Age at first drink as a predictor of all-cause mortality of middle-aged Koreans

Background. Early alcohol use is hazardous to health and restrictions to age at first drink (AFD) is a cornerstone of public health policy in many nations. We explored the long-term impact of AFD on mortality after early adulthood in community-dwelling Koreans. Methods. A cohort of 36 159 adults aged 35–64 years from the Korean National Health and Nutrition Examination Survey, linked to cause-of-death statistics, was followed up for a median of 9.9 years. Based on AFD with a cutoff at South Korea’s legal drinking age, the participants were divided into three groups: AFD < 19, AFD ≥ 19, and lifetime abstainer. The outcome variable was all-cause mortality. Results. A total of 9723 (26.9%) participants reported AFD < 19. During the follow-up, 1073 (3.0%) participants died. AFD < 19 was associated with an increased risk of mortality than lifetime abstainers (adjusted hazards ratio [aHR] 1.29, 95% confidence interval [CI] 1.02–1.64). Female drinkers with AFD < 19 showed an increased risk of mortality than female lifetime abstainers (aHR 2.02, CI 1.26–3.25). Current drinkers with AFD < 19 was associated with a greater risk of mortality than those with AFD ≥ 19 (aHR 1.20, 95%CI 1.01–1.42). Among participants with hazardous drinking habits, AFD < 19 was associated with a greater risk of mortality than AFD ≥ 19 (aHR 1.32, 95%CI 1.07–1.64). Conclusion. Individuals with AFD < 19 were at greater risk of mortality than lifetime abstainers; earlier AFD was associated with a greater mortality risk than later AFD. Prevention and early intervention programs can improve the long-term health of alcohol-consuming population.