Are Lifetime Abstainers the Best Control Group in Alcohol Epidemiology? On the Stability and Validity of Reported Lifetime Abstention
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Lifetime abstainers have often been recommended as the comparison group in alcohol epidemiology. The objective of this study was to provide insight into the validity and stability of lifetime abstention by using data derived from the National Alcohol Survey, a national probability survey of US households conducted in 1984, and its 2 follow-up surveys conducted in 1990 and 1992. Results indicated that more than half (52.9%; all proportions were weighted to represent the US population) of those who reported never having a drink of any alcoholic beverage in the 1992 survey reported drinking in previous surveys. Depending on assumptions, this difference may result in an underestimation of alcohol-attributable mortality of 2%-15% in men and 2%-22% in women. Sociodemographic factors differentiated those who consistently reported lifetime abstention across surveys from the rest of the study population. Results suggest that using reported lifetime abstainers as a sole comparison group is problematic, especially if reporting is based on 1 measurement only. Establishing multiple measurement points and including irregular lifetime light drinkers with lifetime abstainers as the comparison group are recommended for future epidemiologic studies.
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Relative risks for cancer are dependent on the systematic search strategy, inclusion and exclusion criteria, reference group (including former drinkers), use of case-control and/or cohort studies, and use of categorical or continuous estimates for alcohol consumption.
“Furthermore, as with other diseases related causally to alcohol consumption, the relative risks for cancer are dependent upon the systematic search strategy, inclusion and exclusion criteria, reference group (and if this includes former drinkers) of the underlying studies 172, 173, 174, use of case–control and/or cohort studies 175 and use of categorical or continuous estimates for alcohol”
From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [173]
Lifetime abstention may be the theoretically preferred measure but has been proven to be unreliable.
“life‐time abstention may be the theoretically preferred measure but has been proven to be unreliable 173”
From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [173]
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Self-citation
- Authors
- Rehm, J., Irving, H., Ye, Y., Kerr, W. C., Bond, J., & Greenfield, T. K.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Rehm, J.
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-08-12
- Volume
- 168
- Issue
- 8
- Pages
- 866-871
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- PMC
- PMC2565735
- OpenAlex
- W2137074485
- Cited by
- 215
- References
- 20
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 10 · 2023: 7 · 2022: 14 · 2021: 16 · 2020: 11 · 2019: 9 · 2018: 10 · 2017: 18 · 2016: 14 · 2015: 17 · 2014: 6 · 2013: 13 · 2012: 8
- FWCI
- 10.65
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- American Journal of Epidemiology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- University of Toronto
- University of California, San Francisco
- National Institute on Alcohol Abuse and Alcoholism (R01AA016644, P50AA005595)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Keywords
- alcohol consumption, measurement stability, alcohol-attributable mortality, National Alcohol Survey, follow-up survey, sociodemographic differences, light drinkers, comparison group selection
- MeSH terms
- Alcohol Drinking, Female, Humans, Male, Middle Aged, Sensitivity and Specificity, Socioeconomic Factors, Time Factors, Reproducibility of Results, Control Groups
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