Abstract
BackgroundIn observational studies moderate alcohol use reduces cardio-respiratory mortality. However observational studies may be biased by many factors including residual confounding by unmeasured differences between moderate alcohol users and other groups or by changes in alcohol use with ill-health and aging. We used two different analytic strategies in an under-studied population, i.e. southern Chinese, to provide an assessment of the specific impact of moderate alcohol use on mortality from ischemic heart disease (IHD) and chronic obstructive pulmonary diseases (COPD).MethodsIn a population-based case-control study of all adult deaths in Hong Kong Chinese in 1998, we used adjusted logistic regression to compare alcohol use in decedents aged ≥ 60 years from IHD (2270) and COPD (1441) with 10,320 living and 9043 dead controls (all non-alcohol related deaths). We also examined whether the association of alcohol use with death from IHD or COPD varied with sex or smoking status.ResultsUsing living controls and adjusted for age, socio-economic status and lifestyle, occasional and moderate alcohol use were generally associated with lower mortality from IHD and COPD. However, using dead controls the protection of occasional and moderate alcohol use appeared to be limited to ever-smokers for IHD (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.46 to 0.73 for moderate compared to never-use in ever-smokers, but OR 1.07, 95% CI 0.76 to 1.50 in never-smokers), and possibly to men for COPD. High alcohol use was associated with lower IHD mortality and possibly with lower COPD mortality.ConclusionHigh levels of alcohol use in an older Chinese population were associated with lower IHD mortality. Moderate alcohol use was less consistently protective against IHD mortality. Alcohol use was associated with lower COPD mortality particularly in men, either due to some yet to be clarified properties of alcohol or as the artefactual result of genetic selection into alcohol use in a Chinese population. Given the increasing use of alcohol in China with economic development, other designs and analytic strategies are needed to assess the impact of alcohol in this population, so that an evidence-based public health policy can be formulated.
Highlights
In observational studies moderate alcohol use reduces cardio-respiratory mortality
Self-selection of prudent or healthy moderate alcohol users might be evident as non-specific or systematic benefits, similar to that seen for hormone replacement therapy (HRT) in the observational studies realized to be over-stated by selection into HRT use [10]
In a large population-based Chinese sample using two different analytic strategies, we found consistent with many other studies [1], that reasonably high alcohol use was associated with lower ischemic heart disease (IHD) mortality, and that high alcohol use was usually associated with lower chronic obstructive pulmonary diseases (COPD) mortality
Summary
In observational studies moderate alcohol use reduces cardio-respiratory mortality. We used two different analytic strategies in an under-studied population, i.e. southern Chinese, to provide an assessment of the specific impact of moderate alcohol use on mortality from ischemic heart disease (IHD) and chronic obstructive pulmonary diseases (COPD). Many observational studies have shown that moderate alcohol use is associated with lower mortality from ischemic heart disease (IHD) [1] and ischemic stroke [2], but not hemorrhagic stroke [2]. Self-selection of prudent or healthy moderate alcohol users might be evident as non-specific or systematic benefits, similar to that seen for hormone replacement therapy (HRT) in the observational studies realized to be over-stated by selection into HRT use [10]. The other two studies had few IHD deaths; one was too small to examine IHD separately [12], and the other found no association between moderate alcohol use and IHD mortality [13]
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