To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations, researchers analyzed data from 12,519 participants in the Health and Retirement Study, a nationally representative study of US adults aged 55 and older. Participants were asked about their alcohol use, activities of daily living, mobility, SES, psychosocial factors (depressive symptoms, social support, and importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbid conditions. The outcome measure was death during the 4-year follow-up period.

• Moderate drinkers (1 standard drink per day) had a markedly more favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking versus no drinking was associated with 50% lower mortality.
• When smoking, obesity, and comorbidities were also adjusted for, the protective effect was slightly lower. When all risk factors (including functional status and SES) were adjusted for, the protective effect was markedly lower but remained statistically significant.
• After calculating a propensity score for alcohol intake to provide more precise estimates of confounding, an even stronger association between moderate alcohol use and lower mortality was seen compared with nondrinkers.

Comments by James Harrison, MHS, CADC
This study suggests that moderate alcohol use has benefits even when factoring in nontraditional risk factors and differences in socioeconomic status. Behavioral health professionals working with older Americans in treatment for alcohol-related problems may be able to reduce harm by pointing out that, in terms of consumption, less is better.