Per capita alcohol consumption and ischaemic heart disease mortality

Aim. To test the hypothesis that alcohol consumption is inversely related to ischaemic heart disease (IHD) mortality at the population level. Most individual-level studies find a reduced risk of IHD with a moderate level of alcohol consumption, but it is as yet unknown whether this association also exists at the aggregate level. Measurements. The study period was approximately 1950 to 1995; 14 EU countries and Norway were included. Time series analyses on differenced data were utilized, and age-standardized IHD mortality for men and women in the age groups 30-44, 45-59, 60-74 and 30-74 years was measured. The effects of alcohol (sales per capita) were controlled for a weighted lag of per capita sales of cigarettes. Findings. There was a random distribution of insignificant negative and positive alcohol effect estimates. A slight indication of a cardioprotective effect of alcohol among 30- to 44-year-old women in high consumption countries could be observed (significant for Italy). Mean alcohol effect estimates were nearly exactly zero (absent alcohol effect) among men and weakly positive among women. Because changes in cigarette consumption were often significantly and positively related to subsequent changes in IHD mortality, poor validity in the IHD time series cannot explain the unsystematic findings. Including a 6-year weighted lag of alcohol consumption changed the weak positive effect among women to an absent alcohol effect. A brief analysis of abstinence rates indicated no particular relationship to IHD mortality. Conclusion. The alleged cardioprotective alcohol effect is absent at the population level, and great caution should be taken concerning alcohol policies for cardioprotective purposes.     

Population-level relationships between alcohol consumption measures and Ischemic Heart Disease mortality in U.S. time-series

BACKGROUND: Individual-level studies indicate the possibility of both protective and harmful effects of alcohol consumption on Ischemic Heart Disease (IHD) mortality depending on the pattern of consumption. Population-level relationships could be in either direction and previous studies have found mixed results. METHODS: Population-level relationships between IHD mortality rates and per capita consumption of alcoholic beverages, cirrhosis mortality rates, cigarettes, and sugar sweetened soda for the period from 1950 to 2002 are modeled using autoregressive integrated moving average (ARIMA) and vector error correction methods. RESULTS: In multivariate ARIMA models controlling for accumulated heavy drinking as represented by cirrhosis mortality, a protective effect of 4%/l was found for total alcohol consumption while cirrhosis mortality rates had significant positive effects on IHD rates. Beverage-specific models found no effect for wine, positive risks for spirits, and significant protective effects for beer. The protective effects for both total alcohol and beer were also found in vector error correction models. Significant positive effects of cigarette sales on IHD rates were also found in both types of models. CONCLUSIONS: The complexity of alcohol's relationship with IHD is highlighted. Aspects of pattern represented by beverage-specific consumption and cirrhosis mortality indicate potential protective effects from moderate drinking and harmful effects from heavy drinking in accord with individual-level findings.     

Per capita alcohol consumption and ischemic heart disease mortality in a panel of US states from 1950 to 2002

Aims To estimate the overall impact of alcohol on ischemic heart disease (IHD) mortality in the United States using aggregate‐level models and to consider beverage‐specific effects that may represent more effectively the changes in drinking patterns over time that are related to both harmful and protective impacts of alcohol consumption on IHD. Design Several model specifications are estimated, including state‐specific autoregressive integrated moving average (ARIMA) models and generalized least squares (GLS) panel models on first‐differenced data. Setting US states from 1950 to 2002. Participants US general population. Measurements Per capita alcohol sales and cigarette sales, age‐standardized IHD and cirrhosis mortality rates. Findings Apparent consumption of total alcohol was associated with a significant overall increase of IHD of about 1% mortality per litre of ethanol. Beverage‐specific models found that spirits consumption was significantly positively related to IHD mortality overall, for both genders and in three regions defined by drinking culture (or ‘wetness’), while beer was found to have a significant protective relationship overall and in the wet region. The results for wine also suggest a protective relationship, but only marginally significant effects were found. Cirrhosis mortality rates were consistently positively related to IHD mortality. Combined results from state‐specific ARIMA models including both cigarette sales and cirrhosis rates were generally consistent with the GLS results. Conclusions Population‐level models confirm individual‐level findings of both harmful and protective relationships between alcohol use patterns and ischemic heart disease mortality. However, an overall harmful impact of per capita alcohol consumption on IHD mortality was found.     

The cardioprotective association of average alcohol consumption and ischaemic heart disease: a systematic review and meta-analysis

Aims Most, but not all, epidemiological studies suggest a cardioprotective association for low to moderate average alcohol consumption. The objective was to quantify the dose–response relationship between average alcohol consumption and ischaemic heart disease (IHD) stratified by sex and IHD end‐point (mortality versus morbidity). Methods A systematic search of published studies using electronic databases (1980–2010) identified 44 observational studies (case–control or cohort) reporting a relative risk measure for average alcohol intake in relation to IHD risk. Generalized least‐squares trend models were used to derive the best‐fitting dose–response curves in stratified continuous meta‐analyses. Categorical meta‐analyses were used to verify uncertainty for low to moderate levels of consumption in comparison to long‐term abstainers. Results The analyses used 38 627 IHD events (mortality or morbidity) among 957 684 participants. Differential risk curves were found by sex and end‐point. Although some form of a cardioprotective association was confirmed in all strata, substantial heterogeneity across studies remained unexplained and confidence intervals were relatively wide, in particular for average consumption of one to two drinks/day. Conclusions A cardioprotective association between alcohol use and ischaemic heart disease cannot be assumed for all drinkers, even at low levels of intake. More evidence on the overall benefit–risk ratio of average alcohol consumption in relation to ischaemic heart disease and other diseases is needed in order to inform the general public or physicians about safe or low‐risk drinking levels.     

Alcohol and its relation to all-cause and cardiovascular mortality

There exists a considerable body of evidence indicating that light-to-moderate alcohol consumption is associated with a reduced mortality from ischaemic heart disease (IHD). However, an L-shaped saturation curve has been observed in many prospective studies on alcohol consumption and IHD mortality. No further risk reduction is expected if more than 30 grams of ethanol per day is consumed. In ecological studies, particularly wine showed a strongly negative correlation with IHD mortality. This possible specific effect of wine has not yet been confirmed in observational prospective studies. The evidence found in the ecological studies may partly be explained by several healthy dietary habits associated with wine drinking. Although the results of the prospective studies are less consistent for stroke mortality, the largest risk reduction was observed among the drinkers with 10-20 grams of ethanol per day, and then the risk increased. However as an opposite effect of alcohol is expected to ischaemic and haemorrhagic stroke, further studies with consideration to the type of stroke are needed. Several prospective studies demonstrated a J-shaped curve between alcohol consumption and all-cause mortality both in men and women. It is usually explained by a risk reduction of mortality from IHD and stroke among light drinkers. Considering that the risk reduction for all-cause mortality is limited in light-to-moderate drinkers and the reduction is small and that heavy alcohol consumption has an apparently harmful effect, a general increase in alcohol consumption at the population level is not recommended.     

Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol--the case of Canada

Aims To analyse post‐war variations in per capita alcohol consumption in relation to gender‐specific liver cirrhosis mortality in Canadian provinces and to assess the extent to which alcohol bears a different relation to cirrhosis deaths with mention of alcohol (alcoholic cirrhosis) compared to cirrhosis deaths without mention of alcohol (non‐alcoholic cirrhosis). Data and method Annual liver cirrhosis mortality rates by 5‐year age groups were converted into gender‐specific and age‐adjusted mortality rates. Outcome measures included total cirrhosis—the conventional measure of liver cirrhosis—alcoholic cirrhosis and non‐alcoholic cirrhosis. Per capita alcohol consumption was measured by alcohol sales and weighted with a 10‐year distributed lag model. A graphical analysis was used to examine the regional relationship and the Box–Jenkins technique for time‐series analysis was used to estimate the temporal relationship. Findings Geographical variations in alcohol consumption corresponded to variations in total liver cirrhosis and particularly alcoholic cirrhosis, whereas non‐alcoholic cirrhosis rates were not associated geographically with alcohol consumption. In general, for all provinces, time‐series analyses revealed positive and statistically significant effects of changes in alcohol consumption on cirrhosis mortality. In Canada at large, a 1‐litre increase in per capita consumption was associated with a 17% increase in male total cirrhosis rates and a 13% increase in female total cirrhosis rates. Alcohol consumption had a stronger impact on alcoholic cirrhosis, which increased by fully 30% per litre increase in alcohol per capita for men and women. Although the effect on the non‐alcoholic cirrhosis rate was weaker (12% for men and 7% for women) it was nevertheless statistically significant and suggests that a large proportion of these deaths may actually be alcohol‐related. Conclusions Some well‐established findings in alcohol research were confirmed by the Canadian experience: per capita alcohol consumption is related closely to death rates from liver cirrhosis and alcohol‐related deaths tend to be under‐reported in mortality statistics.     

Effect of the Type of Beverage and Meat Consumed by Alcoholics with Alcoholic Liver Disease

We analyzed meat products and alcoholic beverage preference in patients with the three stages of alcoholic liver disease (ALD) compared with controls using diet history data. Daily consumption of total alcohol, types of alcoholic beverages, and types of meat and meat products in grams was obtained by dietary history taken from patients with biopsy proven stage of ALD. A strong association was found between the ALD subjects and total alcohol and beer consumption. There was a significant increase in the consumption of total pig products, pork, and offal in the ALD groups compared with controls. There was a significant positive correlation between beer consumption and pork in alcoholic hepatitis, total pork products in alcoholic hepatitis, and cirrhosis and offal in alcoholic hepatitis and cirrhosis. There was no correlation with the fatty liver stage of ALD. The strongest correlation was between beer and total pig products in the alcoholic hepatitis group. Wine consumption was negatively correlated with the consumption of pig products and beer in the alcoholic cirrhosis group. In conclusion, the association of total pig product consumption with cirrhosis mortality in various countries was validated by personal diet history data obtained from ALD patients in a tested clinical microcosm. The results suggest that this association may be modified by the type of alcoholic beverage that is preferentially consumed.     

Beverage-specific alcohol consumption and cirrhosis mortality in a group of English-speaking beer-drinking countries

Aims. To compare beverage-specific per capita consumption and total alcohol consumption's associations with cirrhosis mortality rates in multiple countries. Design. Pooled cross-sectional time-series analysis. Setting. Australia, Canada, New Zealand, the United Kingdom and the United States during the years 1953-1993. Measurements. National level data on per capita total alcohol, beer, wine and spirits consumption and standardized all-cause cirrhosis mortality rates. Findings. Significant associations with cirrhosis mortality are found for both total ethanol and spirits. Spirits consumption is found to make up the majority of the effect of alcoholic beverage consumption on cirrhosis mortality and the model including only spirits is found to fit the data at least as well as the model including only total ethanol consumption. The lag relationship between all alcohol types and cirrhosis is found to be short with only present and 1 year's lagged consumption having significant associations. Conclusions. Spirits consumption rather than beer or wine is associated with cirrhosis mortality in this group of primarily beer-drinking countries. This finding offers important clues to understanding the drinking behaviors associated with cirrhosis mortality on the individual level.     

Declining cardiovascular disease incidence and environmental components

After rising for many years in the mid-to-late 1960s the mortality from ischaemic heart disease (IHD) began to decline in many countries. This represents a decline in both out-of-hospital (community) and hospital deaths. Non-fatal myocardial infarction (MI) has also declined. A literature review was conducted to examine lifestyle and environmental factors contributing to the decline. Half of the decline is attributable to changes in lifestyle and in the known major risk factors. Changes in nutrition appear relevant to the decline, in particular an increased ratio of polyunsaturated to saturated fat intake and a reduced saturated fat intake overall. There is little evidence to support a role of changing alcohol consumption, changing coffee consumption, changing exercise levels or reduction in excess weight in the declining incidence of IHD. While the benefit of smoking cessation is a clear one, its impact on the differing trends in various countries is not clear. Socio-economic factors appear to influence the rate and extent of decline in IHD in different groups and may help explain some of the regional differences in IHD incidence. Reductions in blood pressure within the ‘normal range’ which may occur with lifestyle changes may also be an important contributor.     

Methodological approaches to conducting pooled cross-sectional time series analysis: the example of the association between all-cause mortality and per capita alcohol consumption for men in 15 European states

AIM: To compare different statistical models in order to estimate the association of alcohol consumption and total mortality when time series data stem from different regions. DATA AND METHODS: Data on per capita consumption in 15 European countries were combined with standardized mortality rates covering different periods between 1950 and 1995. An indicator of region-specific drinking patterns was measured without reference to a concrete time point, thus generating a hierarchical data structure. Two groups of models were compared: pooled cross-sectional time series models with different error structures and hierarchical linear models (random coefficient models). RESULTS: If historical time is not controlled for in cross-sectional models, this might result in estimating a negative association between alcohol consumption and total mortality. Hierarchical linear models or cross-sectional models controlling for historical time, however, resulted in the expected positive association. Only hierarchical linear models were able to adequately estimate the moderating effect of drinking patterns on the association between alcohol consumption and total mortality. CONCLUSION: For pooled cross-sectional time series data, control for the potential impact of historical time is of utmost importance. Hierarchical linear models constitute a superior alternative to analyze such complex data sets, especially as time-independent characteristics of regions can be implemented in the model.     

Alcohol and pancreatitis mortality at the population level: experiences from 14 western countries

Aims To test if there is relationship between alcohol consumption and pancreatitis mortality at the population level. Data and methods Annual pancreatitis death rates for 1950–95 were converted into age‐adjusted mortality rates per 100 000 inhabitants. Per capita alcohol consumption was measured by alcohol sales. The relationship was estimated with time‐series analysis on data from 14 western countries. Several models were tested with different assumptions about risk function and lag structure. Results According to the assumed most appropriate model, a positive relationship was found in each country, and statistical significance was reached in all countries except from Finland, Italy and Canada. The magnitude of the association was fairly consistent across countries, with the alcohol effect parameters ranging between 0.05 and 0.14. However, Sweden and Norway deviated from this pattern with estimates between 0.30 and 0.40. Conclusions Pancreatitis joins a wide range of causes of death where the mortality rate is influenced by per capita alcohol consumption, and more so in northern Europe. It is suggested that pancreatitis mortality is an important indicator of alcohol‐related harm, not least because a large amount of morbidity is likely to be connected to the mortality rate.     

Per capita alcohol consumption and liver cirrhosis mortality in 14 European countries

Aim. To estimate the effects of changes in per capita alcohol consumption on liver cirrhosis mortality rates in various demographic groups across 14 western European countries. Method. Yearly changes in gender- and age-specific mortality rates from 1950 to 1995 were analysed in relation to corresponding yearly changes in per capita alcohol consumption, employing the Box-Jenkins technique for time series analysis. Country-specific estimates were pooled into three regions: northern, central and southern Europe. Measurements. Cirrhosis mortality data for 5-year age groups were converted into gender-specific mortality rates in the age groups 15 +, 15-44, 45-64 and 65 + and expressed as the number of deaths per 100 000 inhabitants. Alcohol sales were used to measure aggregate consumption, which were calculated into consumption (litres 100% alcohol) per year per inhabitant over 14 years of age and weighted with a 10-year distributed lag model. Findings. The country-specific analyses demonstrated a positive and statistically significant effect of changes in per capita consumption on changes in cirrhosis mortality in 13 countries for males and in nine countries for females. The strongest alcohol effect was found in northern Europe, due mainly to a large effect in Sweden. Moreover, when different age groups were analysed significant estimates were obtained in 29 of 42 cases for males and in 20 of 42 cases for females. Most of the non-significant estimates were found in older age groups. Conclusions. The results suggest clearly that a change in the overall level of drinking as a general rule affect cirrhosis mortality in different drinking cultures as well as among different demographic groups. Moreover, the findings correspond with what is expected from the collectivity theory of drinking cultures.     

Trauma in Cirrhosis: An Indicator of the Pattern of Alcohol Abuse in Different Societies

While some morbidities associated with the excessive use of alcohol are related to the total amount of alcohol consumed--cirrhosis being an example--other pathologies, such as trauma and those of psycho-social origin, are mainly related to the frequency of acute alcoholic intoxication rather than to the total amount consumed. The balance between these two types of alcohol-associated morbidities can provide an indication of the relative frequency of intoxication, and thus of the pattern of alcohol abuse in a population. Since trauma is highly associated with acute alcoholic intoxication, the prevalence of bone fractures was determined in cirrhotics in nine countries. The prevalence of rib and vertebral fractures on routine chest x-rays showed a 17-fold variation in the different countries, from 2% and 6% in Spain and Italy to 30% and 34% in Canada and the USA, suggesting marked differences in the pattern of alcohol abuse to intoxication. Conversely, the prevalence of cirrhosis is twice as high in Spain and Italy than in Canada and the USA. A strong positive correlation between per capita consumption and cirrhosis mortality (r = 0.86; p less than 0.01) exists among the nine countries studied, while the correlation between per capita alcohol consumption and the prevalence of trauma is not statistically significant (r = 0.40). Supporting a strong association between trauma and alcoholic intoxication, the prevalence of trauma was found to be highly correlated: r = 0.88, p less than 0.002, with the degree of concern for the psycho-social consequences of alcohol abuse in the different countries. Data indicate that trauma can be used as an objective indicator to assess the pattern of alcohol abuse in a population.     

Population drinking and liver cirrhosis mortality: is there a link in eastern Europe?

AIMS: To analyse the relationship between population drinking and liver cirrhosis mortality in eastern European countries and compare it with similar findings from western Europe. DESIGN AND MEASUREMENTS: Yearly data, from the approximate period 1960-2002, on liver cirrhosis mortality in total and by gender were analysed in relation to per capita alcohol consumption in nine eastern European countries divided into 'spirits countries' and 'non-spirits countries'. The Box-Jenkins technique for time-series analysis was used to estimate the impact on liver cirrhosis resulting from a 1-litre increase in per capita consumption in terms of relative (%) and absolute effects (number of cirrhosis deaths). FINDINGS: Cirrhosis mortality rates were related significantly to population drinking in eight of nine eastern European countries and both relative and absolute alcohol effects laid within the range of previous western European estimates. A 1-litre increase in per capita consumption was on average estimated to cause three to four additional cirrhosis deaths per 100,000 for men and one additional death for women. The absolute effects for men were relatively high in a European perspective: stronger than in mid- and northern Europe and only marginally weaker in comparison with southern Europe. CONCLUSIONS: A reduction in per capita alcohol consumption would prevent many cirrhosis deaths in eastern Europe, particularly for men. It is suggested that further studies of the extent other forms of alcohol-related mortality respond to changes in population drinking in eastern Europe would be valuable.     

Effect of alcoholism treatment on cirrhosis mortality: a 20-year multivariate time series analysis

Substantial empirical evidence suggests that alcohol consumption is an important cause of cirrhosis mortality levels. However, recent research has failed to find the expected positive relationship between consumption and cirrhosis mortality, in both the United States and Canada, when data from the mid-1970s through the late 1980s are analysed. Although recent studies have investigated a number of possible explanations, this study examines the hypothesis that an increase in the provision of treatment for alcoholism resulted in a disjuncture in the established relationship between consumption and cirrhosis deaths. This hypothesis if evaluated with a multivariate time series model in which the relationship between consumption and cirrhosis mortality is estimated with controls for treatment and the unemployment rate, using data from the US state of North Carolina. The results indicate that with treatment controlled, changes in cirrhosis mortality are independent of consumption. Further, treatment has a significant short-term lagged effect on cirrhosis mortality, suggesting that the impact of treatment on chronic alcohol abusers may be one of delaying the consequences of such abuse.     

The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality.

AIMS: To determine the combined influence of leisure-time physical activity and weekly alcohol intake on the risk of subsequent fatal ischaemic heart disease (IHD) and all-cause mortality. METHODS AND RESULTS: Prospective cohort study of 11 914 Danes aged 20 years or older and without pre-existing IHD. During approximately 20 years of follow-up, 1242 cases of fatal IHD occurred and 5901 died from all causes. Within both genders, being physically active was associated with lower hazard ratios (HR) of both fatal IHD and all-cause mortality than being physically inactive. Further, weekly alcohol intake was inversely associated with fatal IHD and had a U-shaped association with all-cause mortality. Within level of physical activity, non-drinkers had the highest HR of fatal IHD, whereas both non-drinkers and heavy drinkers had the highest HR of all-cause mortality. Further, the physically inactive had the highest HR of both fatal IHD and all-cause mortality within each category of weekly alcohol intake. Thus, the HR of both fatal IHD and all-cause mortality were low among the physically active who had a moderate alcohol intake. Conclusion Leisure-time physical activity and a moderate weekly alcohol intake are both important to lower the risk of fatal IHD and all-cause mortality.     

The effect of moderate alcohol consumption on bone mineral density: a study of female twins

BACKGROUND: Osteoporosis is associated with morbidity and mortality, particularly in postmenopausal women. The effect of moderate alcohol intake on bone mineral density (BMD) and fracture risk remains unclear. OBJECTIVE: To carry out a twin study to investigate this effect while controlling for genetic effects and other confounding variables. METHODS: BMD was determined at the hip and lumbar spine in 46 pairs of monozygotic twins discordant for alcohol consumption. Biochemical evidence of altered bone metabolism was sought. RESULTS: A positive association between alcohol consumption and BMD was shown, in contrast to the negative effect of smoking on BMD. Markers of bone turnover were not associated with alcohol or BMD. CONCLUSIONS: Moderate alcohol consumption is not harmful to bone health in women and may even be beneficial. Beneficial effects do not appear to be mediated through an action on bone metabolism.     

Could the high level of cirrhosis in central and eastern Europe be due partly to the quality of alcohol consumed? An exploratory investigation

BACKGROUND: The burden of alcohol-related diseases differs widely among countries. Since the 1980s, a band of countries in Central and Eastern Europe have experienced a steep rise in deaths from chronic liver diseases and cirrhosis. A possible risk factor is the consumption of illegally produced home-made spirits in these countries containing varying amounts of aliphatic alcohols and which may be hepatotoxic. However, little is known about the composition of such beverages. AIMS: To compare the concentration of short-chain aliphatic alcohols in spirits from illegal and legal sources in Hungary. DESIGN: Samples taken from commercial retailers and illegal sources were collected and their aliphatic patterns and alcohol concentrations were determined by gas chromatographic/mass spectrometric (GC/MS) analysis. FINDINGS: The concentrations of methanol, isobutanol, 1-propanol, 1-butanol, 2-butanol and isoamyl alcohol were significantly higher in home-made spirits than those of from commercial sources. CONCLUSIONS: The results suggest that the consumption of home-made spirits is an additional risk factor for the development of alcohol-induced cirrhosis and may have contributed to high level of liver cirrhosis mortality in Central and Eastern Europe. Restrictions on supply and sale of alcohol from illicit sources are needed urgently to reduce significantly the mortality from chronic liver disease.     

Mortality from ischaemic heart disease by country,region, and age: Statistics from World Health Organisation and United Nations

Background

Ischaemic heart disease (IHD) is the leading cause of death worldwide. The World Health Organisation (WHO) collects mortality data coded using the International Statistical Classification of Diseases (ICD) code.

Methods

We analysed IHD deaths world-wide between 1995 and 2009 and used the UN population database to calculate age-specific and directly and indirectly age-standardised IHD mortality rates by country and region.

Results

IHD is the single largest cause of death worldwide, causing 7,249,000 deaths in 2008, 12.7% of total global mortality. There is more than 20-fold variation in IHD mortality rates between countries. Highest IHD mortality rates are in Eastern Europe and Central Asian countries; lowest rates in high income countries. For the working-age population, IHD mortality rates are markedly higher in low-and-middle income countries than in high income countries.Over the last 25 years, age-standardised IHD mortality has fallen by more than half in high income countries, but the trend is flat or increasing in some low-and-middle income countries. Low-and-middle income countries now account for more than 80% of global IHD deaths.

Conclusions

The global burden of IHD deaths has shifted to low-and-middle income countries as lifestyles approach those of high income countries. In high income countries, population ageing maintains IHD as the leading cause of death. Nevertheless, the progressive decline in age-standardised IHD mortality in high income countries shows that increasing IHD mortality is not inevitable. The 20-fold mortality difference between countries, and the temporal trends, may hold vital clues for handling IHD epidemic which is migratory, and still burgeoning.     

Impact of common diseases and habits on daytime sleepiness in adults

We aimed to investigate the impact of common diseases and habits on daytime sleepiness in adults.We retrospectively collected the clinical and overnight polysomnographic data of 2829 adults. The impact of common diseases and habits on the Epworth Sleepiness Scale (ESS) score was analyzed by univariate and multivariate linear regression analyses.The mean ESS score was 6.2 (standard deviation = 4.3; range = 0–24) for all adults. Multivariate linear regression analysis showed that dyslipidemia, acute myocardial infarction (AMI), liver cirrhosis, alcohol drinking, and tea consumption had a significantly positive association with ESS score for all adults after adjusting for age, sex, body mass index, apnea–hypopnea index, sleep efficiency, percentage of sleep N3 stage, and depression. Subgroup analysis by sex showed that AMI, liver cirrhosis, alcohol drinking, and tea consumption had significantly positive association with ESS scores in males, whereas only dyslipidemia had significantly positive association with ESS scores in females. Subgroup analysis by age showed that alcohol drinking had a significantly positive association with ESS scores in young adults. AMI had a significantly positive association with ESS scores, but chronic kidney disease had a significantly negative association with ESS scores in middle-aged adults. Furthermore, dyslipidemia, chronic kidney disease, and cancers had a significantly positive association with ESS scores in older adults.Dyslipidemia, AMI, liver cirrhosis, alcohol drinking, and tea consumption had a significantly positive association with daytime sleepiness in adults but differed by sex and age.