Behavior-related risk factors and time to death among persons with alcohol consumption versus persons without: A general population study with mortality follow-up after 20 years

Background: Evidence shows that low to moderate alcohol consumers seem to live longer than abstainers. Insufficient consideration of subgroups among abstainers and of further behavior-related risk factors for death might be reasons. The aim of this study was to compare alcohol lifetime abstainers, former drinkers, and current consumers with regard to mortality considering tobacco smoking, body overweight, and physical inactivity. Methods: A general adult population sample of residents aged 18 to 64 had been drawn at random in northern Germany. Among eligible persons, 4093 (70.2%) participated. Assessments included alcohol consumption by the Alcohol Use Disorders Identification Test Consumption in addition to lifetime alcohol abstinence and former drinking. A score of behavior-related risk factors was built from tobacco smoking, body overweight, and physical inactivity. Twenty years later, a mortality follow-up was conducted. Data of 4028 study participants were analyzed. Results: At baseline, former alcohol consumers but not current low to moderate alcohol drinkers had more behavior-related risk factors than lifetime abstainers. At follow-up, former alcohol drinkers with two or more behavior-related risk factors had a shorter time to death than lifetime abstainers with 0 or one behavior-related risk factor (hazard ratio 3.43, 95% confidence interval: 1.63-7.20). Low to moderate alcohol drinkers did not survive longer than lifetime alcohol abstainers with 0 or one behavior-related risk factor. Conclusion: The results provide evidence against the assumption that alcohol consumption has a beneficial effect on health and longevity. (c) 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).