R, Israel Y, Kalant H, Sellers EM. 1974, New York, NY: John Wiley and Sons, Inc, 355-374.
Metadata
Title
Are psychosocial stressors associated with the relationship of alcohol consumption and all-cause mortality?
Authors
Esther Ruf
Jens Baumert
Christa Meisinger
Angela Döring
Karl-Heinz Ladwig
for the MONICA/KORA investigators
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-312

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