Drinking profiles, social capital and health in later life

(2013-2014)

Clare Holdsworth (PI) Nicola SheltonMarina Mendonça Hynek Pikhart

Martin Frisher Cesar Oliveira

Background

• Levels of alcohol consumption increased for middle and older age groups in the last 30 years for both men and women (Smith and Foxcroft, 2009).– Cohort effect (i.e. Generation)– Period effect (e.g. more financial resources)– Age (e.g. active ageing and greater life expectancy)

• Number of elderly population expected to increase 38% in the UK by 2031 (IAS, 2010): Alcohol consumption among the elderly - cause of public concern

Background

• U-shape relationship between alcohol consumption and health: Poorer health associated with abstainers (e.g. ‘sick-quitter’ hypothesis ) or excessive drinkers (e.g. Polen et al, 2010).

• Relation between drinking and health contradictory in older ages:– Alcohol consumption associated with more physical and mental health

problems and higher mortality rates (e.g. Crome, et al. 2011; Dar, 2006; NHS Information Centre, 2008)

– But, some studies found no association between levels of alcohol consumption and health (e.g. Lang, et al., 2007).

Background• Alcohol consumption and health moderated by social capital (Bloomfield

et al., 2006; Marmot 2005) – Alcohol Harm Paradox: Higher social position associated with higher

alcohol consumption and better health, whereas alcohol-related illness and mortality linked with deprivation.

• Research on drinking behaviours focused both on quantity and frequency of drinking. – But findings suggest that they are not equally associated with health

and social capital

• Unpacking complexity : Explore relationship between different drinking behaviours/profiles and its association with health and social capital

Aims

• To identify and characterize drinking profiles in older age

• To analyse how these drinking profiles are associated with social capital, health and socio-demographic characteristics

Data

ELSA W0 (HSE): Baseline for alcohol variables

• Present study: – W0: Drinking and health variables– W1: Social capital variables

1998 1999 2001

W62012/13

W42008/9

W52010/11

W32006/7

W22004/5

W12002/3

N = 11205

English Longitudinal Study of Ageing (ELSA): Panel study of people living in England aged 50 and older

Drinking VariablesDrinking Profiles

Drinking Status Amount of Alcohol Frequency of drinking

Non-drinker Non-Drinker

Drinker

Below Limits

(Men ≤21 units;

Women≤ 14 units)

Occasional

(≤ 4 days)Low Drinker

Daily

(≥ 5days)Steady Drinker

Above Limits

(Men > 21 units

Women > 14 unit)

Occasional

(≤ 4 days)Focal Drinker

Daily

(≥ 5days)Heavy Drinker

Social Capital & Health Variables

Level of Education Wealth Quintiles SES Self-Rated Health

Socio-demographic

Age Marital Status

Variables

VariablesMen (%)

(n = 5057)

Women (%)

(n = 6148)

All (%)

(N = 11205)

Mean age at baseline 62.09 (9.97) 62.63 (10.49) 62.39 (10.26) 45-64 60.90 59.22 59.98 65-74 25.71 24.69 25.15 75 + 13.39 16.09 14.87Marital Status Single 6.39 4.98 5.62 Married/remarried 76.03 61.04 67.81 Separated/divorced 9.20 12.32 10.91 Widowed 8.39 21.66 15.67Educational Qualification No qualification 37.00 48.01 43.04 Intermediate 35.58 34.73 35.11 High 27.42 17.25 21.84Wealth Bottom quintile 17.77 21.07 19.57 2nd quintile 19.88 20.11 20.00 3rd quintile 19.74 20.17 19.97 4th quintile 21.02 19.21 20.03 Top quintile 21.60 19.44 20.42SES Manual 50.36 36.40 42.69

Non Manual 48.27 59.79 54.60

Self-Rated Health Poor Health 9.81 8.39 9.03 Fair Health 23.75 25.07 24.48 Good Health 66.44 66.54 66.49

Descriptives: Socio-demographic, social capital and health variables by gender

Descriptives: Percentage distribution of drinking patterns by gender

Non-drinker Low Steady Focal Heavy

7.36

53.55

12.197.16

19.7513.86

64

8.182.67

11.29

Men Women

Multinomial Logistic Regression: Odds of being Steady and Heavy/Binge Drinker versus Low Drinker Note: *** p<.001, **p<.01, *p<.05

Steady Heavy/Focal

Men Women Men Women

Age groups (Ref: 45-64) 65-74 1.54*** 1.94*** .75** .92 75+ 2.21*** 3.05*** .53*** .78Mar. Stat. (Ref: Married) Single 1.38 .67 1.60** .79

Separated/divorced .76 .80 1.46** 1.06

Widowed .96 .81 1.57** .93

Self-Rat. Heal. (Ref: Poor)

Fair .90 .92 1.24 .82 Good .71 1.03 1.46** 1.03

Educ. Qual. (Ref.:No qual.)

Intermediate 1.14 1.25 1.19* 1.27*

High 1.45** 1.77*** 1.45*** 1.57***Wealth (Ref.:Bottom) 2nd 1.08 1.12 1.04 1.08 3rd 1.28 1.08 .86 1.02 4th 1.77** 1.55* 1.01 1.33 Top 2.36*** 2.47*** 1.34* 2.00***SES (Ref.: Manual)

Non Manual 1.17 1.41** .97 1.63***

Summary• Gender: Important moderator of drinking behaviours. Men are more likely

to be drinkers and to be heavy/focal drinkers than women. • Age: Older participants are more likely to be steady drinkers, while those at

‘younger’ older ages are more likely to engage in heavy/focal drinking. • Health: Drinking profiles are generally not associated with self-rated health,

but male heavy drinkers are more likely to report better health.

• Social Capital: People in higher social position are more likely to be steady and heavy drinkers. This association is stronger for women.

• Marital Status: Being married seems to be a protective factor for men against heavy drinking

Thank you for your attention!

For further information please contact mmendonca@keele.ac.uk

Variables Men (%)(n = 5057)

Women (%)(n = 6148)

All (%)(N = 11205)

Mean age at baseline 62.09 (9.97) 62.63 (10.49) 62.39 (10.26)45-64 60.90 59.22 59.9865-74 25.71 24.69 25.15≥75 13.39 16.09 14.87

Marital StatusSingle 6.39 4.98 5.62Married/remarried 76.03 61.04 67.81

Separated/divorced 9.20 12.32 10.91Widowed 8.39 21.66 15.67

Educational QualificationNo qualification 37.00 48.01 43.04Intermediate 35.58 34.73 35.11High 27.42 17.25 21.84

WealthBottom quintile 17.77 21.07 19.572nd quintile 19.88 20.11 20.003rd quintile 19.74 20.17 19.974th quintile 21.02 19.21 20.03Top quintile 21.60 19.44 20.42

SESManual 50.36 36.40 42.69

Non Manual 48.27 59.79 54.60

Self-Rated HealthPoor Health 9.81 8.39 9.03Fair Health 23.75 25.07 24.48Good Health 66.44 66.54 66.49

Drinking ProfilesNon-drinkers 7.36 13.86 10.93Low drinkers 53.55 63.99 59.28Steady drinkers 12.19 8.18 9.99

Focal drinkers 7.16 2.67 4.70Heavy drinkers 19.75 11.29 15.10

Descriptives: Sociodemographic, Health and Drinking Variables by Gender