Page last updated: Monday, November 20, 2006
Moderate drinkers use doctors and out patients clinics less than non drinkers
Two studies show that moderate drinkers appear to have better health than non drinkers and as such cost medical services less.

The first study investigated this relationship further by including several confounding variables and effect modifiers. It was hypothesized that abstainers utilize more health services because they have less social resources, practice more risky health behaviours, have poorer self-reported health and suffer more from chronic diseases.

The study was based on a cross-sectional health survey of a random sample of adults aged 20–64 in Germany. The response rate was 68.8%. Alcohol consumption was assessed using a quantity–frequency measure and categorized into past-year abstainers, low-risk, medium-risk and high-risk drinkers. Confounders and effect modifiers included socio-demographic and health-related variables.

The study found that abstainers had a 43% higher rate (rate ratio = 1.43, 95% CI = 1.24, 1.63) of physician visits compared to low-risk drinkers, adjusting for age and gender. Medium-risk and high-risk drinkers did not differ from low-risk drinkers in terms of out-patient visits. Further regression adjustment for socio-economic covariates, self-reported health status and chronic diseases suggested that abstainers used more out-patient services because they were more ill than drinkers. The effect of mental health status and the number of chronic diseases on out-patient visits was greater for abstainers than drinkers.

The authors conclude that the relation between alcohol consumption and out-patient services is explained partly by poorer health among the abstainers.

Source: Alcohol consumption and out-patient services utilization by abstainers and drinkers Sebastian E. Baumeister, Anja Schumann, Terry T. Nakazono, Dietrich Alte, Nele Friedrich, Ulrich John & Henry Völzke Addiction Volume 101 Page 1285 - September 2006 doi:10.1111/j.1360-0443.2006.01538.x

In the second study, the authors determined the relationship of alcohol consumption and Medicare costs among 4,392 participants in the Cardiovascular Health Study (CHS), a longitudinal, population-based cohort study of adults age 65 or over in four U.S. communities. They assessed 5-year Parts A and B costs and self-reported intake of beer, wine, and liquor at baseline. Their results indicated that among both sexes, total costs were approximately $2,000 lower among consumers of >1 to 6 drinks per week than abstainers. The lower costs associated with moderate drinking were most apparent among those with cardiovascular disease (CVD) and for hospitalization costs for CVD in healthy participants. Former drinkers had the highest costs.

Comments: A number of studies have shown that moderate drinkers, in comparison with abstainers, have fewer episodes of coronary disease and heart failure, and thus fewer hospitalizations; some have suggested that health-care costs are lower among moderate drinkers. The authors of this study conclude that moderate drinkers, especially those with evidence of cardiovascular disease at baseline, have lower Medicare costs for hospitalization (Medicare Part A) than do non-drinkers.

Professor Curtis Ellison comments ‘We have some concerns about the authors’ decision to not adjust in their analyses for differential survival according to alcohol use; they stated that such an adjustment would “obscure true differences in total costs accrued by Medicare by minimizing the costs associated with interventions that reduce mortality.” However, we would expect that non-drinkers died earlier than moderate drinkers in this elderly cohort (especially from cardiovascular disease). If that were the situation, the lower costs for moderate drinkers would tend to have been under-estimated in their analysis, since moderate drinkers would have lived longer and thus had more opportunity for hospitalizations. Unfortunately, we have no information on survival by alcohol intake, or even the number of deaths during the follow-up period. And data are not presented that would make it possible to look at average annual costs, rather than just the total costs accrued over the entire 5-year observational period’.

Lay Summary: This analysis of Medicare costs in an elderly cohort (the Cardiovascular Health Study) according to alcohol consumption of the participants suggests that Medicare Part A (hospitalization) costs are lower among moderate drinkers than among abstainers. There are some questions about the analytic methods, but these results are in line with most other reports.

Source: Alcohol consumption in older adults and Medicare costs, Mukamal KJ, Lumley T, Luepker RV, Lapin P, Mittleman MA, McBean AM, Crum RM, Siscovick DS. Health Care Financing Review 2006;27:49-61.

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