Age at first drink below 19 years and all-cause mortality in Chinese older adults: a 10-year prospective cohort study

The association between age at first drink (AFD) and long-term survival in older adults remains unclear, especially in Chinese populations with high alcohol metabolism genetic variants. We aimed to investigate whether AFD < 19 years (legal drinking age in China) was associated with all-cause mortality in Chinese older adults.

This prospective cohort study included 7,187 participants aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey (2008-2018). AFD was categorized as never drinking, early drinking (AFD < 19 years), and non-early drinking (AFD ≥19 years). The primary outcome was all-cause mortality. Cox proportional hazards models were used, with progressive adjustment for sociodemographic, lifestyle, dietary (hPDI), BMI, and chronic diseases. Dose-response analysis within early drinkers used ≤ 1 cup/day as the reference category.

During the 10-year follow-up period, early drinking was associated with a 16% higher risk of all-cause mortality (HR = 1.16, 95% CI: 1.01-1.32) compared with never drinking, while non-early drinking showed no significant association. Among early drinkers, a dose-response relationship was observed: ≥3 cups/day increased mortality risk by 38% (HR = 1.38, 95% CI: 1.06-1.79, p for trend = 0.015). The association was stronger in participants aged < 75 years (HR = 1.99), those with heart disease (HR = 1.63), dementia (HR = 1.91), or married and living with spouse (HR = 1.60). Sensitivity analyses (excluding chronic diseases or early deaths, propensity score matching) confirmed the robustness.

AFD below 19 years was significantly associated with higher all-cause mortality in Chinese older adults, especially in younger-old individuals and those with heart disease, dementia, or married status.