Drinking Patterns & Ethnicity: Impact on Mortality Risks

描述（由研究者提供）：本修订后的申请响应PA-05-088，对现有数据进行二次分析，以加强对饮酒模式和酒精相关问题（这里是死亡率）流行病学的理解。PA的目标将通过解决美国人口以及男女白人、黑人和西班牙裔亚人群的风险和保护因素（帮助阐明酒精相关死亡率的差异）、饮酒史对死亡率的影响以及模式测量和分析（包括倾向评分策略）中的方法问题来实现。最近的酒精死亡率研究，包括一项成功的R01 （AA10960， T.K. Greenfield，首席研究员），已经发现了饮酒模式的作用的初步证据，即在低到中等量的饮酒者中大量饮酒，在全因死亡率的风险中。早期的分析受到功率不足、测量不充分或两者兼而有之的限制。这个应用程序使用了全国酒精调查（NAS）的两波，对饮酒模式、终生酗酒和酒精相关问题进行了异常彻底的测量。它将把1984年全国死亡指数（NDI）随访（n = 5,221，有效率为74%）从11年延长到21年（如果可能的话，22年），并增加对1995年全国死亡指数（n = 4,950，有效率为79%）的新的11年或12年随访。两项调查（年龄在18岁及以上）都是由天普大学ISR面对面进行的，使用了大量黑人和西班牙裔超额样本的概率抽样，并评估了许多相关的相同项目和量表。饮酒模式测量包括12个月啤酒、葡萄酒、白酒和整体饮酒的数量/频率，每天饮酒最多，以前饮酒和最大饮酒量，每周饮酒5次以上，发病年龄等。吸烟，吸毒，抑郁/士气低落，以及许多其他风险因素进行评估。共同的设计允许汇集NASs，预期死亡人数增加了三倍多（与早期R01的532例死亡相比，超过1800例死亡），在测试全因、缺血性心脏病（IHD）和癌症死亡率的假设以及对损伤和肝硬化死亡率的探索性分析方面，比迄今为止的能力要大得多。分析将按性别分类，并在可能的情况下按本群体和族裔/种族群体分类。将对酒精消费与种族之间的相互作用进行建模；理论上重要的协变量及其与酒精措施的相互作用将被添加到一系列计划的分析中，例如，CES-D抑郁症、社会孤立和其他风险因素，如重度饮酒史和酒精问题、因健康问题而戒烟、酒精治疗、药物使用和其他变量。研究结果将为公共卫生战略、酒精政策制定提供信息，并有助于理清模式对死亡率的影响。

DESCRIPTION (provided by investigator): This revised application responds to PA-05-088 for secondary analysis of existing data to enhance understanding of drinking patterns and the epidemiology of alcohol-related problems-here, mortality. The PA's objectives will be met by aims addressing risk and protective factors in the US population and in white, black and Hispanic subpopulations of both genders (helping elucidate disparities in alcohol-related mortality), impact of drinking history on mortality, and methodological issues in pattern measurement and analysis including propensity score strategies. Recent alcohol mortality studies, including a successful R01 (AA10960, T.K. Greenfield, Principal Investigator), have found preliminary evidence of the role of drinking pattern, i.e., heavy drinking among low to mid-volume drinkers, in risk of all-cause mortality. Earlier analyses have been limited by lack of power, inadequate measurement, or both. This application uses two waves of the National Alcohol Survey (NAS) with unusually thorough measurement of drinking pattern, lifetime heavy drinking, and alcohol-related problems. It will extend from 11 to 21 (or if possible 22) years the National Death Index (NDI) follow up of the 1984 NAS (n = 5,221, response rate of 74 percent) adding a new 11- or 12-year follow up of the 1995 NAS (n = 4,950, response rate = 79 percent). Both surveys (ages 18 and older) were conducted face-to-face by Temple University ISR, used probability sampling with large black and Hispanic over-samples, and assessed many relevant identical items and scales. Drinking pattern measures include 12-month quantity/frequency of beer, wine, liquor and overall drinking, most drinks/day, former drinking and largest quantity, ever 5+ weekly, age of onset, etc. Smoking, drug use, depression/ demoralization, and many other risk factors are assessed. The common design permits pooling NASs, more than tripling number of expected deaths (to over 1,800 compared to the earlier R01's 532 deaths), yielding considerably greater power than heretofore for testing hypotheses about all-cause, ischemic heart disease (IHD) and cancer mortality, with exploratory analyses on injury and liver cirrhosis mortality. Analyses will disaggregate by gender and, where possible, by this and ethnic/racial group. Interactions between alcohol consumption and ethnicity will be modeled; theoretically important covariates and their interactions with alcohol measures will be added in a series of planned analyses, e.g., CES-D depression, social isolation, and other risk factors such as history of heavy drinking and alcohol problems, quitting because of health problems, alcohol treatment, drug use, and other variables. Results will inform public health strategies, alcohol policy development, and help disentangle pattern effects on mortality.