Epidemiologic survey data were used to examine relationships between alcohol use and abuse and the physical and mental health status of elderly public housing residents (weighted n = 865) and to determine the influence that drinking behavior had on mortality. Residents with a current alcohol disorder (4%) were more likely to rate their physical health as fair/poor but had fewer major medical illnesses, functional impairments, and other current psychiatric disorders. Individuals with a current or past alcohol disorder (22%) were more likely than others to die (odds ratio [OR] = 7.5) during the 28-month follow-up period. In multivariate analyses, women with a past alcohol disorder were more likely than lifetime abstainers to die (OR = 21.9). Drinking behavior was not predictive of death in men. The high prevalence of alcohol disorder and its strong influence on mortality in this predominantly African-American female population demonstrate the need for programs designed to prevent and treat alcoholism in public housing developments for the elderly.