The substantially increased mortality associated with alcohol abuse disorders may be attributable to familial risk factors and the direct result of the disorders themselves, results of a study published online April 20 suggest.
“These results have clear implications for interventions that seek to reduce the substantially elevated rates of mortality in those with [alcohol use disorders],” Dr. Kenneth S. Kendler and his associates wrote.
Dr. Kenneth S. Kendler
The investigators examined the mechanisms underlying the association between alcohol abuse disorders and excess mortality using a large-scale, population-based prospective cohort study design. The pattern of mortality hazard ratios in nine age groups in unrelated members of the general population and in half-siblings, full-siblings, and monozygotic twins discordant for alcohol abuse disorders was assessed using a database including information for all people born in Sweden from 1940 to 1965 who had not died or migrated before1973 or the age of 15 years (JAMA Psychiatry. 2016 Apr 20. doi: 10.1001/jamapsychiatry.2016.0360).
The total study population included 2,821,036 Swedish nationals, 6.17% of whom were registered for alcohol use disorders. Commensurate with findings from previous studies, those registered for alcohol use disorders had a substantially elevated mortality. After controlling for sex, educational status, and year of birth, the mortality hazard ratio for this population was estimated to be 5.83.
An additional analysis using a linear model showed that the mortality hazard ratio changed across the lifespan and declined rapidly with increasing age. In the youngest age group (15-24 years), the alcohol use disorders–related mortality hazard ratio was 5.04, and the ratio increased to a maximum of 8.19 at ages 30-39 years before showing a slow decline to 4.14 in those aged 65-70 years, reported Dr. Kendler of the Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University in Richmond.
In additional analyses involving the general population and relative pairs discordant for exposure to alcohol use disorders, the findings suggested that the excess rate of death in people with alcohol use disorders was attributable to both predispositions in people who develop alcohol use disorders and the direct effect of the alcohol use disorders themselves.
Funding for this project was provided by grants from the U.S. National Institute of Alcohol Abuse and Alcoholism; the Swedish Research Council; the Swedish Research Council for Health, Working Life and Welfare; and Region Skåne. The authors disclosed no conflicts of interest.