The changing alcohol drinking patterns among older adults show that women are closing the gender gap in more frequent drinking: the Troms&oslash; study, 1994–2016

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Abstract

Background

As the population of older adults continues to grow, changes in alcohol consumption are important to monitor because an increase may have public health consequences. Rates of alcohol use vary with geographical location. The aim of this study was to examine trends in alcohol consumption among older adults in a geographically defined area in Norway, especially changing sex differences in drinking patterns over a 22-year period.

Methods

Repeated cross-sectional survey (in 1994–95, 2007–08, and 2015–16) of a general population of older adults. Eligible for this study were 20,939 participants (aged 60–99 years). The data were analysed using generalized estimating equations, stratified by age and sex. Alcohol consumption and drinking patterns were assessed, using an adaptation of the AUDIT-C.

Results

Between 1994 and 2016, there has been a significant increase in the proportion of current drinkers among older adults. Furthermore, the probability of frequent drinking (alcohol consumption at least twice weekly) increased significantly between 1994 and 2016, particularly among older women; OR 8.02 (CI 5.97–10.79) and OR 5.87 (CI 4.00–8.63) in the age groups 60–69 and 70+ respectively for women, and OR 4.13 (CI 3.42–4.99) and OR 3.10 (CI 2.41–3.99), in the age groups 60–69 and 70+ respectively for men. The majority of older adults drank small amounts of alcohol on typical drinking days, but there was an increasing probability of drinking three drinks or more on each occasion over the study period, except among women aged 70+ years.

Conclusions

Among older adults in Norway, alcohol consumption in terms of frequency and quantity on typical drinking days has increased considerably from 1996 to 2016. This change is in the opposite direction of what has been reported among younger adults. The gap between women and men in frequent drinking has been markedly narrowed, which indicate that women’s drinking patterns are approaching those of men. This may involve a need to change alcohol policy in Norway to more targeted interventions aimed at older people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-021-00376-9.

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Most cited references 58

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The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.

K Bush, D R Kivlahan, M McDonell … (1998)

To evaluate the 3 alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) as a brief screening test for heavy drinking and/or active alcohol abuse or dependence. Patients from 3 Veterans Affairs general medical clinics were mailed questionnaires. A random, weighted sample of Health History Questionnaire respondents, who had 5 or more drinks over the past year, were eligible for telephone interviews (N = 447). Heavy drinkers were oversampled 2:1. Patients were excluded if they could not be contacted by telephone, were too ill for interviews, or were female (n = 54). Areas under receiver operating characteristic curves (AUROCs) were used to compare mailed alcohol screening questionnaires (AUDIT-C and full AUDIT) with 3 comparison standards based on telephone interviews: (1) past year heavy drinking (>14 drinks/week or > or =5 drinks/ occasion); (2) active alcohol abuse or dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria; and (3) either. Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P = .03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881). Three questions about alcohol consumption (AUDIT-C) appear to be a practical, valid primary care screening test for heavy drinking and/or active alcohol abuse or dependence.

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The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking

Kristen Bush (1998)

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Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

Angela M Wood, Stephen Kaptoge, Adam S. Butterworth … (2018)

Summary Background Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease. Methods We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose–response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th–95th percentile 1·04–13·5]) from 71 011 participants from 37 studies. Findings In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10–1·17), coronary disease excluding myocardial infarction (1·06, 1·00–1·11), heart failure (1·09, 1·03–1·15), fatal hypertensive disease (1·24, 1·15–1·33); and fatal aortic aneurysm (1·15, 1·03–1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91–0·97). In comparison to those who reported drinking >0–≤100 g per week, those who reported drinking >100–≤200 g per week, >200–≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively. Interpretation In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines. Funding UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.

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Author and article information

Contributors

Line Tegner Stelander:

ORCID: http://orcid.org/0000-0001-5721-2811

line.tegner.stelander@unn.no

Journal

Journal ID (nlm-ta): Subst Abuse Treat Prev Policy

Journal ID (iso-abbrev): Subst Abuse Treat Prev Policy

Title: Substance Abuse Treatment, Prevention, and Policy

Publisher: BioMed Central (London )

ISSN (Electronic): 1747-597X

Publication date (Electronic): 26 May 2021

Publication date PMC-release: 26 May 2021

Publication date Collection: 2021

Volume: 16

Electronic Location Identifier: 45

Affiliations

[1 ]GRID grid.412244.5, ISNI 0000 0004 4689 5540, Division of Mental Health and Substance Abuse, , University Hospital of North Norway, ; Postboks 6124, 9291 Tromsø, Norway

[2 ]GRID grid.10919.30, ISNI 0000000122595234, Department of Clinical Medicine, Faculty of Health Sciences, , UiT The Arctic University of Norway, ; Tromsø, Norway

[3 ]GRID grid.418193.6, ISNI 0000 0001 1541 4204, Department of Drug and Tobacco Research, , Norwegian Institute of Public Health, ; Oslo, Norway

[4 ]GRID grid.417292.b, ISNI 0000 0004 0627 3659, Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, ; Tønsberg, Norway

[5 ]GRID grid.5510.1, ISNI 0000 0004 1936 8921, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, ; Oslo, Norway

[6 ]GRID grid.412008.f, ISNI 0000 0000 9753 1393, Department of Addiction Medicine, , Haukeland University Hospital, ; Bergen, Norway

[7 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Department of Clinical Psychology, , University of Bergen, ; Bergen, Norway

Author information

Line Tegner Stelander http://orcid.org/0000-0001-5721-2811

Article

Publisher ID: 376

DOI: 10.1186/s13011-021-00376-9

PMC ID: 8152329

PubMed ID: 34039389

SO-VID: 725fd049-6cdf-41bb-9793-eacdc9a1f63e

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date accepted : 16 April 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100007137, Helse Nord RHF;

Award ID: HNF1467-19

Award Recipient : Ole Kristian Grønli

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: alcohol drinking patterns,alcohol policy,older adults,sex differences,public health,tromsø study,norway

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: alcohol drinking patterns, alcohol policy, older adults, sex differences, public health, tromsø study, norway

The changing alcohol drinking patterns among older adults show that women are closing the gender gap in more frequent drinking: the Tromsø study, 1994–2016

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Abstract

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Most cited references 58

The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.

The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking

Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

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