Relatedly, several studies find that moderate alcohol consumption is not associated with better health outcomes among African Americans, as it is for whites. In the NHANES Epidemiologic Follow-up Study (NHEFS) there was no beneficial effect of moderate alcohol consumption on all-cause mortality for black men or women.26 Moreover, although moderate alcohol consumption tends to be cardio-protective in middle-aged adults, in the Atherosclerosis Risk in Communities (ARIC) study, opposite to the pattern for whites and black females, it was positively related to incident coronary heart disease27 and incident hypertension for black men.28 Similarly, the CARDIA study found a positive association between alcohol consumption and the development of coronary calcification with the absence of a beneficial effect of moderate alcohol consumption being clearest among black males.29 The factors underlying these patterns are not well understood, but it is possible that SES is a contributor. There is considerable evidence that at least some of the reported protective effects of moderate drinking are likely due to residual confounding of moderate alcohol consumption with high SES and good health practices,30–32 and limited evidence that when controls are introduced for multiple measures of SES, the inverse association between moderate consumption and mortality is no longer evident.33
