Black-White Differences in Alcohol Drinking and Mortality
Black-White Differences in Alcohol Drinking and Mortality
Among men, 13% of White men and 24% of Black men were never drinkers (Table 1). Among women, 23% of White women and 42% of Black women reported never consuming alcohol (Table 2). Compared with Blacks, Whites were older, less likely to live in poverty (especially women), more likely to be married, to have at least a college education, and to engage in some level of physical activity across levels of alcohol consumption.
Prevalence of poor or fair health status was the same (13%) among Black and White men who never consumed alcohol. Black men who consumed 3 or more drinks on 3 to 7 days per week compared with their White counterparts were, however, much more likely to live in poverty (22% vs 7%; 95% CIs = 18%, 26% vs 6%, 9%) and to be unemployed (10% vs 4%; 95% CIs = 8%, 13% vs 3%, 5%) and less likely to both have a college education or more (8% vs 25%; 95% CIs = 6%, 10% vs. 24%, 26%) and be married (36% vs 57%; 95% CIs = 31%, 40% vs 55%, 58%). A college education or more was most prevalent among White and Black men (34% vs 18%; 95% CIs = 33%, 35% vs 16%, 20%) consuming 1 to 2 drinks on 2 or fewer days per week. Poverty level was comparable across drinking categories for White men but increased with increasing alcohol consumption among Black men. Among the heavier compared with lighter drinkers with the same frequency of consumption, both Black and White men were younger and were less likely to be married as well as to have self-reported hypertension and fair or poor health status.
Poverty level was similar across drinking categories for White women (from 6% to 7%; 95% CIs = 5%, 6% to 6%, 9%), but increased substantially with increasing alcohol consumption among Black women (from 16% to 38%; 95% CIs = 15%, 18% to 33%, 43%). Black women who consumed 2 or more drinks on 3 to 7 days per week were, compared with their White counterparts, much more likely to live in poverty (38% vs 7%; 95% CIs = 33%, 43% vs 6%, 9%) and to be unemployed (11% vs 3%; 95% CIs = 8%, 15% vs 3%, 4%). Black women were also less likely to have a college education or more (11% vs 30%; 95% CIs = 8%, 14% vs 28%, 31%) and be married (24% vs 54%; 95% CIs = 20%, 28% vs 52%, 55%).
During 9 years (median = 6; mean = 6.4) of follow-up from 1997 to 2006, corresponding to 913 506 person-years, there were 13 366 total deaths: 11 221 among Whites and 2145 among Blacks. Participants who consumed 1 to 2 drinks per day on 3 to 7 days per week had the lowest age-adjusted mortality rates (MRs) per 1000 person-years among White men (MR = 65.5; 95% CI = 51.7, 79.3); those who consumed 1 to 2 drinks per day on 2 or fewer days per week had the lowest age-adjusted MR per 1000 person-years among Black men (MR = 116.1; 95% CI = 91.3, 140.8), which was very similar to those who never consumed alcohol (MR = 128.7; 95% CI = 104.3, 153.1; Table 3). One drink per day on 3 to 7 days per week among White women (MR = 40.1; 95% CI = 27.4, 52.8) and 1 drink per day on 2 or fewer days per week in Black women (MR = 68.5; 95% CI = 50.9, 86.0]) were associated with the lowest MR. Figure 1 illustrates death rates from all-causes by amount of alcohol consumption by race and gender.
(Enlarge Image)
Figure 1.
Age-adjusted all-cause mortality rates by amount of alcohol consumption in the past year for Black and White (a) men and (b) women: National Health Interview Survey, United States, 1997–2000.
Note. Standard population = 2000 US Census; 1–2d/< 2d = 1–2 drinks per day on < 2 days per week; 1–2d/3–7d = 1–2 drinks per day on 3–7 days per week; ≥ 3d/< 2d = ≥ 3 drinks per day on < 2 days per week; ≥ 3d/< 2d = ≥ 3 drinks per day on 3–7 days per week; 1d/< 2d = 1 drink per day on < 2 days per week; 1d/< 3–7d = 1 drink per day on 3–7 days per week; ≥ 2d/< 2d = ≥ 2 drinks per day on < 2 days per week; ≥ 2d/3–7d = ≥ 2 drinks per day on 3–7 days per week. Whiskers indicate 95% confidence intervals.
Consumed 0 drinks in past year.
Consumed ≥ 12 drinks in their lifetime but never ≥ 12 in a single year.
Consumed ≤ 12 drinks in life.
The lowest multivariable-adjusted relative risk of mortality was 0.81 (95% CI = 0.64, 1.02) for White men who consumed 1 to 2 drinks on 3 to 7 days per week compared with never drinkers, whereas Black men who were never drinkers had the lowest mortality risk (Table 3). Compared with women who abstained, the lowest mortality risk was among White women who had moderate alcohol consumption up to 7 days a week (HR = 0.71; 95% CI = 0.61, 0.82) and Black women who consumed 2 or more drinks on 2 or fewer days per week (HR = 0.53; 95% CI = 0.33, 0.85). Regarding interactions between race and alcohol categories, Black men who consumed 1 to 2 drinks on 3 to 7 days per week (HR = 1.82; P = .008), 3 or more drinks on 2 or fewer days per week (HR = 1.33; P = .011), and 3 or more drinks on 3 to 7 days per week (HR = 1.42; P = .024) had a significantly higher mortality risk than their White male counterparts.
On the basis of sensitivity analyses, a 2-year lag did not appreciably change the main results across race–gender groups (Table A, available as a supplement to the online version of this article at http://www.ajph.org). Analysis restricted to employed participants did not alter the results, and age did not significantly modify the alcohol–mortality relationship for any group (Table B, available as a supplement to the online version of this article at http://www.ajph.org). Last, not being socially integrated was associated with a mortality risk more than 2 times as high for men and more than 3 times as high for women. Not being socially integrated greatly increased mortality risk, but it did not have a strong interaction with alcohol that explained mortality risk (Table C, available as a supplement to the online version of this article at http://www.ajph.org).
Results
Among men, 13% of White men and 24% of Black men were never drinkers (Table 1). Among women, 23% of White women and 42% of Black women reported never consuming alcohol (Table 2). Compared with Blacks, Whites were older, less likely to live in poverty (especially women), more likely to be married, to have at least a college education, and to engage in some level of physical activity across levels of alcohol consumption.
Sociodemographic Characteristics and Drinking Patterns
Prevalence of poor or fair health status was the same (13%) among Black and White men who never consumed alcohol. Black men who consumed 3 or more drinks on 3 to 7 days per week compared with their White counterparts were, however, much more likely to live in poverty (22% vs 7%; 95% CIs = 18%, 26% vs 6%, 9%) and to be unemployed (10% vs 4%; 95% CIs = 8%, 13% vs 3%, 5%) and less likely to both have a college education or more (8% vs 25%; 95% CIs = 6%, 10% vs. 24%, 26%) and be married (36% vs 57%; 95% CIs = 31%, 40% vs 55%, 58%). A college education or more was most prevalent among White and Black men (34% vs 18%; 95% CIs = 33%, 35% vs 16%, 20%) consuming 1 to 2 drinks on 2 or fewer days per week. Poverty level was comparable across drinking categories for White men but increased with increasing alcohol consumption among Black men. Among the heavier compared with lighter drinkers with the same frequency of consumption, both Black and White men were younger and were less likely to be married as well as to have self-reported hypertension and fair or poor health status.
Poverty level was similar across drinking categories for White women (from 6% to 7%; 95% CIs = 5%, 6% to 6%, 9%), but increased substantially with increasing alcohol consumption among Black women (from 16% to 38%; 95% CIs = 15%, 18% to 33%, 43%). Black women who consumed 2 or more drinks on 3 to 7 days per week were, compared with their White counterparts, much more likely to live in poverty (38% vs 7%; 95% CIs = 33%, 43% vs 6%, 9%) and to be unemployed (11% vs 3%; 95% CIs = 8%, 15% vs 3%, 4%). Black women were also less likely to have a college education or more (11% vs 30%; 95% CIs = 8%, 14% vs 28%, 31%) and be married (24% vs 54%; 95% CIs = 20%, 28% vs 52%, 55%).
Death Rates and Alcohol Consumption
During 9 years (median = 6; mean = 6.4) of follow-up from 1997 to 2006, corresponding to 913 506 person-years, there were 13 366 total deaths: 11 221 among Whites and 2145 among Blacks. Participants who consumed 1 to 2 drinks per day on 3 to 7 days per week had the lowest age-adjusted mortality rates (MRs) per 1000 person-years among White men (MR = 65.5; 95% CI = 51.7, 79.3); those who consumed 1 to 2 drinks per day on 2 or fewer days per week had the lowest age-adjusted MR per 1000 person-years among Black men (MR = 116.1; 95% CI = 91.3, 140.8), which was very similar to those who never consumed alcohol (MR = 128.7; 95% CI = 104.3, 153.1; Table 3). One drink per day on 3 to 7 days per week among White women (MR = 40.1; 95% CI = 27.4, 52.8) and 1 drink per day on 2 or fewer days per week in Black women (MR = 68.5; 95% CI = 50.9, 86.0]) were associated with the lowest MR. Figure 1 illustrates death rates from all-causes by amount of alcohol consumption by race and gender.
(Enlarge Image)
Figure 1.
Age-adjusted all-cause mortality rates by amount of alcohol consumption in the past year for Black and White (a) men and (b) women: National Health Interview Survey, United States, 1997–2000.
Note. Standard population = 2000 US Census; 1–2d/< 2d = 1–2 drinks per day on < 2 days per week; 1–2d/3–7d = 1–2 drinks per day on 3–7 days per week; ≥ 3d/< 2d = ≥ 3 drinks per day on < 2 days per week; ≥ 3d/< 2d = ≥ 3 drinks per day on 3–7 days per week; 1d/< 2d = 1 drink per day on < 2 days per week; 1d/< 3–7d = 1 drink per day on 3–7 days per week; ≥ 2d/< 2d = ≥ 2 drinks per day on < 2 days per week; ≥ 2d/3–7d = ≥ 2 drinks per day on 3–7 days per week. Whiskers indicate 95% confidence intervals.
Consumed 0 drinks in past year.
Consumed ≥ 12 drinks in their lifetime but never ≥ 12 in a single year.
Consumed ≤ 12 drinks in life.
Hazard Ratios and Alcohol Consumption
The lowest multivariable-adjusted relative risk of mortality was 0.81 (95% CI = 0.64, 1.02) for White men who consumed 1 to 2 drinks on 3 to 7 days per week compared with never drinkers, whereas Black men who were never drinkers had the lowest mortality risk (Table 3). Compared with women who abstained, the lowest mortality risk was among White women who had moderate alcohol consumption up to 7 days a week (HR = 0.71; 95% CI = 0.61, 0.82) and Black women who consumed 2 or more drinks on 2 or fewer days per week (HR = 0.53; 95% CI = 0.33, 0.85). Regarding interactions between race and alcohol categories, Black men who consumed 1 to 2 drinks on 3 to 7 days per week (HR = 1.82; P = .008), 3 or more drinks on 2 or fewer days per week (HR = 1.33; P = .011), and 3 or more drinks on 3 to 7 days per week (HR = 1.42; P = .024) had a significantly higher mortality risk than their White male counterparts.
On the basis of sensitivity analyses, a 2-year lag did not appreciably change the main results across race–gender groups (Table A, available as a supplement to the online version of this article at http://www.ajph.org). Analysis restricted to employed participants did not alter the results, and age did not significantly modify the alcohol–mortality relationship for any group (Table B, available as a supplement to the online version of this article at http://www.ajph.org). Last, not being socially integrated was associated with a mortality risk more than 2 times as high for men and more than 3 times as high for women. Not being socially integrated greatly increased mortality risk, but it did not have a strong interaction with alcohol that explained mortality risk (Table C, available as a supplement to the online version of this article at http://www.ajph.org).