Self-Reported Disability Type and Risk of Alcohol-Induced Death – A Longitudinal Study Using Nationally Representative Data

Disability is associated with alcohol misuse and drug overdose death, however, its association with alcohol-induced death remains understudied. To quantify the risk of alcohol-induced death among adults with different types of disabilities in a nationally representative longitudinal sample of US adults. Persons with disabilities were identified among participants ages 18 or older in the Mortality Disparities in American Communities (MDAC) study (<i>n</i> = 3,324,000). Baseline data were collected in 2008 and mortality outcomes were ascertained through 2019 using the National Death Index. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated for the association between disability type and alcohol-induced death, controlling for demographic and socioeconomic covariates. During a maximum of 12 years of follow-up, 4000 alcohol-induced deaths occurred in the study population. In descending order, the following disability types displayed the greatest risk of alcohol-induced death (compared to adults without disability): complex activity limitation (aHR = 1.7; 95% CI = 1.3–2.3), vision limitation (aHR = 1.6; 95% CI = 1.2–2.0), mobility limitation (aHR = 1.4; 95% CI = 1.3–1.7), ≥2 limitations (aHR = 1.4; 95% CI = 1.3–1.6), cognitive limitation (aHR = 1.2; 95% CI = 1.0–1.4), and hearing limitation (aHR = 1.0; 95% CI = 0.9–1.3). The risk of alcohol-induced death varies considerably by disability type. Efforts to prevent alcohol-induced deaths should be tailored to meet the needs of the highest-risk groups, including adults with complex activity (i.e., activities of daily living – “ALDs”), vision, mobility, and ≥2 limitations. Early diagnosis and treatment of alcohol use disorder within these populations, and improved access to educational and occupational opportunities, should be considered as prevention strategies for alcohol-induced deaths.

残疾与酒精滥用及药物过量致死存在关联，但目前学界对残疾与酒精源性死亡之间的关联仍研究不足。本研究旨在基于美国成人的全国代表性纵向样本，量化不同残疾类型成人的酒精源性死亡风险。本研究从美国社区死亡率差异（Mortality Disparities in American Communities, MDAC）研究的3,324,000名18岁及以上参与者中识别出残疾人群体。研究于2008年收集基线数据，并通过国家死亡索引（National Death Index）确认截至2019年的死亡结局。本研究控制人口统计学与社会经济协变量后，估算了不同残疾类型与酒精源性死亡之间关联的校正后风险比（adjusted hazard ratios, aHRs）及95%置信区间（confidence intervals, CIs）。在最长12年的随访期间，研究队列中共发生4000例酒精源性死亡病例。与无残疾成人相比，按酒精源性死亡风险从高到低排序，各残疾类型的风险如下：复杂活动受限（aHR=1.7；95%CI=1.3–2.3）、视力受限（aHR=1.6；95%CI=1.2–2.0）、行动受限（aHR=1.4；95%CI=1.3–1.7）、≥2项受限（aHR=1.4；95%CI=1.3–1.6）、认知受限（aHR=1.2；95%CI=1.0–1.4）以及听力受限（aHR=1.0；95%CI=0.9–1.3）。酒精源性死亡风险因残疾类型不同存在显著差异。预防酒精源性死亡的干预措施应针对高风险群体量身定制，包括存在复杂活动受限（即日常生活活动——"ALDs"）、视力受限、行动受限以及≥2项受限的成人群体。针对该类人群尽早诊断和治疗酒精使用障碍，并改善其受教育与就业机会，可作为酒精源性死亡的预防策略。