@article {11265, title = {Cross-country differences in age trends in alcohol consumption among older adults: a cross-sectional study of individuals aged 50~years and older in 22 countries.}, journal = {Addiction}, volume = {116}, year = {2021}, pages = {1399-1412}, abstract = {

BACKGROUND AND AIMS: Age-related changes in physiological, metabolic and medication profiles make alcohol consumption likely to be more harmful among older than younger adults. This study aimed to estimate cross-national variation in the quantity and patterns of drinking throughout older age, and to investigate country-level variables explaining cross-national variation in consumption for individuals aged 50~years and older.

DESIGN: Cross-sectional observational study using previously harmonized survey data.

SETTING: Twenty-two countries surveyed in 2010 or the closest available year.

PARTICIPANTS: A total of 106 180 adults aged 50~years and over.

MEASUREMENTS: Cross-national variation in age trends were estimated for two outcomes: weekly number of standard drink units (SDUs) and patterns of alcohol consumption (never, ever, occasional, moderate and heavy drinking). Human Development Index and average prices of vodka were used as country-level variables moderating age-related declines in drinking.

FINDINGS: Alcohol consumption was negatively associated with age (risk ratio~=~0.98; 95\% confidence interval~=~0.97, 0.99; P-value~<~0.001), but there was substantial cross-country variation in the age-related differences in alcohol consumption [likelihood ratio (LR) test P-value <~0.001], even after adjusting for the composition of populations. Countries{\textquoteright} development level and alcohol prices explained 31\% of cross-country variability in SDUs (LR test P-value~<~0.001) but did not explain cross-country variability in the prevalence of heavy drinkers.

CONCLUSIONS: Use and harmful use of alcohol among older adults appears to vary widely across age and countries. This variation can be partly explained both by the country-specific composition of populations and country-level contextual factors such as development level and alcohol prices.

}, keywords = {alcohol, cross-cultural, development, drink, global, Mixed model, multi-level}, issn = {1360-0443}, doi = {10.1111/add.15292}, author = {Calvo, Esteban and Allel, Kasim and Ursula M. Staudinger and Castillo-Carniglia, Alvaro and Medina, Jos{\'e} T and Katherine M Keyes} } @article {10133, title = {Alcohol consumption in later life and mortality in the United States: Results from 9 waves of the Health and Retirement Study.}, journal = {Alcoholism, Clinical and Experimental Research}, year = {2019}, abstract = {

BACKGROUND: Alcohol consumption in later life has increased in the past decade, and the relationship between alcohol consumption and mortality is controversial. Recent studies suggest little, if any, health benefit to alcohol. Yet most rely on single-time point consumption assessments and minimal confounder adjustments.

METHODS: We report on 16~years of follow-up from the Health and Retirement Study (HRS) cohorts born 1931 to 1941 (N~=~7,904, baseline mean age~=~61, SD~=~3.18). Respondents were queried about drinking frequency/quantity. Mortality was established via exit interviews and confirmed with the national death index. Time-varying confounders included but were not limited to household assets, smoking, body mass index, health/functioning, depression, chronic disease; time-invariant confounders included baseline age, education, sex, and race.

RESULTS: After adjustment, current abstainers had the highest risk of subsequent mortality, consistent with sick quitters, and moderate (men: HR~=~0.74, 95\% CI: 0.60 to 0.91; women: HR~=~0.82, 95\% CI: 0.63 to 1.07) drinking was associated with a lower mortality rate compared with occasional drinking, though smokers and men evidenced less of an inverse association. Quantitative bias analyses indicated that omitted confounders would need to be associated with ~4-fold increases in mortality rates for men and ~9-fold increases for women to change the results.

CONCLUSIONS: There are consistent associations between moderate/occasional drinking and lower mortality, though residual confounding remains a threat to validity. Continued efforts to conduct large-scale observational studies of alcohol consumption and mortality are needed to characterize the changing patterns of consumption in older age.

}, keywords = {Alcohol Consumption, Mortality, NDI}, issn = {1530-0277}, doi = {10.1111/acer.14125}, author = {Katherine M Keyes and Calvo, Esteban and Katherine A Ornstein and Rutherford, Caroline and Matthew P Fox and Ursula M. Staudinger and Linda P Fried} }