Economic Living Standard Indices mediate the apparent health benefits of alcohol consumption among older adults

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1 Economic Living Standard Indices mediate the apparent health benefits of alcohol consumption among older adults Michael C. Philipp & Andy Towers Massey University, New Zealand Background The New Zealand Longitudinal Study of Ageing (NZLSA; Alpass et al., 2007) has been undertaken since 2006 to better understand the social, mental, and physical health of older NZ adults.!, Harmful alcohol consumption is prevalent among older adults in New Zealand (Towers et al., 2011), and such consumption is under-assessed in primary care settings (Towers, et al., 2013), Is there a healthy dose effect for alcohol among older adults? Some evidence claims that moderate amounts of alcohol may bestow benefits relative to some ailments (e.g., arthritis; D. Di Giuseppe et al., 2012) This healthy-dose effect persists when controlling for potential confounds (e.g., age, gender, income) However, economic living standards are infrequently assessed in such studies. To what extent do economic living standards improve our understanding of alcohol s relationship with physical health? B =.03* Alcohol Consumption M = 0.91 SD = 1.04 Economic Living Standards M = SD = 5.71 B =.41 B =.86* B =.57* Physical Health M = SD = Method Secondary cross-sectional analysis of existing data from the 2012 NZLSA 814 interview participants (aged 52-86) The SF-12v2 measured Physical Health AUDIT-C measured Alcohol Consumption Economic Living Standard Index (ELSI) Short Form measured living standards NZ Ministry of Social Development ELSI materials at: bit.ly/nz_elsi Also measured: gender, age, smoking status, mental health, education, and annual income Results A hierarchical regression model (above) was used to predict Physical Health (SF-12v2) controlling for gender, age, smoking, mental health, education, and income. at Step 1 (R 2 =.10) alcohol consumption positively predicted physical health (B = 0.86, ± 0.79) drinks per day physical health Drinks per Day at Step 2 (R 2 Δ=.08) ELSI scores positively predicted health (B = 0.57, ± 0.15) and fully mediated the previous relationship between alcohol consumption and health (B = 0.41, ± 0.76). 0 Plotting across ELSI categories (95% CIs) illustrates that both health and alcohol consumption increase with Standards of Living. Conclusions We do not find evidence for a healthy dose effect. Rather, older adults Living Standards explain the correlation between alcohol use & health. Older people with high economic living standards are healthier and consume more alcohol compared to their at-risk counterparts. Future research will examine whether factors like health literacy might further explain this phenomenon. References Alpass et al. (2007). Independence, wellbeing and social participation in an ageing population. Annals of the New York Academy of Science, 1114, Di Giuseppe et al. (2012). Long term alcohol intake and risk of rheumatoid arthritis in women: a population based cohort study. BMJ, 345, e4230 DOI: /bmj.e4230 Towers et al. (2011). Estimating hazardous and binge drinking prevalence in older NZ ers using AUDIT-C and AUDIT-3 thresholds specific to older adults. Drug and Alcohol Dependence. Towers et al. (2013). Exploring the degree of alcohol consumption in the presence of chronic ill health and medication use in older New Zealanders. Presented at APSAD 2013, Brisbane AUSTRALIA [ ] m.philipp@massey.ac.nz [web] bit.ly/mcp_massey download this poster & supplementary info at: bit.ly/mcp_apsad13

2 Poster presented by Dr Michael Philipp of Massey University at the 2013 APSAD Conference, 26 November CONFERENCE DETAILS: Australasian Professional Society on Alcohol and Other Drugs Scientific Conference November 2013 Brisbane Convention & Exhibition Centre POSTER DETAILS: Title: Economic Living Standard Indices mediate the apparent health benefits of alcohol consumption among older adults. Paper number: Michael Philipp, Andy Towers Massey University, Palmerston North, New Zealand Abstract Introduction and Aims: Considerable population health research suggests that alcohol may have beneficial effects on physical health and mortality rates. This healthy-dose finding persists when controlling for potential confounds (e.g., age, gender, income). We explored the degree to which economic living standards further contribute to our understandings of how alcoholic beverages affect health. Design and Methods: A secondary cross-sectional analysis of existing data on a subsample of 814 face-to-face interview participants (aged 52-86) from the New Zealand Longitudinal Study of Ageing (NZLSA). Physical health was measured with the SF- 12v2. Other measures included alcohol consumption behaviours (measured with the AUDIT-C), the Economic Living Standard Index (ELSI) Short Form, and demographic information. Results: A hierarchical regression model initially replicated the effect found in previous research at Step 1 (R2 =.10); the number of daily drinks positively predicted physical health (B = 0.86, ± 0.79) when controlling for gender, age, smoking, mental health, education, and income. However, at Step 2 (R2Δ=.08) ELSI scores strongly predicted physical health (B = 0.57, ± 0.15) and fully mediated the previous relationship between alcohol consumption and physical health (B = 0.41, ± 0.76). Discussion and Conclusions: The positive health benefit associated with alcohol consumption in the NZLSA data is better explained by who is doing the drinking rather than the quantity of drink. Older people with high economic living standards are healthier and consume more alcohol compared to their at-risk counterparts. Future research will investigate whether factors like health literacy might further explain this phenomenon.

3 Poster presented by Dr Michael Philipp of Massey University at the 2013 APSAD Conference, 26 November Variable coding and descriptive analyses VARIABLE SUPPLEMENTARY INFORMATION dichotomous coding Min Max Grand Mean Grand SD ELSI Short Form Score Average daily drinks SF 12 Physical Score Gender 1=male, =female SF 12 Mental Score Age (in years) Smoking: Ever been a regular smoker? 1=yes, 2=no Have no educational qualification? 1=yes, 2=no Ever received a tertiary qualification? 1=yes, 2=no Net Personal Annual Income (NZD)

4 Poster presented by Dr Michael Philipp of Massey University at the 2013 APSAD Conference, 26 November ELSI Analyses ELSI Scores to ELSI Category conversion Information about the ELSI is available at: bit.ly/nz_elsi ELSI Categories: ELSI Standard Score Ranges (short form) Severe Significant Some Fairly Comfortable Comfortable Good Very Good Means of variables by ELSI Category ELSI Categories Severe Significant Some Fairly Comfortab le Comfortab le Good Very Good ELSI Short Form Score Average daily drinks SF 12 Physical Score Gender SF 12 Mental Score Age (in years) Smoking: Ever been a regular smoker? Have no educational qualification? Ever received a tertiary qualification? Net Personal Annual Income (NZD)

5 Poster presented by Dr Michael Philipp of Massey University at the 2013 APSAD Conference, 26 November Hierarchical Regression Statistics Step R R- Square R Square Change Unstandardized Coefficients Step B Std. Error 1 intercept Average daily drinks Gender SF 12 Mental Score Age (in years) Smoking: Ever been a regular smoker? Have no educational qualification? Ever received a tertiary qualification? Net Personal Annual Income (NZD) intercept Average daily drinks Gender SF 12 Mental Score Age (in years) Smoking: Ever been a regular smoker? Have no educational qualification? Ever received a tertiary qualification? Net Personal Annual Income (NZD) ELSI Short Form Score