Drinking problems and mortality risk in the United States

We examine the links between 41 problems related to alcohol consumption and the risk of death among adults in the United States.

We use Cox proportional hazards models and data from the nationally representative prospective National Health Interview Survey-Linked Mortality Files (NHIS-LMF).

Drinking problems are relatively common among moderate and heavy drinkers and these problems are associated with increases in the risk of death. The strongest associations between problem drinking and mortality involved cases in which physicians, family members, or friends intervened to suggest reduced drinking. Losing one's job because of drinking problems within their lifetime (HR = 1.36, 95% confidence interval [CI]: 1.11, 1.65) was strongly linked to mortality risk. Social risks were equally or more strongly linked to mortality than physiological consequences of alcohol abuse such as lifetime reports of needing a drink to stop shaking or getting sick (HR = 1.23, 95% CI: 1.09, 1.40). Most importantly, these associations were evident despite statistical controls for alcohol consumption levels and demographic, social, economic, behavioral, health, and geographic factors.

Our results highlight the independent and additive effects of alcohol-related problems and alcohol consumption levels on the risk of death. We recommend that studies examining the mortality risks of alcohol consumption take into account drinking status and also specific drinking-related problems, paying particular attention to social problems related to alcohol use or abuse.