Alcohol Consumption, Life Course Transitions and Health in Later Life Research Team: Keele University University College of London Clare Holdsworth, PI Nicola Shelton Marina Mendonça Hynek Pikhart Martin Frisher Cesar de Oliveira
Presentation • Introduction to the project • Data and methodology • Findings: – Cross-sectional analysis of drinking profiles and health – Longitudinal analysis of drinking quantity and frequency over time • Policy implications
Research Objectives • To extend understanding of the diversity of patterns of alcohol consumption at older ages; • To identify the socio-demographic dynamics of drinking during later life and the life events that are associated with changes in drinking behaviours; • To explore the relationship between drinking and health conditions in later life; • To establish the importance of secondary survey data in supporting policy initiatives directed towards individual health behaviours; • To inform health policy initiatives on drinking in later life through identifying the risks associated with excessive drinking (binge drinking or drinking more than recommended weekly amounts) and the relationship between alcohol consumption, health and well-being in later life.
Data & Methodology • English Longitudinal Study of Ageing (ELSA): ELSA W0 (HSE): Baseline for alcohol variables 1998 1999 2001 W1 W2 W3 W4 W5 W6 2002/3 2004/5 2006/7 2008/9 2010/11 2012/13 • Practice-informed modeling approach in collaboration with Beth Johnson Foundation • Cross-sectional analysis : Association between alcohol consumption and socio-demographic and health variables • Longitudinal analysis : Sequencing drinking behaviours over life course; link between drinking behaviours and health; identifying whether changes in drinking behaviours are associated with individual characteristics
Table 1: Percentage distribution of drinking profiles by gender, wave 0 . Drinking Variables % Respondents wave 0 Drinking Profiles Drinking Quantity of Frequency of Men Women Status Alcohol drinking Non-drinker Non-Drinker 7 14 Below Occasional Low Risk: 54 64 Recommended (≤ 4 days) Occasional Drinker Limits (Men ≤21 units; Daily Low Risk: 12 8 Women≤ 14 (≥ 5days) Daily Drinker units) Drinker Above Occasional Focal Drinker 7 3 Recommended (≤ 4 days) Limits (Men > 21 units Daily Heavy Drinker 20 11 Women > 14 (≥ 5days) unit) Number of cases = 11205
Figure 1: Percentage Distribution of Drinking profiles by age and gender: wave 0 Non-drinker Low Risk:Occas. Low risk: Daily Focal Heavy 80 70 60 50 40 30 20 10 0 Men 45-64 Women 45- Men 65-74 Women 65- Men 75+ Women 75 + 64 74 Number of cases = 11205
Figure 2: Percentage of drinking profiles with poor self-rated: wave 0 and wave 5 Wave 0 20 Wave 5 18 16 14 12 10 8 6 4 2 0 Non-drinker: Non-drinker: Low Risk Steady Focal Heavy Always Stopped drinking Number of cases = 5868
Figure 3a and b: Unadjusted and adjusted odds ratios predicting poor self rated health: Unadjusted odd ratios Reference: Occasional Drinker 10 Odds ratios Log scale 1 0.1 Low risk: Low risk: daily Focal: Focal: High Heavy: Heavy: High weekly Hazardous Risk Hazardous Risk Adjusted odds ratios Reference: Occasional Drinker 10 Odds ratios: Log scale 1 0.1 Low risk: Low risk: daily Focal: Focal: High Risk Heavy: Heavy: High weekly Hazardous Hazardous Risk Adjusted for: Age, gender, wealth, social class, education, household size, smoking, BMI
Longitudinal Analysis • Multilevel level longitudinal analysis using alcohol variables in waves 0, 4 and 5 • Quantity: – Growth curve model of log of weekly units of alcohol consumed – Restricted to drinkers in at least 1 time point (3610 valid cases) • Frequency – Ordered logistic regression using frequency of drinking in last 12 months – Restricted to respondents at all 3 time points (4740 valid cases)
Figure 4: Average weekly units over time by gender 1011121314151617181920 1 2 3 4 5 6 7 8 9 0 4 5 wave sex=male sex=female
Table 2: Average weekly units consumed for synthetic profiles of older people Pauline: Pearl: Doreen: Dorothy: In partnership, Not in partnership, In partnership, Working, During 10 year period: • Retired, Good Retired, Good health, Loses partner, retires health, Not in good health, University degree , & health deteriorates Some qualifications, No qualifications, Former smoker, A level qualifications Non-smoker, Non-smoker, Highest wealth group Non-smoker, Above Average Wealth Lowest wealth group average wealth Age 60 Age 70 Age 80 Age 90 Age 50 Age 60 Age 60 Age 70 3.95 3.50 (11%) 3.43 2.92 (15%) 11.92 10.18 (15%) 5.84 4.54(22%) Paul: Peter: Duncan: Derek: In partnership, Not in partnership, During 10 year period: During 10 year period: • • Retired, Good Retired Gets married Loses partner, retires health, Some Not in good health Working, Good health, & health deteriorates qualifications, Non- No qualifications University degree, A level qualifications smoker, Average Non-smoker Former smoker, Non-smoker Wealth Lowest wealth group Highest wealth group Above average wealth Age 65 Age 75 Age 80 Age 90 Age 50 Age 60 Age 60 Age 70 6.75 5.76 (15%) 7.47 6.04 (19%) 33.80 28.0 (17%) 7.76 6.81 (12%)
Figure 5: Percentage distribution of drinking frequency waves 0 and 5 Wave 0 30 Wave 5 25 20 15 10 5 0 Did not Drinks Drinks Drinks Drinks Drinks Drinks Drinks drink in Once or once once or one to three to five to six almost last year twice a every twice a two days four days days a every day year couple of month a week a week week months Number of cases = 4780
Table 3: Summary of results of longitudinal model of frequency of drinking - 1 Variable Men Women -0.11 -0.16 Time (continuous variable) Partnership status Reference: Always in partnership • Always out of partnership 0.28 -0.07 • Enters into partnership between waves 0.56 0.47 • Partnerships ends between waves 0.03 -0.08 Employment status Reference: Always in work • 0.55 Always retired 0.28 • Transition to retirement between waves -0.08 0.13 Health: Reference always in good health -0.61 -1.21 • Always in poor health • Health worsens between waves -0.25 -0.12 • -0.77 -0.76 Health improves between waves
Table 3: Summary of results of longitudinal model of frequency of drinking - 2 Men Women Wealth Quintile Reference category: Bottom Quintile 0.48 0.52 • 2 nd Quintile 0.63 0.80 • 3 rd Quintile 0.75 1.42 • 4 th Quintile 1.41 1.97 • 5 th Quintile Education: Reference: No qualifications • 0.59 Some qualifications 0.28 • 0.39 0.80 A-level or equivalent • 1.41 1.16 Degree
Table 3: Summary of results of longitudinal model of frequency of drinking - 3 Variable Men Women Partnership status * Time Reference: Always in partnership -0.10 -0.09 • Always out of partnership • Enters into partnership between waves -0.01 -0.07 • -0.07 Partnerships ends between waves -0.02 Health: * Time Reference always in good health • -0.14 -0.12 Always in poor health • -0.09 -0.13 Health worsens between waves • Health improves between waves -0.06 -0.02
Main Findings: Drinking, socio-economic status and partnership • Older men tend to drink more and to drink more often than women. • Men and women in higher income groups and with higher levels of education drink more and drink more frequently. • Both the amount that older people drink and how often they drink declines over time. • Men who are not in a partnership drink more compared to men with a partner, though there is no difference in the frequency of men’s drinking by partnership status. • For women loss of a partner is associated with a faster decline in weekly alcohol consumption and with drinking less often.
Main Findings: Drinking in later life and health • Poorer self-rated health is associated with not drinking. • Among drinkers, there is no evidence that a moderate amount of alcohol consumption improves health in later life compared to heavy drinking. • Over time older people with poor self-rated health and deteriorating health report a steeper decline in the quantity and frequency of alcohol consumed (similar finding for depression). • Those who stopped drinking at the start of the period of observation and remained in the study were more likely to experience an improvement in health compared to drinkers.
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