Alcohol Use and Mortality Among Couples in US: Individual and Partner Effects | Hacker News Reader

Alcohol Use and Mortality Among Couples in US: Individual and Partner Effects

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52 pointsgnabgib61 comments

A) Is the following then the appropriate conclusion? Drink moderately, and find a spouse that drinks approximately as much as you.

B) I wonder whether the following set of hypotheses makes sense, and how one could test it:

- Social life is good for health

- Alcohol is bad for health, and the more, the worse (ie, a monotonous relationship)

- At lower levels of alcohol consumption, it brings improvements in social life whose health benefits outweigh the health costs of consumption

- At higher levels, this reverses.

Thus explaining the U-shaped effect (quadratic, as the study terms it).

That’s how I understood it, too. From what I’ve come to learn, social health is most correlated with longevity. Despite alcohol’s negative physical effects, it appears to have net positive effects overall in terms of longevity when consumed at moderate/low doses.

This finding keeps coming up in social science research: being connected to people seems to increase longevity. Which begs the follow up question: what is the underlying mechanism(s) that causes this effect?

Does social comparison promote self maintenance? Does the sharing of ideas lead to better cognitive hygiene? Does sharing power tools lead to less household accidents? Do we need to sniff other people's pheramones?

On a sceptical note, do extraverts, the sort of people who consent to be studied, continually arrive at conclusions that justify extraversion, missing the huge cohort of introverts who are quite content with minimal social contact?

> This finding keeps coming up in social science research: being connected to people seems to increase longevity.

Has a causal relationship in that direction actually been shown in research, or just correlation?

Because it seems very likely (well, certain for at least some people based on anecdotal experience) it goes in the other direction as well, i.e. someone who has serious health issues which cause them pain or low energy levels or whatever, would likely have less of a social life than if they were completely healthy even if they were the most social person imaginable before their health issues.

If for example I were diagnosed with cancer tomorrow and died of it in ten years time, I suspect it would significantly reduce the energy I have for social activity in the next ten years, but a study done just before I die finding correlation between my not having a good social life and my impending death wouldn't change the cause of death from cancer to lack of social contact.

(FYI I'm not arguing that social activity doesn't have any positive impact on physical health / length of life, in fact I'm sure that it can - I just don't know to what extent research has or hasn't shown how much it's one way or the other.)

Having seen elderly people decline, I honestly wouldn’t be surprised if it’s simply that that have a help network in place when they need it. I actually have a widowed neighbor approaching 90 with limited mobility but she’s been able to stay in her home comfortably enough because we have a rotation on our block that brings her meals (eg. We feed her on Wednesday, etc). She doesn’t really need the economic support but having someone cook and prepare and clean for her at each meal is a reason many people her age would move into an assisted living facility. Despite a high degree of social contact, duration of life once entering a facility like that is pretty low. She’s across the street from me so I even go take out her trash weekly to the curb and make sure her lawn guys are keeping things up to her standards (simple stuff like “hey, can you fix that sprinkler head”)

Alcohol consumption could be something as simple as being a net positive for health in moderation after accounting for the impact of various stresses the average person encounters in life. These things are often encountered as a couple for married folks.

I think there’s been research regarding the supposed “J-curve” for alcohol consumption — essentially, the original research that led to the idea of moderate consumption being better than none failed to differentiate between people who have never had alcohol, and those who stopped drinking due to health conditions. I wouldn’t be surprised if this “couples drinking together” also has a similar bias.

I'm not sure if it's because of the alchohol, or the pre-selection of type of people that don't drink, by choice or health

Not at all. The most likely explanation to me is the causality is reversed. Poor health or limited social life causes both abstinence and mortality.

Nothing in the abstract suggests they did any analysis to determine causality which makes their statement at the end "showing that survival varies as a function of one’s own and one’s partner’s drinking" misleading, as it could easily be interpreted to imply causality. Of course they phrased it that way on purpose because implying causality makes their results sound way more important than they are.

> Poor health or limited social life causes both abstinence and mortality.

Your theory doesn't explain the observed positive correlation to lifespan when partners shared the same drinking habit.

A compatible partner is part of "good social life".

It might - if both partners feel good enough to go out and have a drink together, they are probably healthy. Or at least healthier than those who don't feel good enough to do so.

> Of course they phrased it that way on purpose because implying causality makes their results sound way more important than they are.

How do you know that? I am at a loss to understand how someone on HN can read one sentence and begin drawing conclusions about what other ulterior motives they had while writing the sentence?

Maybe that sentence means exactly what it says and nothing more which is Z is a function of X and Y? Why perform psychoanalysis on that sentence? And if you have to perform psychoanalysis of that sentence, at least substantiate your conclusion by telling us what process you followed to rule out about a 100 other possible ulterior motives and conclude that "makes their results sound way more important than they are" is most definitely the ulterior motive they had?

>At lower levels of alcohol consumption, it brings improvements in social life whose health benefits outweigh the health costs of consumption

Patently false, as we know today that the level of alcohol consumption that's best for you is ZERO.

French people seem evidence against that.

In what way? There has been plenty of studies on this and the general consensus is that while there may be certain health benefits to alcohol under certain conditions, in aggregate alcohol in any amount does not have a net positive effect on overall health.

French people are adopting the Western diet in considerable numbers with all of the fast food chains getting in there. Obesity is on the rise. I have not been there recently but I expect to see things have changed across all demographics apart from the elderly.

France cannot be used for comparison studies when it comes to diet and alcohol in the way it used to be.

I'm obviously talking about the ones that eat the traditional diet, not American fake food

The counter argument for the J curve/French Paradox study is that their data for people who don’t drink is biased — it doesn’t distinguish between people who never drink because they don’t want to, and those who stopped due to underlying health conditions (thus making it appear as if mortality among those who don’t drink is higher).

That's the current WHO position apparently, but it's only motivated by lack of evidence of a threshold below which alcohol is safe. I find that approach actually harmful, as it creates an impression that there's little difference depending on the amount consumed, when in reality it's the amount that makes ALL the difference.

I'm thinking about substance use in general that it might even have some benefits but with each repetition the problem use threshold is getting closer. And we have no way of knowing where the threshold is for each of us. It might be ten reps or ten thousand, but even considering the genetics, trauma, etc we cannot know whether the next rep is going to be over the threshold. In addition the threshold in most cases becomes visible after a long time it's been crossed.

The same thing applies to things like chocolate. Yet no one says that since we can't pinpoint a threshold of chocolate consumption harmfulness, we need to assume it's ZERO.

I think it's likely that the WHO is considering people like me in their recommendation.

I have friends who can drink a beer, maybe two, and be quite happy and satisfied. This is a phenomenon I have never been able to understand, because even a small amount of alcohol switches my reward system to REQUIRE more.

If I have zero alcohol, I'm fine. But if I have one beer, I WILL have 7 more. For some portion of the human population (I've seen estimates at 15-20%), the concept of moderation is impossible - and for us, zero is the correct amount.

If the WHO said "drink moderately if you don't experience dopaminergic response to ethanol, but drink zero if you do", it would be more nuanced and accurate, but public health organizations need to target their recommendations to the LCD, as simply as possible.

It's the same as dietary cholesterol and salt. No health organization is going to say "run a double-blind study on yourself to find out if you are part of the population for whom dietary cholesterol impacts serum cholesterol, or sodium intake affects blood pressure, then consult this chart to see what our recommendation is for you" Instead they'll just say GROG SAY SALT AND EGGS BAD, NO EAT.

I have a hunch if you tried a GLP-1 agonist, this reward center would evaporate.

https://www.nature.com/articles/s41598-023-48267-2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820218/

Yes, I've seen this, but I am a bit of a fitness enthusiast, and nobody's going to prescribe semaglutide or tirzepatide until I gain 200lbs and wreck my health, which I am unwilling to do.

I'm not sure if you're tried visiting a doctor lately with your own research, but they look down your nose at you if you try to advocate for your particular edge case, with pubmed articles in hand - because they are better than you, as a filthy plebian patient.

These are the people who murder a quarter million Americans annually due to preventable medical errors. Why anybody with an IQ over 90 would ever bother doing business with them is beyond me.

At this point, I'm just waiting for the more reputable darkweb market suppliers to catch up.

But yes, you're right, I'm looking forward to trying this approach, but I refuse to grant moral sanction or financial resources to the Gatekeeper class who demand we beg Daddy's permission to make decisions about our own bodies. They are all evil, full stop.

All fair points.

I'm similar to you there; the old addage "one is too many, two is too few" (or whatever the current version of that is) always ruled my drinking; I didn't need alcohol, but when I started I'd keep going - nice to have a name for it.

Unrelated to any of this, I have a number of mental health issues, and recently I found that alcohol no longer gives me any of the euphoria effects that is used to do (obviously I still had the negative effects); once I noticed that, my desire for alchol went to zero and I've not touched it since - no idea if I am still have the same response to alcohol, but I'm not going to test it, for obvious reasons :)

That would be "the level of alcohol consumption that's best for your _health_"

First off, what's "best for me" is subjective and as CS Lewis describes in "The Humanitarian Theory of Punishment", the pathologizing of my own conditions that I don't myself regard as pathology is a form of despotism.

There's just one thing after another: your rude, brusque dismissal "Patently false" and then appealing to false consensus "as we know today" (sorry you don't know this, there's some isolated recent evidence of alcohol being harmful to health, but hardly anyone actually abstains completely in such a puritanical manner, and LIVING is harmful to health at the end of the day).

Has their been a large scale alcohol effect study that exploits the fact that some religions (particularly Islam, Judaism) don't tend to consume alcohol?

It will probably need to be delicately applied since religion correlates with many other socioeconomic/genetic conditions, but I think showing that certain cancers are not as common in for example Indonesia and Turkey as compared to Australia and Greece would be an interesting hypothesis concerning the impact of alcohol.

fyi, Judaism does not prohibit the consumption of alcohol. Sometimes it's even required for religious purposes -- notably you need to drink four "cups" (at least the volume of an olive, IIRC) during the upcoming Passover seder. Of course there still may be differences in consumption patterns though.

True, I should have said something like Mormonoism.

Alcohol is considered to be a known carcinogen fwiw

https://www.cancer.gov/about-cancer/causes-prevention/risk/a...

To some extent, I imagine that moderate alcohol consumption is an almost necessary consequence of having an active social life. If a couple tells you that they both drink, it's likely that they do so together and with friends, which is a good thing. There are myriads of exceptions, I am sure.

The caveat is that this is cultural, and so we can change this consequence if we want to.

Me and my friends rarely drink when we meet.

I’m not sure why this is downvoted.

In most Muslim countries you’ll find people having great time drinking mint tea/ playing backgammon/chatting. It goes to show how tightly alcohol consumption is coupled with the cultural upbringing.

As a WASPy dude in ‘merica, not drinking is something people still struggle to grasp. I’m middle aged now, and I still have regular social outings where someone is like flabbergasted “so, you never drink? But, why? Did you ever?” Sometimes I can tell they just are doing mental calculus and just determine I most be a recovering alcoholic and they suddenly apologize for their questioning. There’s some humor in it, but just not enjoying it enough or feeling a thirst for it is the only way I can explain it. I like how it taste ok, I just never really want to consume it. I usually say something like “do you like whole milk? When was the last time you drank a glass of it?” This makes the point 9/10 times, because a lot of people like milk but just never drink it. I’m the same with alcohol.

Hehe, I like that approach. I hate milk, so I'll try to come up with a lactose-free metaphor though. One of the funny things about alcohol as a drug is that if you tell people you don't drink, they automatically assume you have a problem.

I grew up and lived in countries with strong drinking cultures (incl. PL, UK, AT, PT) and I don't mind a drink myself. Having said that, the "cultural programming" (lazy expression, but I'm in a rush, sorry) is so hard to shake off. This stood out to me especially in the UK, where I felt bad for my muslim friends not being able to participate in many social events because they don't drink.

Did the non-drinking couples get regressed out of the confounders? I would guess a lot of people stop drinking after a health scare, so you'd have to remove the effect of the underlying medical issue to compare them with the moderately drinking people.

I would be very interested, if somebody can access the full paper, to know what amount of alcohol is "light drinking" for them. 2 glasses a day ? a week ? a month ? with people ? during dinner ?

"less than 2 drinks a day". They draw the definition from Muscari et al. (2015).

Thanks. Interesting.

In France, where I am, awareness campaigns recommend sticking to a maximum of 2 glasses per day, for men, 1.5 for women. and not every day. And these values only take into account protection against serious health problems, such as stroke, not the problems of moderate daily alcohol consumption, such as for example the fact that alcohol being a depressant, consumption will have a impact on their general well-being.

To be honest, I'm even more confused on what to think about this paper.

The J-curve charts I've seen indicated lowest all-cause mortality at 3 drinks / week for men and 2 drinks / week for women. So even if you believe there's something healthy to alcohol (and it's not just the unhealthy people -> have to drink 0), it probably won't be any healthier going past 3 or 2 / week. Portion size is 12oz 5% beer, 5 oz 12% wine, 1.5oz 40% liquor.

Agreed. From what I know, the positive points of certain alcohols such as wine which would protect against heart problems have either been denied, or the same advantages have been found in everyday non-alcoholic products (green tea if I remember well).

This is a general misconception. Alcohol being a depressant doesn't mean that it causes depression - it means that it depresses (that is - it lowers) the activity of nervous system. The opposite of a depressant is a stimulant (like amphetamine), not an antidepressant.

> "less than 2 drinks a day"

"less than 2 drinks a day" would be called "moderate drinking" in my culture. I mean if someone is having a drink or two everyday that is moderate drinking already.

Light drinking for us would be like 3 drinks in a week! 4 drinks/week or more gets us into the moderate drinking territory.

To be fair, "less than 2 drinks a day" covers any range below the upper limit of 2 a day, and hence also includes what you consider light drinking in your culture.

I suppose that the root of the matter is whether or not the range '>0 to <2 drinks a day' on average is too broad and may be hiding a significant difference of outcomes between the top of the range at 2 a day and the (non-abstinents) at the bottom who drink an average of, say, 2 drinks a week.

And that's not even going into regularity. I'm sure that 2 drinks a day on the regular has different health impacts and social implications than 14 drinks a night only on Fridays.

This is a classic example of selection bias in an observational (= non-randomized) study. There is no mention in the abstract of whether other health variables were statistically controlled for. And since it's a longitudinal study over a long time span, you can pretty much bet that it'd be insufficient anyways.

You would also expect to see exactly this pattern in the data, with light drinking correlating strongly with otherwise-good health and non-drinking correlating mildly with otherwise-bad health.

Parenthetically, the same effect turns up with elective Covid vaccinations. At-risk populations are much more likely to opt in, so vaccinated groups often have worse hospitalization and death rates than unvaccinated ones. Disingenuous observational studies are then used to justify anti-vax nonsense.

Who doesn’t drink? Well definitely someone with stage 4 cancer, so…

Edit: this was too snark, I meant:

If someone has cancer they are less likely to drink. So more of those people end up in the non-drinking cohort. There may not be many of them, but they are outliers in terms of life expectancy, whether measured in age of death, or age from the survey date.

https://news.gallup.com/poll/509501/six-americans-drink-alco... Nearly 40% of respondents to a Gallup poll don't. That seems high to me, but I would expect somewhere around 15% of people to abstain. But then again I'm not so full of myself to put "data science" in my name on here and say obviously incorrect stuff.

What I am saying is someone who is very ill will not drink, because they are very ill.

So regardless of what alcohol does or doesn't do, your non drinking cohort includes all the people who are very ill and don't drink, which I assume is a larger effect than the people who are very ill and drink anyway (due to alcoholism or yolo).

Let's say 40% don't drink, 60% do.

If 1% of the population are terminally ill. Of those 90% don't drink, 10% do.

Then for 1000 people:

10 are terminally ill. 9 don't drink 1 does. 1000 is the total pop. Of those:

* 400 don't drink, and 9 of those are terminally ill.

* 600 drink and 1 of those is terminally ill.

Let's say terminally ill reduces life expectancy by 20 years.

The life lost per person due to terminal illness in the non-drinking category is 20 * 9/400, which is 0.45 years.

For drinkers it is 20 * 1/600 = 0.03 years.

Also it has been pointed out elsewhere, that previous alcoholics will likely show up as non-drinkers in a study like this, but will already have done significant damage to their health. The result being that not drinking looks worse than it is.

I would add that even if they recovered, drinkers increase their risk for a few cancer, so you probably can't just assess their past health issues to correct the life expectancy.

There are lot of people in my region that don't drink alcohol. It is considered taboo

I think it's forbidden for Muslims?

(Theoretically at least: naturally there are people who take such taboos more or less seriously. Previous line manager was an Iranian with Zelda tattoos).

I live in Kashmir, India (unfortunate) anyway, historically we have been pretty isolated from general mass market societal pressures plus strong religious affiliation means people as a society don't like alcohol.

Until last year I think there used to be a single wine shop for like 8 million population. Since then governmental pressure brought more and more shops but natives still don't accept it.

We have a huge tourist population who comes here and they are the customers + army.

Natives have not consumed alcohol for centuries and there doesn't seem to be a cultural shift towards acceptance so I can say the problems associated with alcohol are just not here.

No one gets diagnosed with alcohol liver disease or gets into drunk driving accidents or family abuse stuff. Not do people get into addiction (drugs have been forcefully introduced)

Alcohol is not culturally normal in some other states of India too.

Ofcourse not as much as Kashmiri.

We do have wine shops / bars but there is still taboo around alcohol Thankfully

Probably, but I was too snark to get my point across.

You are fighting for your life => You probably choose not to drink.

This skews the non-drinking cohort, for reasons nothing to do with the positive* health effects of drink.

* There are probably no positive health effects.

Perhaps; I don't know.

My only data point is anecdotal: my dad had bowel cancer, didn't change his water consumption after the surgery, insisted he was drinking plenty even while the nurse was putting a drip in one arm to rehydrate him and the other arm to give meds because he'd almost destroyed his kidneys.

Habits can be hard to change, and self-awareness slow.

But an anecdote isn't data.

This is similar to a friend of mine that read that those who play golf socially, live on average 10 years longer than those who don't.

He's very unfit, drinks a lot and doesn't eat well - but gets a round of golf in 2 or 3 times a month.

Now I agree 'the cohort of people that regularly play golf' likely do live longer than people who don't play golf - BUT that is not caused by the golf itself.

Those who can play golf a) already can get out and do some light exercise b) have the funds to play so putting them in the top 20 to 10 percent of household incomes, c) have a family set up that allows them time away to play golf d) have jobs that leave them with free time and energy to play golf

I could go on, but I'd argue strongly that it is not the GOLF that gives them the longevity of life.

Same here with the drinking - what are all the others things that go with people being ABLE to socially drink (in moderation)? I'd argue the drink does not cause them...

> If someone has cancer they are less likely to drink

Citation?

Anecdotally, I know people with cancer that keep drinking heavily (assuming they were drinkers before getting diagnosed). Then again I live in New Zealand which is definitely a drinking culture.

In my personal experience, this is generally untrue, especially if the cancer is terminal.

There is a human tendency to adopt a "fuck it" attitude when confronted with death, and any recreational substance that doesn't interfere with treatment is fully on the menu.

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