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Years of heavy drinking put alcoholics at risk for a host of health problems ranging from poor nutrition to heart disease and cirrhosis of the liver. Alcoholics also are more likely to die prematurely. During the last several months, School of Medicine researchers have published four new studies that shed light on some of the risk factors for premature death. The most recent study appears in the October 1995 issue of Alcoholism: Clinical and Experimental Research.
The researchers followed 259 male and female alcoholics who were hospitalized for treatment in the late 1960s. Overall, they found that nearly half of the alcoholic women and almost 60 percent of the male alcoholics died within a 20-year follow-up period. Most patients were in their 30s or 40s at the time they were hospitalized for treatment.
"These men and women were dying as much as 20 years prematurely," said lead investigator Elizabeth M. Smith, Ph.D., associate professor of social work in psychiatry. "We're talking about people who should be living into their 70s, but instead they're dying in their 50s."
The average age of death for both male and female alcoholics in this study was 56. The time from hospital admission to death averaged nine years for men and 10.5 years for women.
In all four studies, which were published in the journal, the investigators report on risk factors at admission that can predict early death in alcoholic men and women. Their research, which is funded by grants from the U.S. Public Health Service and the National Institutes of Health, may help alcohol-treatment programs target certain therapies to individual patients who may be at the greatest risk of early death.
The study patients were treated in the detoxification units at a private psychiatric hospital and a public mental health center, both in St. Louis. When they were admitted to the hospital, the patients took part in detailed interviews that assessed their drinking habits, the age at which they began drinking and the medical complications related to their alcohol use.
Most of the men had been problem drinkers since before age 25. Most women in the study had been problem drinkers for seven to 10 years before they were admitted for treatment. The researchers reviewed their medical records, interviewed their close relatives and followed the patients for 20 years.
This study is unique, said co-investigator Collins E. Lewis, M.D., associate professor of psychiatry, because the researchers had access to so much information collected over a long period of time.
By following this sample of alcoholic men and women over time, Smith and Lewis said, they were able not just to learn about mortality rates but also about risk factors.
Prior research has determined that the mortality rates of alcoholics are two to five times higher than age- and sex-matched comparison groups from the general population, and the goal of this research was to determine the risk factors that predicted an early death.
Mortality rates in this study were high, and although death rates were higher for men than for women, the researchers said that is less a function of gender than of the severity of alcoholism in the male patients. Most of the men drank more and had been drinking heavily for longer than the women in the study group. Once the severity of alcoholism was taken into account, the men and women had comparable death rates.
Marital status a key predictor
As expected, age was the strongest predictor of death in both men and women. Those who were older at the time of hospitalization were more likely to die during the follow-up period. However, other predictors differed with gender. For men, the risk of death increased in those who were not married or had cirrhosis of the liver at the time they were admitted. For women, the risk increased with binge drinking and decreased when there was a diagnosis of depression.
The researchers said these predictors have important implications for future treatment of alcoholics. "We can target the high-risk groups," Lewis said. "If an older, divorced man with cirrhosis checks into the hospital for treatment, we know that he is at very high risk for an early death, so we need to target him for intensive therapy."
Smith said if they know the risk factors, clinicians can tailor treatment to a patient's individual needs. "There were several findings in these studies that surprised us, and as a result, we may need to rethink the way in which we treat some patients," Smith said.
-- Jim Dryden
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