Drinking Patterns & Ethnicity: Impact on Mortality Risks

说明(由调查员提供)：本修订申请响应PA-05-088，对现有数据进行二次分析，以加强对饮酒模式和与酒精有关的问题--这里是死亡率--的流行病学的了解。PA的目标将通过解决美国人口以及白人、黑人和西班牙裔男女亚群中的风险和保护因素(帮助阐明与酒精相关的死亡率的差异)、饮酒史对死亡率的影响以及模式测量和分析中的方法问题(包括倾向评分策略)来实现。最近的酒精死亡率研究，包括成功的R01(AA10960，T.K.Greenfield，首席调查员)，发现了饮酒模式在各种原因死亡风险中的作用的初步证据，即中低量饮酒者大量饮酒。早期的分析因缺乏动力或测量不足，或两者兼而有之而受到限制。这个应用程序使用了国家酒精调查(NAS)的两次浪潮，对饮酒模式、终生酗酒和与酒精相关的问题进行了异常彻底的测量。它将把国家死亡指数(NDI)对1984年NAS(n=5,221，应答率为74%)的后续行动从11年延长到21年(如果可能的话，22年)，增加了对1995年NAS(n=4950，应答率=79%)的新的11年或12年的后续行动。这两项调查(年龄在18岁及以上)都是由坦普尔大学ISR面对面进行的，采用了大样本黑人和西班牙裔的概率抽样，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、白酒和总饮酒量/频率、每天最多饮酒量、以前饮酒量和最大饮酒量、每周5+次、发病年龄等。通用设计允许汇集NASS，将预期死亡人数增加两倍以上(超过1,800人，而此前R01的S死亡人数为532人)，从而产生比以往更大的能力来测试关于全原因、缺血性心脏病和癌症死亡率的假设，并对损伤和肝硬变死亡率进行探索性分析。分析将按性别分列，并在可能的情况下按这一群体和族裔/种族群体分列。酒精消费和种族之间的交互作用将被建模；理论上重要的协变量及其与酒精测量的交互作用将被添加到一系列计划分析中，例如CES-D抑郁、社会隔离和其他风险因素，如酗酒和酒精问题史、因健康问题戒烟、酒精治疗、药物使用和其他变量。结果将为公共卫生战略、酒精政策发展提供参考，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.