Aging, Health Behaviors, and Health Outcomes

By K. Warner Schaie; Dan Blazer et al. | Go to book overview

The Laudables and Limits of Large Epidemiologic Studies of Mortality

Dan Blazer

Duke University Medical Center

The Alameda County Study is a prototype of community-based morbidity and mortality studies. The investigative team, of which Dr. Kaplan has been an integral member and now director, has utilized this cohort and existing data banks as extensively and productively as any group of investigators in the United States. In his chapter, Dr. Kaplan has reviewed for us in great detail the variety of risk factors for morbidity and mortality available for study, and has informed us where positive associations have been found, where no associations have been found, and what areas remain for future study. He has also reviewed a series of questions that provide a next step of analyses that, I am certain, he will pursue with great diligence.

Let me return, however, to the "so what?" questions that I posed as goals for this volume. I am the only physician among the participants. Therefore, I ignore my social epidemiology background for a few minutes and address the findings of the Alameda County Study regarding one risk factor--alcohol use, as a physician treating older adults who use alcohol on a regular basis. I recognize that these comments appear provocative and even unsophisticated. They are delivered, however, in the service of sharpening the focus of the participants upon the meaning of their past investigative efforts and directions for the future investigations. If these comments stimulate challenges and rebuttals, they will have served their purpose.

I related the four questions that I asked previously to alcohol use in the elderly as a risk factor. First, "so what" is the true nature and characteristic of this risk factor labeled "alcohol use" (and defined as 45 or more drinks per month). The patterns of alcohol use that I observe in my practice are many and the quantity of alcohol use over a given month appears uninformative regarding

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