Heavy drinking hastens death in chronic diseases.
The effect seems particularly pronounced in women drinkers, who lose their survival advantage over men at an early age, wrote Dr. Yi, an epidemiologist with the National Institute on Alcohol Abuse and Alcoholism.
"When no heavy alcohol use is involved, women have a lower cumulative probability of death from all major chronic diseases from age 40 and throughout the rest of life," wrote Dr. Yi and his coauthors. "However, when heavy alcohol use is involved, the cumulative probability of death for women does not diverge significantly from that for men until close to age 55, suggesting an undue effect of alcohol on women."
The researchers examined death records from 1999 to 2004 from the Multiple Causes of Death database, maintained by the National Center for Health Statistics. The database contained information on more than 14.5 million deaths in the United States over that time period. Each death record contained one underlying cause of death and up to 20 contributing causes, all identified by International Classification of Diseases (ICD) codes.
They divided chronic diseases into five categories: malignant neoplasms, diabetes mellitus, neuropsychiatric conditions, cardiovascular disease, and digestive disease, each with detailed subcategories. The death records did not contain direct drinking measures, so the researchers presumed heavy drinking when they saw any of 12 ICD-10 codes for alcohol-induced medical conditions (alcohol-induced Cushing's syndrome; mental/behavioral disorders due to alcohol; degeneration of nervous system due to alcohol; alcohol in blood; alcohol poisoning, either accidental or undetermined; and alcoholic polyneuropathy, myopathy, gastritis, liver disease, or chronic pancreatitis).
The researchers then compared the cumulative probability of death by age and the mean age at death between the drinking and nondrinking groups within each of the disease categories.
"The analysis of all deaths from major chronic diseases showed that heavy alcohol use is associated with a higher cumulative probability of death beginning as early as age 35," Dr. Yi wrote. "The gap between heavy alcohol use and no heavy alcohol use in the cumulative probability of death from major chronic diseases becomes increasingly wider throughout life until around age 70."
The average years of life lost due to heavy drinking varied by disease, ranging from 25 years for neuropsychiatric conditions to 7 years for malignant neoplasms, and was generally much greater in women than in men. (See box.)
Heavy drinkers with neuropsychiatric conditions lost the most years of life, compared with similar patients who didn't drink heavily. Those with cardiovascular disease died a mean of 17 years earlier, and those with digestive diseases, a mean of 15 years earlier. Diabetics who drank heavily lost a mean of 16 years, compared with those without heavy drinking.
Heavy alcohol use also shortened the life spans of those with cancer by more than 7 years, and was associated with shorter life span in all five cancer subcategories examined, including cancer of the mouth and oropharynx, esophagus, liver, and breast, and other malignancies.
The analysis--the first to examine the relationship of heavy alcohol use to death across a wide range of disease states--provides stark but easy-to-grasp information that could be a valuable educational tool, Dr. Yi wrote.
"The study provides much-needed evidence that is important, yet straightforward, to convey to the general public," he wrote.
BY MICHELE G. SULLIVAN
Age at Death Lower With a History of Heavy Drinking History of No History of Heavy Drinking Heavy Drinking Disease Male Female Male Female Malignant neoplasms 63 65 70 71 Diabetes mellitus 57 58 70 75 Neuropsychiatric conditions 54 58 76 83 Cardiovascular disease 60 64 74 81 Digestive disease 57 56 68 76 Note: Based on a study of 14,500,465 deaths in the United States from 1999 to 2004. Source: Dr. Yi ELSEVIER GLOBAL MEDICAL NEWS