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This study included 15,758 participants with 61,032 person-years of follow-up data. The mean age was 82.8 (± 11.9) years at baseline. 7,199 (45.7%) participants were male, and 12,319 (78.2%) were in the rural area. Current drinkers accounted for 17.6% of the participants, 69.6% were non-drinkers, and 12.8% were former drinkers who had ceased drinking at the time of the baseline survey or during the follow-up time. The characteristics of individuals with different alcohol use status are presented in Table 1.
Characteristics Current drinkers Former drinkers Nondrinkers P value Quit < 5 years Quit 5–9 years Quit > 9 years Age, mean ± SD, y 82.1 ± 11.8 80.6 ± 10.8 77.5 ± 10.2 83.4 ± 11.5 83.3 ± 12.0 0.004 65–79 1,232 (44.5) 364 (48.6) 310 (60.3) 298 (39.8) 4,494 (40.9) < 0.001 80– 1,534 (55.5) 385 (51.4) 204 (39.7) 451 (60.2) 6,486 (59.1) Sex < 0.001 Male 2,028 (73.3) 591 (78.9) 410 (79.8) 597 (79.7) 3,573 (32.5) Female 738 (26.7) 158 (21.1) 104 (20.2) 152 (20.3) 7,407 (67.5) Residence < 0.001 Urban 523 (18.9) 146 (19.5) 104 (20.2) 192 (25.6) 2,474 (22.5) Rural 2,243 (81.1) 603 (80.5) 410 (79.8) 557 (74.4) 8,506 (77.5) Marital statusa < 0.001 In marriage 1,338 (48.4) 410 (54.7) 296 (57.6) 350 (46.7) 4,062 (37.0) Not in marriage 1,428 (51.6) 339 (45.3) 218 (42.4) 399 (53.3) 6,914 (63.0) Educational levela < 0.001 None 1,269 (46.2) 344 (46.2) 203 (39.5) 348 (46.6) 7,144 (65.6) 1–6 years 1,092 (39.7) 295 (39.5) 220 (42.8) 307 (41.1) 2,808 (25.8) 6– years 387 (14.1) 107 (14.3) 91 (17.7) 92 (12.3) 940 (8.6) Living pattern < 0.001 Live without family 2,339 (84.6) 641 (85.6) 419 (81.5) 641 (85.6) 9,013 (82.1) Live with family 427 (15.4) 108 (14.4) 95 (18.5) 108 (14.4) 1,967 (17.9) Smoking statusa < 0.001 Nonsmoker 1,149 (41.5) 262 (35.0) 141 (27.5) 201 (26.8) 8,705 (79.3) Current smoker 1,170 (42.3) 298 (39.8) 198 (38.5) 186 (24.8) 1,411 (12.9) Former smoker 447 (16.2) 189 (25.2) 175 (34.0) 362 (48.4) 856 (7.8) Physical activitya < 0.001 No 987 (35.7) 285 (38.1) 207 (40.3) 302 (40.3) 3,329 (30.4) Yes 1,779 (64.3) 464 (61.9) 307 (59.7) 447 (59.7) 7,626 (69.6) Fish intake < 0.001 Everyday 607 (21.9) 155 (20.7) 101 (19.6) 150 (20.1) 2,146 (19.5) Often 1,238 (44.8) 362 (48.3) 229 (44.6) 300 (40.1) 4,805 (43.8) Occasionally 796 (28.8) 196 (26.2) 157 (30.5) 241 (32.3) 3,248 (29.6) Rarely or never 125 (4.5) 36 (4.8) 27 (5.3) 56 (7.5) 778 (7.1) Participant-reported hypertensiona 389 (14.1) 126 (16.9) 113 (22.0) 181 (24.2) 2,074 (18.9) < 0.001 Participant-reported diabetesa 40 (1.4) 18 (2.4) 17 (3.3) 27 (3.6) 321 (2.9) < 0.001 Participant-reported heart diseasea 168 (6.1) 58 (7.7) 58 (11.3) 93 (12.4) 1,013 (9.2) < 0.001 Participant-reported strokea 89 (3.2) 35 (4.7) 38 (7.4) 70 (9.4) 506 (4.6) < 0.001 Participant-reported cancera 31 (1.1) 11 (1.5) 9 (1.8) 16 (2.1) 149 (1.4) 0.273 ADL disability 283 (10.2) 77 (10.3) 45 (8.8) 137 (18.3) 1,579 (14.4) < 0.001 Note. The sample size for each group (Current drinkers, quit < 5 years, Quit 5–9 years, Quit > 9 years, Nondrinkers) was 2,766, 749, 514, 749, 10,980, respectively. a: missing values existed. ADL, activities of daily living. Table 1. Characteristics of study participants, n (%)
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During the 61,032 person-years of follow-up (the mean follow-up time was 3.9 years), 3,404 cases of cognitive impairment were identified (704 in wave 2005, 921 in wave 2008, 1,166 in wave 2011, 613 in wave 2014).
Current drinkers especially heavy drinkers showed significantly higher risk of cognitive impairment compared to non-drinkers (Table 2). Former drinking with longer abstinence was associated with lower risk than current drinking. Based on Model 3, the adjusted risk of cognitive impairment for former drinkers quitting drinking less than five years, five to nine years, and more than nine years were 0.94 (95% CI: 0.80–1.10), 0.79 (95% CI: 0.66–0.96), and 0.82 (95% CI: 0.69–0.98), respectively, compared with current drinkers (Table 3). The risk decreased rapidly and reached plateau after 10 years of drinking cessation (Figure 2).
Group NO. of cases/total person-years Model 1 Model 2 Model 3 Nondrinkers 2,336/41,818 1 [Reference] 1 [Reference] 1 [Reference] Light-moderate drinkersbc 160/2,835 1.13 (0.96−1.33) 1.14 (0.97−1.34) 1.15 (0.97−1.35) Heavy drinkersbc 270/4,886 1.18 (1.04−1.34) 1.20 (1.05−1.37) 1.21 (1.06−1.38) Former drinkers 511/9,126 1.00 (0.91−1.11) 1.01 (0.91−1.13) 1.01 (0.91−1.12) Note. aHRs were obtained from cause-specific hazard models. Model 1 was adjusted for age, sex, education status, marriage status, residential area and financial status; Model 2 was adjusted for variables in model 1 plus smoking status, fish intake, fruit intake and exercise status, Model 3 was adjusted for variables in model 2 plus medical history of hypertension, diabetes, heart disease, stroke, cancer, ADL and baseline MMSE score. bLight-moderate drinkers: alcohol consumption ≤ 25 g/day (male), or ≤ 15 g/day (female); Heavy drinkers: alcohol consumption > 25 g/day (male), or > 15 g/day (female). cMissing values existed for alcohol consumption. HR, hazard ratio; MMSE, Mini-mental State Examination; ADL, activities of daily living. Table 2. Hazard ratios for associations of current drinking in different daily consumption and incidence of cognitive impairmenta
Variables Current drinkers Former drinkers Non-drinkers Quit < 5 years Quit 5–9 years Quit > 9 years Cases 557 203 135 173 2,336 Person-years 10,087 3,192 2,850 3,084 41,818 Rate/1,000 person-years 55.2 63.6 47.4 56.1 55.9 HR (95% CI) Model 1 1 [Reference] 0.93 (0.79−1.09) 0.81 (0.67−0.97) 0.88 (0.74−1.04) 0.88 (0.80−0.97) Model 2 1 [Reference] 0.94 (0.80−1.10) 0.80 (0.66−0.97) 0.85 (0.71−1.01) 0.86 (0.78−0.95) Model 3 1 [Reference] 0.94 (0.80−1.10) 0.79 (0.66−0.96) 0.82 (0.69−0.98) 0.85 (0.77−0.94) Note. aHRs were obtained from cause-specific hazard models. Model 1 was adjusted for age, sex, education status, marriage status, residential area and financial status; Model 2 was adjusted for variables in model 1 plus smoking status, fish intake, fruit intake and exercise status, Model 3 was adjusted for variables in model 2 plus medical history of hypertension, diabetes, heart disease, stroke, cancer, ADL and baseline MMSE score. HR, hazard ratio; MMSE, Mini-mental State Examination; ADL, activities of daily living. Table 3. Hazard ratios for association between alcohol use and the incidence of cognitive impairmenta
Figure 2. Association between alcohol cessation and risk of incident cognitive impairment. The association between alcohol cessation and risk of incident cognitive impairment was delineated using restricted cubic splines, and adjusted for age, sex, education status, marriage status, residential area, financial status, smoking status, fish intake, fruit intake, exercise status, medical history of hypertension, diabetes, heart disease, stroke, cancer and activities of daily living (ADL). The reference group is current smokers. The red line and red shading indicate hazard ratio (HR) and 95% CI.
The hazard ratio for former drinkers who used to drink more than 30 g/d was 0.95 (95% CI: 0.82–1.11) and for those used to drink 30 g/d or less was 0.78 (95% CI: 0.66–0.91), which indicated that less alcohol consumed before quitting was associated with a significantly reduced risk of cognitive impairment than current drinking (Table 4).
Group NO. of cases/total person-years Model 1 Model 2 Model 3 Current drinker 557/10,087 1 [Reference] 1 [Reference] 1 [Reference] Former drinker, ≤ 30 g/day 229/4,027 0.80 (0.68, 0.93) 0.79 (0.67, 0.92) 0.78 (0.66, 0.91) Former drinker, > 30 g/day 246/4,476 0.97 (0.83, 1.13) 0.96 (0.82, 1.12) 0.95 (0.82, 1.11) Note. aHRs were obtained from cause-specific hazard models. Model 1 was adjusted for age, sex, marriage status, education status, residential area and financial status; Model 2 was adjusted for variables in model 1 plus smoking status, fish intake, fruit intake and exercise status, Model 3 was adjusted for variables in model 2 plus medical history of hypertension, diabetes, heart disease, stroke, cancer, ADL and baseline MMSE score. HR, hazard ratio; MMSE, Mini-mental State Examination; ADL, activities of daily living. Table 4. Hazard ratios for different daily alcohol consumption before quitting in former drinkers, HR (95% CI)
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In males and females, the decreased risks of cognitive impairment for drinking cessation of 5–9 years were both observed. Among participants under 80 years old, drinking cessation for less than 5 years was related to reduced risk than current drinking (adjusted hazard ratio [aHR] = 0.72; 95% CI: 0.54–0.96). While in older adults over 80 years old, the association was not significant (Table 5). Among former smokers and current smokers, non-drinking was associated with lower risk of cognitive impairment than current drinking, the adjusted HR were 0.67 (95% CI: 0.5–0.9) and 0.75 (95% CI: 0.62–0.91), respectively.
Characteristics NO. of cases/
total person-yearsCurrent
drinkersFormer drinkers Non-drinkers P value for
interactionQuit < 5 years Quit 5–9 years Quit > 9 years Sex 0.019 Male 1,371/28,132 1 0.97
(0.81, 1.18)0.83
(0.67, 1.03)0.84
(0.68, 1.03)0.77
(0.67, 0.88)Female 2,033/32,899 1 0.86
(0.63, 1.17)0.66
(0.44, 0.99)0.74
(0.53, 1.05)0.94
(0.81, 1.1)Age (years) < 0.001 ≥ 80 2,170/26,605 1 1.06
(0.87, 1.29)0.73
(0.55, 0.97)0.87
(0.7, 1.1)0.97
(0.85, 1.1)< 80 1,234/344,265 1 0.72
(0.54, 0.96)0.8
(0.61, 1.03)0.74
(0.56, 0.97)0.68
(0.58, 0.8)Chronic diseasesb 0.642 Yes 1,106/20,886 1 1.05
(0.78, 1.41)0.73
(0.53, 1.01)0.87
(0.65, 1.15)0.84
(0.7, 1.02)No 2,295/40,097 1 0.87
(0.72, 1.06)0.82
(0.64, 1.04)0.79
(0.63, 0.99)0.85
(0.76, 0.96)Physical activity 0.241 Yes 1,066/20,747 1 0.89
(0.68, 1.18)0.75
(0.55, 1.02)0.96
(0.73, 1.27)0.78
(0.65, 0.93)No 2,335/40,238 1 0.94
(0.77, 1.15)0.82
(0.64, 1.04)0.74
(0.59, 0.93)0.89
(0.79, 1.01)Smoking status 0.013 Nonsmoker 2,390/39,973 1 0.96
(0.75, 1.23)0.83
(0.6, 1.13)0.82
(0.61, 1.11)0.95
(0.83, 1.08)Current smoker 644/13,687 1 0.88
(0.68, 1.14)0.77
(0.57, 1.04)0.77
(0.55, 1.07)0.75
(0.62, 0.91)Former smoker 368/7,350 1 0.94
(0.65, 1.38)0.73
(0.48, 1.09)0.77
(0.55, 1.06)0.67
(0.5, 0.9)Note. aHR were analyzed with Model 3. bChronic diseases included hypertension, diabetes, stroke, other cerebrovascular disease, heart disease and cancer. If any one of the above is reported by the subject, then he (she) was classified as having chronic disease. Table 5. Hazard ratios for association between alcohol use and the incidence of cognitive impairment among different subgroups, HR (95% CI)a
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When excluding events died or loss to follow-up within the first one and two years or excluding participants lost to follow-up, or when MMSE score < 24 was used to define cognitive impairment, the association between alcohol use and cognitive impairment did not substantially alter. The decreased trend remained with years of cessation when we accounted for the history of the volume of alcohol consumption for the former drinkers in the cause-specific hazard model. Compared with people who ceased drinking for less than five years, the HRs for those who quitted for five to nine years and more than nine years were 0.82 (95% CI: 0.65–1.04) and 0.79 (95% CI: 0.63–0.99), respectively.
Alcohol Cessation in Late Life is Associated with Lower Risk of Cognitive Impairment among the Older Adults in China
doi: 10.3967/bes2021.071
- Received Date: 2020-10-28
- Accepted Date: 2021-04-12
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Key words:
- Cognition /
- Alcohol abstinence /
- Alcohol drinking /
- Epidemiology /
- Aging
Abstract:
Citation: | ZHANG Xiao Chang, GAO Xiang, LYU Yue Bin, ZHOU Jin Hui, WEI Yuan, YIN Zhao Xue, MA Ji Xiang, MAO Chen, SHI Xiao Ming. Alcohol Cessation in Late Life is Associated with Lower Risk of Cognitive Impairment among the Older Adults in China[J]. Biomedical and Environmental Sciences, 2021, 34(7): 509-519. doi: 10.3967/bes2021.071 |