Mortality in alcohol use disorder in the Lundby Community Cohort-A 50 year follow-up

Department of Clinical Sciences, Lund Division of Psychiatry, the Lundby Study, Lund University, SE-221 85 Lund, Sweden.
Drug and alcohol dependence (Impact Factor: 3.42). 04/2011; 118(2-3):141-7. DOI: 10.1016/j.drugalcdep.2011.03.008
Source: PubMed


To describe the mortality and causes of death among subjects with alcohol use disorder in comparison with those without alcohol disorder and to study whether mental disorders increase mortality in alcoholics.
Data were analysed from the database of the Lundby Study, comprising 3563 subjects followed from 1947 to 1997.
A community-based sample was investigated in 1947 with follow-ups in 1957, 1972 and 1997. Best-estimate consensus diagnoses of mental disorders, including alcohol use disorder, were assessed. In the total cohort, 427 cases of alcohol use disorders were identified. Differences in mortality between subjects with alcohol use disorders and non-alcoholics were studied using Cox regression models and causes of death were compared between alcoholic subjects and other participants. Risk factors for mortality among the 348 individuals with alcohol use disorders and known age-of-onset were analysed by means of Cox regression analyses.
The hazard ratio for mortality was higher for alcoholics compared to other subjects in the cohort. A substantial proportion of the causes of death among the alcoholics was suicide N=27 (6.3%) (26 males, 1 female). In the multivariate models of risk factors in alcohol use disorders, anxiety disorders, psychotic disorders, alcohol induced psychotic disorders and dementia were risk factors for premature death.
The mortality risk for subjects with alcohol use disorder was increased, females were especially vulnerable. The risk for suicide was high among males with alcohol problems. Anxiety disorders and severity of alcohol use disorder turned out as risk factors for premature death.

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Available from: Agneta Ojehagen, Jul 26, 2015
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    • "We found that those diagnosed with alcoholism had an HR of 1.8 of dying during 41 years of follow-up. This is similar to risks in most population-based studies with shorter as well as longer follow ups in the New Haven and Baltimore ECA samples (DSM-III dependence and abuse RR 1.7 and 1.8, respectively) (Bruce, et al., 1994; Neumark, et al., 2000), the Finnish Health Survey 2000 (DSM-IV alcohol use disorder HR = 1.7) (Markkula, Harkanen, Perala, Patti, et al., 2012) and the Swedish rural Lundby study (own criteria of alcoholism HR 1.5) (Mattisson, et al., 2011), but contrasts a recent 27-year follow-up of four pooled ECA samples, where DSM-III mortality for dependence and abuse combined was much lower, HR 1.3 (Eaton, et al., 2013). Both different diagnostic criteria and length of follow up is likely to bring differences in risk estimates, because cases are of different severity, and become more misclassified with time. "
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    ABSTRACT: The purpose of this study was to examine the effects of alcoholism, alcohol consumption amount, and alcohol consumption pattern on mortality in a general population sample. This study used a 1970 prospective population sample (double-phase random sample) of 2,300 individuals ages 18-65 years in Stockholm County, which was also linked to mortality registers. A total of 1,895 individuals participated in a semi-structured, baseline psychiatric interview with a psychiatrist and social worker. Alcoholism and other mental disorders were recorded according to the eighth revision of the International Classification of Diseases (ICD-8). Information on the usual amount and frequency of alcohol consumption was collected at the psychiatric interview. Mortality up to year 2011 was assessed with Cox proportional hazard regression models. At baseline, there were 65 men and 21 women diagnosed with alcoholism. During followup, there were 873 deaths in the study population of 1,895. Alcoholism was associated with increased mortality rate. Former drinkers, but not never-drinkers, also had increased risk for mortality compared with moderate drinkers. We found no associations between heavy consumption and mortality. Frequent heavy episodic drinking was uncommon but related to mortality before, but not after, adjusting for an alcoholism diagnosis. Our results demonstrated that alcoholism-but not a reported high consumption of alcohol or frequent heavy episodic drinking-predicted a long-term risk of death.
    Journal of studies on alcohol and drugs 07/2015; 76(4):544-551. DOI:10.15288/jsad.2015.76.544 · 2.76 Impact Factor
    • "The association between heavy drinking and mortality could be reflecting the increased mortality for those with an existing disorder (pathological involvement with alcohol) or reflect an increased risk of developing harm. Studies examining the overall mortality for alcohol use disorder all report increased mortality (Bruce et al., 1994; Vaillant, 1996; Ojesjo et al., 1998; Dawson, 2000; Neumark et al., 2000; Fichter et al., 2011; Mattisson et al., 2011; Markkula et al., 2012), and this might overstate the mortality associated with high consumption per se, since a large proportion of heavy drinkers might have alcohol use disorder and additional risk factors for mortality. We know of only two previous studies that jointly examine consumption level and alcohol use disorder, both based on US samples, and showing partly contrasting findings. "
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    ABSTRACT: To examine the relationship of alcohol consumption, alcohol use disorder and mortality. A cohort of 4316 male former Vietnam-era US army personnel participating in telephone survey and medical examination in middle age (mean age 38.3 years) in 1985-1986 was used. Alcohol consumption was reported in face-to-face interview on medical history and information on DSM-III alcohol use disorder was obtained from structured psychiatric interview (using the Diagnostic Interview Schedule). Mortality hazard during 15 years of follow-up was assessed with Cox proportional hazard regression modeling. A total of 4251 individuals participated in the psychiatric interview and the medical history interview. Of these 998 were abstainers, and for the remaining 3253 we calculated weekly average consumption and monthly frequency of binge drinking. A total of 1988 had alcohol dependence, abuse or both. There were 237 deaths during follow up. A J-shaped association was found for both consumption and binging. In multivariable analysis jointly modeling average consumption and disorder, and binging and disorder, increased mortality remained significant for both very high consumption (Hazard Ratio (HR) 1.62, 95% Confidence Intervals [1.02-2.57]) for drinking 29 or more drinks per week, and frequent bingeing HR 1.81 [1.03-3.18] for bingeing 16 or more times per month). This study showed that alcohol consumption measures were associated with mortality, partly independent from the potential confounding effect of alcohol use disorder, which is an established risk factor for mortality. This further highlights the importance of alcohol consumption measures in public health. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and alcohol dependence 03/2015; 151. DOI:10.1016/j.drugalcdep.2015.03.013 · 3.42 Impact Factor
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    • "Many studies show a U- or J-shaped relationship between alcohol intake and mortality [14]. High alcohol intake is strongly associated with both elevated mortality [14,15] and absence from work [16-18]. Sickness absence from work is a predictor of mortality [19]. "
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    ABSTRACT: Background Alcohol use disorders (AUDs) are associated with the highest all-cause mortality rates of all mental disorders. The majority of patients with AUDs never receive inpatient treatment for their AUD, and there is lack of data about their mortality risks despite their constituting the majority of those affected. Absenteeism from work (sick leave) due to an AUD likely signals worsening. In this study, we assessed whether AUD-related sick leave was associated with mortality in a cohort of workers in Germany. Methods 128,001 workers with health insurance were followed for a mean of 6.4 years. We examined the associations between 1) AUD-related sick leave managed on an outpatient basis and 2) AUD-related psychiatric inpatient treatment, and mortality using survival analysis, and Cox proportional hazard regression models (separately by sex) adjusted for age, education, and job code classification. We also stratified analyses by sick leave related to three groups of alcohol-related conditions (all determined by International Classification of Diseases 9th ed. (ICD-9) codes): alcohol abuse and dependence; alcohol-induced mental disorder; and alcohol-induced medical conditions. Results Outpatient-managed AUD-related sick leave was significantly associated with higher mortality (hazard ratio (HR) 2.90 (95% Confidence interval (CI) 2.24-3.75) for men, HR 5.83 (CI 2.90-11.75) for women). The magnitude of the association was similar for receipt of AUD-related psychiatric inpatient treatment (HR 3.2 (CI 2.76-3.78) for men, HR 6.5 (CI 4.41-9.47) for women). Compared to those without the conditions, higher mortality was observed consistently for outpatients and inpatients across the three groups of alcohol-related conditions. Those with alcohol-related medical conditions who had AUD-related psychiatric inpatient treatment appeared to have the highest mortality. Conclusions Alcohol use disorder-related sick leave as documented in health insurance records is associated with higher mortality. Such sick leave does not necessarily lead to any specific AUD treatment. Therefore, AUD-related sick leave might be used as a trigger for insurers to intervene by offering AUD treatment to patients to try to reduce their risk of death.
    Addiction science & clinical practice 01/2013; 8(1):3. DOI:10.1186/1940-0640-8-3
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