Copyright © 2004 by the Johns Hopkins Bloomberg School of Public Health
LETTERS TO THE EDITOR |
TWO AUTHORS REPLY
1 Division of Cardiology, Department of Medicine, Kaiser Permanente Medical Center, Oakland, CA 94611
2 Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94611
We thank Jian Wang (1) for finding our study (2) of interest. We agree completely that the age of subjects is highly relevant to the overall risk/benefit ratio of moderate alcohol drinking. The reduced mortality risk in light/moderate drinkers is substantially due to less coronary heart disease. Thus, we would not expect much impact upon total deaths before the age of 40 years in men and the age of 50 years in women. Table 1 presents the relative risk of death by baseline age decade among persons who report 1–2 drinks per day compared with lifelong abstainers. Age disparity is clear since there is reduction of total mortality risk only among persons aged 50 or more years. The independent relation of wine frequency to total mortality (as relative risk per day per week) is also shown in the table. The wine frequency relation also shows a downward trend ending at 40–49 years (vs. 50–59 years for 1–2 drinks/day vs. never).
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We acknowledge that ascertainment of alcohol intake only at baseline is a limitation of our data. However, a recent survey (3) showed that few persons in our study population start to drink or increase drinking as they become older. A larger proportion decrease or stop drinking. We would expect these changes to weaken rather than produce associations. To indirectly study this aspect, we examined deaths in three time periods. For persons reporting 1–2 drinks/day (vs. never), we obtained the following relative risks: for all deaths (n = 5,325) in 1978–1988, the relative risk was 0.79 (95 percent confidence interval (CI): 0.72, 0.88); for all deaths (n = 5,000) in 1989–1993, the relative risk was 0.90 (95 percent CI: 0.81, 1.00); and for all deaths (n = 5,808) in 1993–1998, the relative risk was 0.93 (95 percent CI: 0.85, 1.03). The lessening of reduced risk with the passage of time could be due to cessation of drinking by some proportion of older persons. Such cessation of drinking might also account for the slight progressive lessening of the inverse relation in persons aged 60–69 years and aged 70 or more years at baseline (table 1).
As stated in our article (2), there was little diminution of the apparent wine frequency effect in the three time periods studied (relative risks per day per week were 0.95, 0.96, and 0.96). A hypothetical possible factor is a greater prevalence of persistence of drinking into older ages by wine drinkers, compared with beer or liquor drinkers. Another explanation might be that the lower risk of wine drinkers is due substantially to their more favorable user traits. Whatever the explanation, the validity of the lower mortality associated with wine drinking frequency seems strengthened by both the age bracket and time-to-death analyses.
REFERENCES
REFERENCES
- Wang J. Re: "Wine, liquor, beer, and mortality." (Letter). Am J Epidemiol 2004;160:299.
[Free Full Text] - Klatsky AL, Friedman GD, Armstrong MA, et al. Wine, liquor, beer, and mortality. Am J Epidemiol 2003;158:585–95.
[Abstract/Free Full Text] - Klatsky AL, Armstrong MA, Landy C, et al. The effect of coronary disease on changes in drinking in an older population. Alcohol Res 2003;8:211–13.
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  A. L. Klatsky and G. D. Friedman TWO AUTHORS REPLY Am. J. Epidemiol., August 1, 2004; 160(3): 299 - 300. [Full Text] [PDF]
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