Substance Use
The behavioral correlates alcohol consumption and sleep duration in relation to all-cause mortality risk among a nationally representative sample of US adults Erline E Martinez-Miller* Erline Martinez-Miller Frankie LaPorte Symielle A. Gaston Chandra L. Jackson
Alcohol use and short sleep are correlated and independently linked to mortality; joint alcohol-sleep contributions to mortality are unclear and may vary by sociodemographic characteristics. Evidence could, for instance, inform sleep targets to reduce alcohol-related risk. We used pooled, self-reported National Health Interview Survey data (2004-2018) linked to the National Death Index (2004-2019). Alcohol use categories were: lifetime abstainer, former drinker, current drinker, and for current drinkers: consumption (infrequent, light, moderate, heavy) and binging (none, occasional, frequent). Sleep duration was very short (<5 hours/night), short (<7), recommended (7-9), and long (>9). We estimated joint sleep-alcohol associations with mortality risk overall (Figure[F]1) and by sex/gender, race/ethnicity, and age in adjusted Cox proportional hazard models. Among 188,255,360 US adults, median age was 41 (IQR: 29-52) years, 51% were female, 65% were non-Hispanic White (NHW), 68% were current drinkers, and 7,244,235 (4%) died. Current drinkers reported 11% heavy drinking and 10% frequent binging. For 31%, sleep duration was short. For those with recommended sleep, mortality risk was higher for former drinkers (HR: 1.15 [1.04, 1.27]) and lower for current (0.88 [0.81, 0.96]) compared to lifetime abstainers (F1a). Among those with short and recommended sleep, light vs. infrequent drinking was associated with lower risk (0.83 [0.73-0.95]) while heavy drinking was associated with higher (1.48 [1.23-1.78]; F1b). For those with short sleep, compared to non-bingers, frequent bingers had higher risk (1.44 [1.22, 1.70]); occasional drinkers did not (F1c). For moderate drinkers with recommended sleep, NHWs had lower risk (0.82 [0.72, 0.94]) and NH Black adults had higher (1.30 [0.99, 1.71]). For those aged ≥35 years, frequent vs. non-bingers with short sleep had higher risk, while those <35 did not. Behavioral correlates and sociodemographic characteristics shape mortality risk.
