Social and Behavioral Predictors of Mortality: Alcohol Abuse

older couple jogging in park

Last summer, researchers at the University of British Columbia (UBC) in Vancouver published a study that examined the behavioral and social factors that predict mortality in older adults. The phrase predict mortality may be confusing to many people reading this article: after all, as hard as it is to accept, no one lives forever. We understand that as we age, the optimal functioning of our bodies degrades. We have accidents and injuries, we contract illnesses, we develop chronic medical conditions, and eventually, our bodies no longer support us: we experience mortality.

That’s why the phrase predict mortality sounds odd. But let’s sort that out. It may seem obvious, but the prime predictor of mortality is age. That’s a biological and health predictor of mortality. Other biological and health predictors of mortality are diseases, accidents, and injuries. Let’s sort that out further, with the help of the authors of the UBC study:

“Proxy measures of health itself, as measured through self-reported health, recent morbidities, disability, and medication…were the strongest predictors of all-cause mortality, as they capture the most proximal underlying pathophysiology preceding death. In contrast, when those recent illnesses were excluded, smoking emerged as an important predictor of mortality.”

The mention of smoking in the last sentence is the key that unlocks how to understand what scientists mean when they say behavioral and social predictors of mortality. Smoking can cause lung cancer, and lung cancer can be fatal: we all know these facts. In the case of smoking, lung cancer is the biological predictor or proximate cause of mortality, while smoking itself is identified as a behavioral predictor of mortality.

We hope that makes sense: behavioral predictors of mortality are things people do that increase mortality risk, as opposed to things that happen to them, such as disease or accidents.

How This Knowledge Helps Us

Researchers study mortality predictors so that we can allocate our time, energy, and resources to preventing unnecessary mortality. For instance, the Centers for Disease Control (CDC) identifies the top ten causes of death in the U.S. as:

1. Heart disease

2. Cancer

3. Accidents

4. Chronic lower respiratory disease

5. Stroke

6. Alzheimer’s disease

7. Diabetes

8. Influenza and pneumonia

9. Nephritis, nephrotic syndrome, and nephrosis

10. Suicide

This information, based on population-level data, helps health scientists understand where to focus research. They know from this list that to prevent unnecessary mortality, they can explore new ways to treat and/or prevent heart disease, cancer, respiratory diseases, stroke, Alzheimer’s disease, and the rest of the pathologies on the list. Public safety officials know from the supporting data associated with “accidents” that car crashes are a significant cause of mortality. Therefore, they create regulations like seat belt laws and speed limits to decrease mortality rates associated with accidents. Mental health professionals note that suicide is the 10th leading cause of mortality in the U.S., and know to focus effort and attention on suicide prevention.

That’s why the researchers at UBC conducted this study. They wanted to understand — aside from the proximate biological causes such as disease or accident-related injury — how social and behavioral factors contribute to mortality. Their goal is to use this information to devise new ways not only to screen older adults for mortality risk, but also to target early interventions in social and behavioral domains that may help decrease mortality risk overall.

The Study Results: Alcohol Abuse Near the Top

Researchers examined 57 nonbiological economic, behavioral, and social factors that predict mortality. The study included data from 13, 611 adults in the U.S. and examined reports collected between 1992 and 2008 in the U.S. Health and Retirement Study (HRS). They grouped mortality predictors factors into six categories:

· Adverse socioeconomic and psychosocial experiences during childhood

· Socioeconomic conditions

· Health behaviors

· Social connections

· Psychological characteristics

· Adverse experiences during adulthood

After performing rigorous statistical analysis on the data, they identified the following social and behavioral factors as the top ten nonbiological predictors of mortality:

1. Current smoker

2. History of divorce

3. Alcohol abuse

4. Recent financial difficulties

5. History of unemployment

6. History of smoking

7. Lower life satisfaction

8. Never married

9. History of food stamps

10. Negative affectivity*

*Negative affectivity means the consistent tendency to experience negative emotions*

Notice that alcohol abuse ranks as the third leading nonbiological risk factor for mortality. That’s surprising to us, even though we see the negative short- and long-term effects of alcohol abuse every day.

In the top ten nonbiological mortality predictors, alcohol abuse ranks above financial problems, unemployment, and past history of smoking. Among the top 50 nonbiological mortality predictors, it ranks above factors it’s reasonable to expect would appear higher, such as negative interactions with family (#11), childhood adversity (#16), low/no vigorous activity (#22), and lower wealth (#28), loneliness (#32), and low/no moderate activity (#34).

What the Results Mean to Us — And You

Let’s look at the big picture.

In previous years — now previous generations — we used data like this to inform public health and safety advocacy efforts that reduced unnecessary mortality. These advocacy efforts are the reasons we have seatbelt laws, speed limits, and warning labels on tobacco products. Yes, mortality eventually finds us all, but we can take proactive steps to avoid unnecessary or early mortality. That’s why we put on our seatbelts, obey the rules of the road, and avoid cigarette smoking — hint, hint, smokers.

The results of this UBC study fall into the same category: we can use them to inform public health advocacy efforts that target alcohol use, misuse, and abuse. We already know that alcohol abuse — known now as alcohol use disorder (AUD) — causes significant short- and long-term emotional, psychological, and physical harm.

Now we know that — aside from biological factors such as age and disease — the misuse, abuse, and/or disordered use of alcohol is one of the top behavioral predictors for mortality. We encourage everyone — that means us, you, your family, your friends — to understand this new knowledge and apply it to daily choices and behavior. We also encourage our civic leaders, policy makers, and public health officials to acknowledge this data and consider it when allocating resources to health awareness and advocacy initiatives in communities, schools, and other public settings. Finally, we encourage our colleagues in healthcare to understand the implications of this data and use it to improve the overall wellbeing of anyone and everyone who may be at risk of abusing alcohol. Together, we can use the result of studies like this to help us all live longer, healthier lives.



Christopher Johnston, MD, ABPM-ADM

Christopher Johnston, MD, ABPM-ADM, is the Chief Medical Officer for Pinnacle Treatment Centers and has practiced addiction medicine for the past 15 years