A life-time of hazardous drinking and harm to health among older adults: findings from the Whitehall II prospective cohort study.
Level 3 - non-randomized controlled study
Prospective cohort study
PubMed 32233123 · doi:10.1111/add.15013
What was done
Authors analyzed 4,820 drinkers aged 59–83 years from the Whitehall II prospective cohort of UK civil servants who had biological measurements taken during the 2011–2012 survey. Lifetime hazardous drinking was categorized using AUDIT-C scores (≥ 5) assessed for each decade of life into: never hazardous, former early (stopped before 50), former later (stopped after 50), current hazardous, and consistent hazardous drinkers (hazardous at each decade). Outcomes included cardiometabolic biomarkers, liver function indices, incident cardiovascular disease (median follow-up 4.5 years), and mortality.
What was found
Over half the participants had been hazardous drinkers: 19% former early, 11% former later, 21% current, and 5% consistent. Adjusted waist circumference increased with persistence of hazardous drinking compared with never hazardous drinkers: former early (+1.17 cm, 95% CI: 0.25 to 2.08), former later (+1.88 cm, 95% CI: 0.77 to 2.98), current (+2.44 cm, 95% CI: 1.50 to 3.34), and consistent hazardous drinkers (+3.85 cm, 95% CI: 2.23 to 5.47). Current hazardous drinkers had higher systolic blood pressure (+2.44 mmHg, 95% CI: 1.19 to 3.68), higher fatty liver index scores (+4.05, 95% CI: 2.92 to 5.18), and higher risk of incident stroke (HR = 2.75, 95% CI: 1.44 to 5.22). Former later hazardous drinkers had elevated non-CVD mortality risk (HR = 1.93, 95% CI: 1.19 to 3.14).
Why it matters
This study demonstrates that cardiometabolic and vascular harms compound with persistent hazardous drinking across decades, while stopping hazardous drinking earlier in adulthood is associated with lower risk accumulation.
Limits
The study is restricted to UK civil servants, which may limit generalizability to more diverse or disadvantaged populations. Assessment of lifetime drinking relied on retrospective recall per decade, introducing potential recall and survival bias. Median follow-up for incident cardiovascular disease was relatively short (4.5 years), and residual confounding cannot be excluded.
Cited by
- supports In adults aged 59 to 83, current hazardous drinkers had a 2.4 cm larger waist circumference compared to lifetime non-hazardous drinkers, while those who stopped before age 50 had a 1.2 cm larger waist and those stopping after age 50 had a 1.8 cm larger waist.
- supports In older adults, being a hazardous alcohol drinker across every decade of adult life was associated with a waist circumference nearly 4 cm larger compared to never-hazardous drinkers.