Alcohol and Life Expectancy: Unraveling the Mystery of Why Nondrinkers Have Higher Risk of Premature Death
Patrick M. Krueger, PhD, is an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program. He is an assistant professor at the University of Colorado-Denver in the departments of sociology and health and behavioral sciences, and research faculty at the University of Colorado-Boulder Population Program. He recently co-authored a study, published in Population Research and Policy Review, that examines the characteristics and mortality risks of nondrinker subgroups to explain why people who do not drink alcohol are at greater risk for death than light to moderate drinkers.
Prior research has documented that both heavy drinkers and nondrinkers have higher risks of premature death than their peers who drink in moderation. Heavy drinkers have elevated rates of death from accidents, suicides, homicides, liver disease, and some cancers. But the reason for the elevated rates of death among nondrinkers is less well understood. Some researchers* have advocated for national guidelines that discourage nondrinking and encourage moderate alcohol consumption. But physicians are reticent to suggest that their nondrinking patients drink more, because alcohol is a nonessential part of a person’s diet, is disallowed by many religions, and can have adverse consequences for health if consumed to excess.
I have worked with collaborators at the University of Colorado to understand the factors that explain the elevated risk of premature death among nondrinkers relative to their peers who drink in moderation. In particular, we use the stated reasons that people report for nondrinking to better understand why they have higher rates of premature death than their peers who drink in moderation.
We find that nondrinkers are a diverse group. Some nondrinkers avoid drinking because they have had problems with drinking or because they fear they would have problems if they started drinking. Other nondrinkers quit drinking because of health problems. Nondrinkers who have concerns about controlling their drinking or that drinking is damaging to their health may experience elevated risks of death compared to moderate drinkers, but might reap few health benefits if they were to return to drinking.
In contrast, other adults provide neutral or even positive reasons for nondrinking. Some avoid drinking for religious or moral reason or because they seek to be responsible family members. The most common reason that people give for nondrinking is that they dislike the taste of alcohol (disliking the taste of alcohol may result from genetic factors or from low exposure to alcohol earlier in adulthood). Nondrinkers also have other characteristics, aside from their reasons for nondrinking, that are correlated with premature mortality. For example, the subset of nondrinkers who drank regularly earlier in their lives, but who have since quit, also have high rates of cigarette smoking.
Our findings show that diverse groups of nondrinkers also have diverse rates of death. For example, adults who quit drinking because of their histories with problem drinking or for health reasons have among the highest rates of death among the nondrinkers. As such, the subgroups of nondrinkers who have the worse mortality outcomes would likely have even higher rates of death if they were to begin drinking. In contrast, adults who have consumed very little alcohol throughout their lives, due to interests in being responsible family members or for moral reasons, have mortality risks that are as low as those who drink in moderation. Thus, nondrinkers who avoid drinking for the most positive reasons may have little to gain, in terms of further reducing their mortality risk, if they were to begin drinking in moderation.
Our results suggest that broad encouragements to drink in moderation, rather than nondrinking, may yield few survival benefits. Instead, given the diverse reasons for nondrinking, each individual might work with his or her physician to better understand the costs and benefits of nondrinking.
*Doll R, Peto R, Hall E, Wheatley K, Gray R. Mortality in relation to consumption of alcohol: 13 years' observations on male british doctors. BMJ. 1994;309:911-918.