Adults
Dima Mazen Qato, PharmD, MPH, PhD,*† Beenish S. Manzoor, MPH,* and
Todd A. Lee, PharmD, PhD*†
time of screening in 2004) from households across the Uni- and other. Level of education was defined as less than high
ted States. Blacks, Hispanics, men, and the oldest persons school education, high school graduate or GED comple-
(75–84 at the time of screening) were oversampled. Of tion, some college or vocational education (associate
4,017 eligible persons, 3,005 were successfully interviewed, degree included), and a bachelor’s degree or higher. Lastly,
yielding an unweighted response rate of 74.8% and a income was divided into four categories by asking,
weighted response rate of 75.5%. Professional interviewers “Approximately what was the income of your household
conducted in-home interviews and compiled medication last year [this year minus one] before taxes or deductions
logs in English and Spanish between July 2005 and March (<$25,000, $25,000–50,000, <$50,000–74,999, ≥$75,000)?”
2006. The National Institutes of Health sponsors NSHAP, Healthcare and health-related factors were also impor-
and the study protocol has been previously described.1 The tant considerations. Information about insurance status
University of Chicago and National Opinion Research was ascertained by asking, “Are you currently covered by
Center institutional review boards approved the NSHAP any of the following health insurance programs (Medicare,
protocol, and all respondents provided written informed Medicaid, private insurance, Veterans Administration, or
consent. other)?” Participants who did not report being covered by
any of these programs (including other) were considered to
have no insurance.
Data
A measure of self-reported health was included
Data on medication use were collected during the house- whereby respondents had to qualify their physical health
hold interview by direct observation of medication bottles into a standard 5-point scale (poor, fair, good, very good,
using a computer-based log. Participants were asked to excellent). A measure of comorbidity was included because
provide the interviewer with all medications used “on a concurrent health conditions can affect drug–alcohol inter-
regular schedule, like every day or every week” and were actions. A comorbidity index was calculated based on a
instructed to include “prescription and nonprescription previously validated algorithm used in questionnaire and
medications, over-the-counter medicines, vitamins, and survey research11 in response to whether they had had a
herbal and alternative medicines.” All identifiable drug myocardial infarction, heart failure, peripheral vascular
names for prescription and over-the-counter medications disease, peptic ulcer disease or stomach ulcers, arthritis,
and dietary supplements were coded. Additional details on emphysema or chronic obstructive pulmonary disease,
the method of drug coding have been previously stroke, diabetes mellitus, dementia or Alzheimer’s disease,
described.10 cirrhosis, leukemia, lymphoma, poor kidney function, or
A drug information database (Thomson Micromedex; cancer.
Truven Health Analytics, Denver, CO) was used to iden-
tify alcohol-interacting medications and to provide a mea-
Analysis
sure of the severity of the interaction (contraindicated—the
drugs are contraindicated for use; major—the interaction Weights included in the National, Social life, Health and
may be life threatening or require medical intervention to Aging Project (NSHAP) data set were used for each analy-
minimize or prevent serious adverse events; moderate—the sis to adjust for oversampling, differential probability of
interaction may result in the exacerbation of the individ- selection, and differential nonresponse.12 Descriptive statis-
ual’s condition or require an alternative therapy; minor— tics were used to estimate the prevalence of drug–alcohol
the interaction has limited clinical effects). interactions (overall and according to drinking frequency)
Drinking characteristics were defined based on in the entire sample and stratified according to age and
responses to a series of questions: “Do you ever drink any sex. The chi-square statistic was used to test statistical sig-
alcohol beverages such as beer, wine, or liquor?” “In the nificance at the .05 level. Logistic regression was used to
past three months, on average, how many days per week assess which variables were significantly (P < .05) associ-
have you had any alcohol to drink (for example, beer, ated with a potential drug–alcohol interaction. All analyses
wine, or liquor)?” and “How many drinks do you have on were performed using SAS version 9.3 (SAS Institute, Inc.,
the days that you drink?” Nonregular drinkers were Cary, NC).
respondents who did not drink alcohol or drank less than
1 day per week. Regular drinkers were respondents who
RESULTS
drank at least 1 day per week. Regular drinkers were fur-
ther characterized into three categories based on the fre- Table 1 presents older adult sociodemographic and health
quency of drinking on drinking days: light drinkers characteristics overall and according to drinking status. In
(1 drink/d), heavy drinkers (2–3 drinks/d), and binge drin- 2005 and 2006, 41% of older adults were regular drinkers
kers (≥4 drinks/d). These definitions have been previously of alcohol (≥1 drinks/wk). The prevalence of regular drink-
used to define drinking behavior in older adults.2,4 respon- ing was more common in older adult men, participants
dents with the potential for a drug–alcohol interaction aged 57 to 64, and white participants and those with
were defined as those who were regular drinkers and using higher income, more education, and excellent self-reported
at least one alcohol-interacting medication with any level health. Older adults who were regular drinkers were sig-
of interaction severity. nificantly (P < .001) less likely to use alcohol-interacting
The following age intervals were used: 57 to 64, 65 to medications. Seventeen percent of older adults were light
74, and 75 to 85. (Some individuals originally 84 years drinkers (≥1 drinks/d), 20% were moderate drinkers (2–
old at the time of interview had turned 85.) Race and eth- 3 drinks/d), and less than 5% were heavy or binge drin-
nicity were defined as white, black, Hispanic non-black, kers (≥4 drinks/d). Women of all ages were significantly
2326 QATO ET AL. NOVEMBER 2015–VOL. 63, NO. 11 JAGS
(P < .001) less likely to drink alcohol regularly than men, one alcohol-interacting medication). The prevalence of
and of those who drank, women of all ages were signifi- potential drug–alcohol interactions increased with age for
cantly more likely to be light drinkers (Appendix S1). men, but not women, and was highest in in the oldest men
Respondents in the sample used 76 of the 165 alco- (75–84). The prevalence of any drug–alcohol interaction
hol-interacting medications identified in Micromedex. was higher in men than women of all age groups.
Whereas 57.7% of older U.S. adults use at least one alco- Figure 1 depicts the prevalence of multiple (≥2) drug–
hol-interacting medication, approximately 21% (95% con- alcohol interactions according to age and sex. Approxi-
fidence interval = 18.7–23.0) are at risk of a drug–alcohol mately 8.3% of respondents reported the concurrent use of
interaction (regular drinkers who concurrently use at least two or more alcohol-interacting medications with regular
Table 1. Weighted Distribution of Sample Characteristics Overall and According to Drinking Status (N = 2,975)
Regular Drinkers Nonregular Drinkers
Overall (≥1 drinks/wk), n = 1,106 (<1 drinks/wk), n = 1,869
Gastrointestinal bleeding
ter medications and dietary supplements.14 Therefore, peo-
impairment
interactions increases with age, particularly for men, and is
Sedation
Sedation
Bleeding
highest in men aged 75 to 85. Older adults with multiple
chronic conditions, particularly those with liver disease,
–
(6.5–10.6)
(4.8–8.3)
(1.2–3.7)
(3.7–6.8)
(4.3–7.7)
(4.1–7.9)
(2.8–5.0)
(3.3–6.6)
potentially harmful drug–alcohol interactions in these
Overall
P < .05 using chi-square test between aregular and nonregular drinkers and bbetween drinking frequency (≤1, 2–3, ≥4 drinks/d) among regular drinkers.
ularly ask patients about their drinking behavior and medi-
6.6
2.4
5.3
8.5
6.0
6.0
3.9
4.9
26.7
18.9
cation use.
Several medications commonly used in the older adult
Regular Drinkers, Drinks/D, n = 1,106
(15.5–29.2)
(2.4–11.0)
(1.9–10.3)
(7.9–18.1)
≥4, n = 134
(0.0–6.6)
(3.5–9.3)
(0.8–8.1)
(0.9–7.8)
(0.0–4.5)
(0.9–7.8)
6.4
4.5
4.4
1.8
4.4
(4.8–11.4)
2–3, n = 498
(4.3–8.5)
(1.1–4.5)
(3.2–7.5)
(2.6–8.2)
(3.1–8.7)
(2.1–5.4)
(2.0–6.8)
% (95% Confidence Interval)
8.1
5.4
5.9
3.7
4.4
26.6
20.3
(6.6–12.5)b
(4.4–9.0)b
(0.2–3.5)b
(2.8–7.1)b
(4.9–9.3)b
(4.2–8.9)b
(2.9–6.6)b
(3.7–7.6)b
≤1, n = 474
9.6
7.1
6.6
4.7
5.6
27.8
18.9
(10.3–14.2)a
(25.8–31.9)a
(23.1–27.8)a
(10.1–14.6)a
(7.9–11.5)a
(8.3–11.0)a
(2.7–5.5)a
(3.6–5.8)a
Nonregular
(2.8–4.8)
n = 1,869
Drinkers,
28.9
25.4
12.4
4.1
9.7
9.7
5.4
4.7
3.8
(25.3–30.7)
(21.1–24.4)
(8.4–11.4)
(9.3–12.3)
(7.2–9.1)
(4.7–6.5)
(3.7–5.1)
(3.3–5.2)
Overall
8.2
5.6
4.4
4.2
28.0
22.8
10.8
Limitations
This study has several limitations. The potential for drug–
Alcohol-Interacting Medication
Antidepressant
Folic acid
Analgesic
Vitamin
Aspirin
Table 2. Demographic, Socioeconomic, and Health Characteristics Associated with Drug–Alcohol Interactions in
Older U.S. Adults (N = 2,975)
Unadjusted Adjusted
Prevalence
Characteristic % (95% CI) Odds Ratio (95% CI)
Age
57–64 39.6 (33.7–45.5) 1
65–74 36.2 (31.5–40.9) 1.11 (0.85–1.46) 1.13 (0.86–1.48)
75–85 24.2 (19.5–28.9) 1.09 (0.82–1.47) 1.14 (0.85–1.52)
Sex
Male 58.8 (55.3–62.3) 1 1
Female 41.2 (37.7–44.7) 0.60 (0.51–0.69)a 0.59 (0.51–0.69)a
Race and ethnicity
Non-Hispanic white 87.3 (83.5–91.1) 1 1
Non-Hispanic black 6.8 (4.2–9.5) 0.58 (0.39–0.85)a 0.59 (0.41–0.85)a
Hispanic 4.6 (2.6–6.6) 0.56 (0.33–0.96)a 0.56 (0.33–0.96)a
Other 1.2 (0.2–2.2) 0.38 (0.15–1.00) 0.36 (0.14–0.95)a
Income, $
<25,000 14.2 (10.1–18.4) 1 1
25,000–50,000 41.6 (35.7–47.4) 3.07 (2.22–4.23)a 3.11 (2.25–4.32)a
>50,000–74,999 12.5 (9.0–15.9) 2.29 (1.44–3.64)a 2.42 (1.53–3.83)a
≥75,000 31.7 (24.7–38.7) 3.62 (2.40–5.45)a 3.91 (2.56–5.99)a
Education
<High school 10.1 (7.1–13.2) 1 1
High school graduate, GED 21.5 (17.8–25.1) 1.54 (1.09–2.18)a 1.58 (1.12–2.22)a
Some college, associate’s degree, vocational school 34.7 (30.5–39.0) 2.45 (1.81–3.32)a 2.58 (1.90–3.50)a
≥Bachelor’s degree 33.7 (28.0–39.3) 3.08 (2.19–4.34)a 3.04 (2.20–4.20)a
Self-reported health
Poor 5.9 (3.3–8.5) 1 1
Fair 18.0 (14.4–21.7) 1.19 (0.76–1.85) 1.19 (0.77–1.84)
Good 31.5 (27.0–36.1) 1.29 (0.81–2.05) 1.33 (0.83–2.13)
Very good 33.1 (27.9–38.2) 1.20 (0.78–1.86) 1.22 (0.79–1.86)
Excellent 11.5 (8.4–14.6) 1.01 (0.57–1.73) 1.03 (0.60–1.76)
Insurance coverage
None 3.8 (2.1–5.5) 0.68 (0.42–1.11) 0.66 (0.41–1.06)
Medicare 60.4 (54.0–66.8) 1.15 (0.89–1.48) 1.24 (0.97–1.59)
Medicaid 4.0 (2.3–5.7) 0.61 (0.39–0.96)a 0.61 (0.40–0.94)a
Private insurance 71.2 (65.8–76.6) 1.71 (1.33–2.21)a 1.73 (1.36–2.21)a
Department of veterans affairs 7.7 (5.0–10.3) 1.15 (0.82–1.62) 0.94 (0.67–1.31)
Other 10.6 (6.9–14.2) 0.82 (0.53–1.26) 0.86 (0.56–1.31)
Number of comorbidities
0 19.3 (14.6–24.0) 1 1
1–4 73.1 (68.1–78.1) 1.46 (1.08–1.97)a 1.52 (1.14–2.04)a
≥5 7.6 (5.2–9.9) 1.63 (1.05–2.52)a 1.62 (1.07–2.46)a
CI = confidence interval.
Adjusted model includes all variables in the table (age group, sex, race and ethnicity, household income, education, self-reported health, insurance cover-
age, comorbidity index).
a
P < .05 using chi-square test.
25% of emergency department admissions are associated differences in data source and definitions of alcohol-inter-
with a drug–alcohol interactions.7 acting medications limit comparability.
These estimates of drug–alcohol interactions were The current findings suggest that efforts to improve
greater than those reported in adults aged 20 and older in the safe use of medications in older adults should focus on
the 1999 to 2002 NHANES,9 the only national popula- increasing awareness of the health risks associated with
tion-based study of drug–alcohol interactions in the United the use of specific medications concurrently with alcohol,
States. This is not surprising, considering that the prior particularly in regular, heavy (or binge) drinkers. Although
study excluded nonprescription medications and that the drinking is common in older adults, increasing awareness
use of prescription and nonprescription medications, to facilitate more-informed decisions about drinking
including alcohol-interacting medications, increases with behavior and medication use is especially important con-
age.1 The higher prevalence of drug–alcohol interactions sidering the increasingly unhealthy drinking patterns iden-
may also be related to the increasing prevalence of tified in older U.S. adults.13
unhealthy drinking in older U.S. adults.2 Although the The use of alcohol-interacting nonprescription medica-
findings are similar to those reported previously,8 tions is particularly noteworthy. More than half of the
JAGS
Table 3. Weighted Prevalence Estimates of Drug–Alcohol Interactions According to Interaction Severity and Therapeutic Class of Alcohol-Interacting Medi-
cation Overall and According to Sex and Age Group (N = 2,975)
57–64, n = 1,015 65–74, n = 1,082 75–85, n = 878
Therapeutic Class, Users Male, n = 525 Female, n = 490 Male, n = 543 Female, n = 539 Male, n = 377 Female, n = 501 Total, N = 2,975
Major severity
Overall, n = 126 5.0 (3.1–6.9) 4.2 (2.2–6.2) 6.0 (4.1–7.9)a 2.3 (1.0–3.7) 5.1 (2.4–7.8) 2.9 (1.0–4.9) 4.3 (3.5–5.1)
NOVEMBER 2015–VOL. 63, NO. 11
Antidiabetics, n = 98a 7.3 (4.7–9.8) 1.1 (0.0–2.2) 5.6 (3.7–7.5)d 1.4 (0.4–2.4) 2.6 (0.9–4.2) 1.4 (0.2–2.6) 3.4 (2.5–4.3)
Analgesic, n = 78 2.1 (0.9–3.2)d 3.5 (1.6–5.4) 3.3 (1.7–5.0) 1.3 (0.4–2.2) 3.8 (1.3–6.3) 2.5 (0.7–4.3) 2.7 (2.0–3.4)
Narcotic analgesic 1.0 (0.0–1.9) 1.3 (0.0–3.0) 1.6 (0.4–2.8) 0.6 (0.1–1.1) 1.0 (0.0–1.9) 0.3 (0.0–0.7) 1.0 (0.5–1.5)
Hydrocodone 0.7 (0.0–1.5) 0.6 (0.0–1.5) 1.4 (0.3–2.6) 0.6 (0.1–1.1) 0.7 (0.0–1.6) 0.3 (0.0–0.8) 0.7 (0.3–1.1)
Oxycodone 0.3 (0.0–0.7) 0.8 (0.0–2.1) 0.2 (0.0–0.6) 0 (0) 0.2 (0.0–0.7) 0 (0) 0.3 (0.0–0.6)
Other analgesic 1.0 (0.1–1.8) 2.0 (0.6–3.5) 1.5 (0.3–2.7) 0.7 (0.0–1.5) 2.2 (0.0–4.4) 2.4 (0.6–4.1) 1.6 (0.9–2.2)
Acetaminophen 1.7 (0.6–2.7) 2.8 (1.0–4.5) 3.1 (1.5–4.7) 1.0 (0.2–1.9) 2.4 (0.7–4.1) 2.1 (0.5–3.7) 2.1 (1.5–2.8)
Tramadol 0.1 (0.0–0.4) 0.9 (0.0–1.8) 0.4 (0.0–1.0) 0 (0) 1.3 (0.0–3.3) 0.4 (0.0–1.0) 0.5 (0.1–0.8)
Moderate severity
Overall, n = 503 20.2 (14.9–25.6)d 14.6 (10.8–18.4) 25.1 (21.3–28.8)d 14.2 (10.4–18.0) 26.3 (20.5–32.1)d 12.9 (8.6–17.2) 18.5 (16.3–20.7)
Analgesic, n = 300 12.1 (8.3–16.0) 6.3 (3.6–9.0) 16.1 (12.7–19.5) 8.7 (5.8–11.5) 17.5 (11.3–23.7) 8.0 (4.6–11.4) 11.0 (9.4–12.7)
Narcotic, n = 3 0 (0) 0.1 (0.0–0.4) 0.2 (0.0–0.6) 0.3 (0.0–0.8) 0 (0) 0 (0) 0.1 (0.0–0.2)
Aspirin, n = 296 12.1 (8.3–16.0) 6.2 (3.5–8.8) 15.9 (12.5–19.3) 8.4 (5.6–11.2) 17.5 (11.3–23.7) 8.0 (4.6–11.4) 10.9 (9.2–12.6)
Psychotropic medication, n = 204 4.9 (2.6–7.2)d 9.9 (7.0–12.9) 9.3 (6.3–12.4) 8.1 (5.3–10.8) 7.7 (4.8–10.7) 6.4 (4.0–8.8) 7.7 (6.6–8.8)
Antidepressant, n = 90 2.2 (0.8–3.6) 5.8 (3.7–7.9) 3.8 (1.8–5.9) 3.4 (1.5–5.3) 1.6 (0.0–3.2) 3.2 (1.2–5.2) 3.5 (2.7–4.3)
Anxiolytic, n = sedative, n = hypnotic, n = 68 2.3 (0.6–4.0) 2.5 (1.1–3.9) 3.0 (1.1–4.8) 2.6 (0.8–4.4) 2.3 (0.9–3.6) 2.0 (0.8–3.2) 2.5 (1.7–3.2)
Vitamin, n = 65 2.2 (0.6–3.8) 2.7 (0.7–4.7) 3.4 (2.0–4.8) 2.3 (0.8–3.7) 4.0 (1.4–6.6) 0.4 (0.0–1.0) 2.5 (1.7–3.2)
Warfarin, n = 45 0.8 (0.0–1.7) 0.9 (0.0–1.9) 2.1 (1.0–3.2) 0.4 (0.0–0.9) 7.0 (4.0–9.9) 0.9 (0.0–1.8) 1.6 (1.1–2.1)
Other, n = 35b 1.6 (0.6–2.6) 1.0 (0.0–2.1) 1.0 (0.0–1.9) 0.7 (0.0–1.4) 2.8 (0.2–5.4) 0.5 (0.0–1.1) 1.2 (0.7–1.7)
Minor severity
Overall, n = 81 1.5 (0.2–2.7)d 4.3 (1.6–7.0) 4.8 (2.4–6.0) 3.0 (1.3–4.6) 4.9 (1.8–8.1)d 1.5 (0.7–2.3) 3.1 (2.4–3.9)
Folic acid, n = 52 1.2 (0.0–2.4) 2.4 (0.5–4.2) 2.8 (1.5–4.0) 2.1 (0.7–3.4) 3.7 (1.1–6.3) 0.4 (0.0–1.0) 2.0 (1.3–2.7)
Beta-blocker, n = 6 0 (0) 0.6 (0.0–1.9) 0.8 (0.0–1.9) 0.2 (0.0–0.7) 0.3 (0.0–0.7) 0 (0) 0.3 (0.0–0.7)
Contraindicated severity, n = 3c 0.1 (0.0–0.4) 0 (0) 0.5 (0.0–1.2) 0 (0) 0 (0) 0 (0) 0.1 (0.0–0.2)
Gastrointestinal bleeding
ter medications and dietary supplements.14 Therefore, peo-
impairment
interactions increases with age, particularly for men, and is
Sedation
Sedation
Bleeding
highest in men aged 75 to 85. Older adults with multiple
chronic conditions, particularly those with liver disease,
–
(6.5–10.6)
(4.8–8.3)
(1.2–3.7)
(3.7–6.8)
(4.3–7.7)
(4.1–7.9)
(2.8–5.0)
(3.3–6.6)
potentially harmful drug–alcohol interactions in these
Overall
P < .05 using chi-square test between aregular and nonregular drinkers and bbetween drinking frequency (≤1, 2–3, ≥4 drinks/d) among regular drinkers.
ularly ask patients about their drinking behavior and medi-
6.6
2.4
5.3
8.5
6.0
6.0
3.9
4.9
26.7
18.9
cation use.
Several medications commonly used in the older adult
Regular Drinkers, Drinks/D, n = 1,106
(15.5–29.2)
(2.4–11.0)
(1.9–10.3)
(7.9–18.1)
≥4, n = 134
(0.0–6.6)
(3.5–9.3)
(0.8–8.1)
(0.9–7.8)
(0.0–4.5)
(0.9–7.8)
6.4
4.5
4.4
1.8
4.4
(4.8–11.4)
2–3, n = 498
(4.3–8.5)
(1.1–4.5)
(3.2–7.5)
(2.6–8.2)
(3.1–8.7)
(2.1–5.4)
(2.0–6.8)
% (95% Confidence Interval)
8.1
5.4
5.9
3.7
4.4
26.6
20.3
(6.6–12.5)b
(4.4–9.0)b
(0.2–3.5)b
(2.8–7.1)b
(4.9–9.3)b
(4.2–8.9)b
(2.9–6.6)b
(3.7–7.6)b
≤1, n = 474
9.6
7.1
6.6
4.7
5.6
27.8
18.9
(10.3–14.2)a
(25.8–31.9)a
(23.1–27.8)a
(10.1–14.6)a
(7.9–11.5)a
(8.3–11.0)a
(2.7–5.5)a
(3.6–5.8)a
Nonregular
(2.8–4.8)
n = 1,869
Drinkers,
28.9
25.4
12.4
4.1
9.7
9.7
5.4
4.7
3.8
(25.3–30.7)
(21.1–24.4)
(8.4–11.4)
(9.3–12.3)
(7.2–9.1)
(4.7–6.5)
(3.7–5.1)
(3.3–5.2)
Overall
8.2
5.6
4.4
4.2
28.0
22.8
10.8
Limitations
This study has several limitations. The potential for drug–
Alcohol-Interacting Medication
Antidepressant
Folic acid
Analgesic
Vitamin
Aspirin
interacting, whereas other software (e.g., Lexi-comp; 2. Merrick EL, Horgan CM, Hodgkin D et al. Unhealthy drinking patterns in
older adults: prevalence and associated characteristics. J Am Geriatr Soc
Wolter Kluwer, Indianapolis, IN) does not. Therefore, the
2008;56:214–223.
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findings may also overestimate the potential for harm 2003;289:1107–1116.
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drinking among older adults: the project SHARE study. J Gen Intern Med
derived based on regular drinkers (≥1 drinks/wk), and the 2010;25:840–846.
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ACKNOWLEDGMENTS mich.edu/NACDA/news.html—nshap/ Accessed June 2013.
13. Merrick EL, Hodgkin D, Garnick DW et al. Unhealthy drinking patterns
The National Institutes of Health, including the National
and receipt of preventive medical services by older adults. J Gen Intern
Institute on Aging, the Office of Research on Women’s Med 2008;23:1741–1748.
Health, the Office of AIDS Research, and the Office of 14. Hensrud DD, Engle DD, Scheitel SM. Underreporting the use of dietary
Behavioral and Social Sciences Research (5R01AG021487) supplements and nonprescription medications among patients undergoing a
periodic health examination. Mayo Clin Proc 1999;74:443–447.
supports NSHAP. The National Opinion Research Center,
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LifeSource, Wilmer Eye Institute at the Johns Hopkins
Bloomberg School of Public Health, Schleicher & Schuell
Bioscience, BioMerieux, Roche Diagnostics, Digene, and SUPPORTING INFORMATION
Richard Williams donated supplies were to NSHAP.
Conflict of Interest: The editor in chief has reviewed Additional Supporting Information may be found in the
the conflict of interest checklist provided by the authors online version of this article:
and has determined that the authors have no financial or
any other kind of personal conflicts with this paper. Appendix S1. Drinking characteristics among older
Author Contributions: Qato: study concept and adults in the United States (N = 2,975).
design. Qato: acquisition of subjects and data. Qato, Lee, Appendix S2. Weighted prevalence estimate of poten-
Manzoor: data analysis and interpretation. Qato, Lee tial drug–alcohol interaction by health conditions overall
Manzoor: manuscript preparation. and by gender and age group.
Sponsor’s Role: The sponsor had no role in the design, Appendix S3. Adjusted weighted prevalence estimates
methods, subject recruitment, data collections, analysis, or of potential drug–alcohol interactions by therapeutic class
preparation of the paper. and drinking frequency among older adults (N = 2,975).
Please note: Wiley-Blackwell is not responsible for the
REFERENCES content, accuracy, errors, or functionality of any support-
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