Changes in Alcohol Consumption and Risk of Dementia in a Nationwide Cohort in South Korea
Authors and Affiliations
Authors and Affiliations
Keun Hye Jeon, MD1; Kyungdo Han, PhD2; Su-Min Jeong, MD3,4,5; Junhee Park, MD6; Jung Eun Yoo, MD, PhD7; Juhwan Yoo, MS8; Jinkook Lee, MD9,10; SangYun Kim, MD11; Dong Wook Shin, MD, DrPH, MBA6,12
1Department of Family Medicine, Cha Gumi Medical Center, Cha University, Gumi, Republic of Korea
2Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
3Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
4Department of Family Medicine, Seoul National University Health Service Center, Seoul, Republic of Korea
5Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
6Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
7Department of Family Medicine, Healthcare System Gangnam Center Seoul National University Hospital, Seoul, Republic of Korea
8Department of Medical Statistics, The Catholic University of Korea, Seoul, Republic of Korea
9Department of Economics, Center for Economic & Social Research, University of Southern California, Los Angeles
10RAND Corporation, Santa Monica, California
11Department of Neurology, Seoul National University Bundang Hospital & Seoul National University College of Medicine, Seongnam, Republic of Korea
12Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Republic of Korea
Corresponding Authors: Dong Wook Shin, MD, DrPH, MBA ; Kyungdo Han, PhD
Importance: The impact of serial changes in alcohol consumption on dementia risk has rarely been investigated to date.
Objective: To investigate the association of comprehensive patterns of changes in alcohol consumption with the incidence of all-cause dementia, Alzheimer disease (AD), and vascular dementia (VaD).
Design, setting, and participants: This is a retrospective cohort study. Data were obtained from the Korean National Health Insurance Service database. Adults aged 40 years and older underwent 2 health examinations in 2009 and 2011. The cohort was assessed until December 31, 2018, and statistical analysis was performed in December 2021.
Exposures: Alcohol consumption level was categorized into none (0 g per day), mild (<15 g per day), moderate (15-29.9 g per day), and heavy (≥30 g per day) drinking. On the basis of changes in alcohol consumption level from 2009 to 2011, participants were categorized into the following groups: nondrinker, quitter, reducer, sustainer, and increaser.
Main outcomes and measures: The primary outcome was newly diagnosed AD, VaD, or other dementia.
Results: Among 3 933 382 participants (mean [SD] age, 55.0 [9.6] years; 2 037 948 men [51.8%]), during a mean (SD) follow-up of 6.3 (0.7) years, there were 100 282 cases of all-cause dementia, 79 982 cases of AD, and 11 085 cases of VaD. Compared with sustained nondrinking, sustained mild (adjusted hazard ratio [aHR], 0.79; 95% CI, 0.77-0.81) and moderate (aHR, 0.83; 95% CI, 0.79-0.88) drinking were associated with a decreased risk of all-cause dementia, whereas sustained heavy drinking was associated with an increased risk of all-cause dementia (aHR, 1.08; 95% CI, 1.03-1.12). Compared with sustained levels of drinking, reducing alcohol consumption from a heavy to a moderate level (aHR, 0.92; 95% CI, 0.86-0.99) and the initiation of mild alcohol consumption (aHR, 0.93; 95% CI, 0.90-0.96) were associated with a decreased risk of all-cause dementia. Increasers and quitters exhibited an increased risk of all-cause dementia compared with sustainers. The trends in AD and VaD remained consistent.
Conclusions and relevance: In this cohort study of a Korean population, decreased risk of dementia was associated with maintaining mild to moderate alcohol consumption, reducing alcohol consumption from a heavy to a moderate level, and the initiation of mild alcohol consumption, suggesting that the threshold of alcohol consumption for dementia risk reduction is low.