Primary Submission Category: Mortality
Racial/Ethnic Disparities in Early Midlife Cardiovascular Disease Mortality among Lifetime Abstainers: Evidence from the 1997–2018 National Health Interview Survey
Authors: Muntasir Masum,
Presenting Author: Nishat Tasnim Koli*
Background
Recent research shows that early midlife (ages 25–45) is a critical window for cardiovascular disease (CVD) risk, yet little is known about how lifetime alcohol abstention intersects with race/ethnicity to shape those risks. While moderate alcohol consumption sometimes appears protective for CVD, lifetime abstainers may represent a heterogeneous group, including individuals with poorer overall health or structural disadvantages. This study examines whether racial/ethnic minority lifetime abstainers experience elevated early midlife CVD mortality relative to current drinkers.
Methods
Data were drawn from the National Health Interview Survey–Linked Mortality Files (1997–2018), including 183,445 adults aged 25–45 at baseline. The primary outcome was CVD mortality (1,116 deaths). Cox proportional hazards models with mixed effects accounted for sociodemographics (age, sex, education, marital status, income), region of residence, obesity, and smoking. Drinking status was categorized as lifetime abstainer vs. current drinker; race/ethnicity included Hispanic, non-Hispanic White, Black, Asian, and other.
Results
Overall, 20% of participants were lifetime abstainers, who on average had lower socioeconomic status, were less likely to be male, and were more likely to be Hispanic or Black. In fully adjusted models, lifetime abstainers had significantly higher risk of CVD mortality than current drinkers (hazard ratio [HR] ~1.30). Racial/ethnic disparities were pronounced: non-Hispanic Black, other, and White lifetime abstainers showed particularly elevated hazards compared to Hispanic current drinkers. For example, among lifetime abstainers, non-Hispanic Black participants had HR=2.36 (p<0.001), and non-Hispanic other race had HR=6.79 (p<0.001), underscoring substantial racial/ethnic inequalities in midlife CVD outcomes.
Conclusions
Lifetime abstention was associated with an increased risk of CVD mortality in early midlife, and this effect was most pronounced among non-Hispanic Black and other racial/ethnic groups. These findings highlight complex social and biological pathways that disadvantage specific racial/ethnic minority abstainers, underscoring the need for more nuanced, equity-focused prevention efforts targeting early midlife cardiovascular health.