Long-term mortality from alcoholism: A descriptive analysis

Objective: Short-term alcoholism mortality studies are limited in their ramifications for long-term, comprehensive treatment program planning. Therefore, this study was pursued for more than 33 years to answer questions such as how, when, and why alcoholics die after discharge from an intermediate care component of a comprehensive community-based treatment program. Method: A cohort of 500 alcoholics admitted in five groups of 100 in the years 1963, 1964, 1967, 1970, and 1972 to an intermediate care unit of a community-based, comprehensive treatment program was tracked for 33-42 years to document deaths. Case-fatality rate (CFR) and cause-specific mortality rate were computed and correlated with follow-up lag and ethnicity. Results: Four hundred and forty nine subjects died within 39 years, with 50% of the deaths occurring by Year 11. Average annual CFR was .057. Cause-specific mortality varied over time and with ethnicity. Deaths attributable to lifestyle causes (i.e., suicide, homicide, accidents, and AIDS) occurred disproportionately in the earlier years of the follow-up, claiming the youngest and ethnic minority (black and Hispanic) persons disproportionately to white. Whites tended to live longer, but all three racial/ethnic groups died of lifestyle causes at young ages, early in the follow-up series, and at relatively older ages from cancer and diseases of the lung late in the follow-up series. Conclusions: Comprehensive treatment programs must prepare for lifestyle crises soon after discharge from intermediate care and for organ diseases later. Ethnicity is a significant predictor of early death in alcoholic cohorts and must be considered in comprehensive treatment program planning.