Taking a life-course perspective – does previous drinking matter? Annie Britton Research Department of Epidemiology and Public Health University College London Follow us on 1

Outline: 1.Why might previous drinking matter? 2.What do alcohol trajectories over life-course look like? 3.Why do people change drinking behaviour as they age? 4.DOES previous drinking matter when estimating harm? 2

1. Why might previous drinking matter? 3

Evidence on health consequences of alcohol consumption comes from observational cohort studies Alcohol (baseline) Health outcome (decades later) Ignores changes in consumption over the life-course Ignores cumulated effects over life-course Ignores “critical” age-specific effects 4

Alcohol trajectories across the life-course 5

Trajectories across the life-course 6

2. What do alcohol trajectories over life course look like? 7

Cohorts included so far…  MRC NHSD 1946 British Birth Cohort Study (N= 3,552)  NCDS 1958 British Birth Cohort Study (N= 14,651)  1970 British Birth Cohort Study (N=12,594)  UK Whitehall II Cohort study (N= 10,284)  English Longitudinal Study of Ageing (N= 10,924)  West of Scotland Twenty s (N= 1,485)  West of Scotland Twenty s (N=1,432)  West of Scotland Twenty s (N=1,551)  Caerphilly Prospective Study (N=2,906)  European Prospective Investigation into Cancer-Norfolk (N= 24,255) COMBINED SAMPLE 83,600 individuals with 200,000+ alcohol observations 8

Harmonisation Alcohol volume: Mean weekly consumption derived from each cohort Frequency: “none in past year”, “monthly/special occasions”, “weekly infrequent”, “weekly frequent” Covariates: Smoking, social class, physical activity, diet, ethnicity… Outcomes: Death, CHD, biomarkers… 9

Life time drinking 10 Predicted mean alcohol consumption trajectories (in units of alcohol per week) and 95% CI across the life course in 9 UK cohort studies MenWomen Britton et al. Life-course trajectories of alcohol consumption in the UK using longitudinal data from nine cohort studies. BMC Medicine 2015

Results: Combined predicted mean alcohol 11 Britton et al. Life-course trajectories of alcohol consumption in the UK using longitudinal data from nine cohort studies. BMC Medicine 2015

Results: 12 Britton et al. Life-course trajectories of alcohol consumption in the UK using longitudinal data from nine cohort studies. BMC Medicine 2015

Results: 13 Britton et al. Life-course trajectories of alcohol consumption in the UK using longitudinal data from nine cohort studies. BMC Medicine 2015

Results: 14 Britton et al. Life-course trajectories of alcohol consumption in the UK using longitudinal data from nine cohort studies. BMC Medicine 2015

Alcohol consumption is clearly not a stable behaviour So why are we ignoring that fact in much of the harm evidence…? 15

3. Why do people change their drinking behaviour as they age? 16

Reasons for change in consumption Britton & Bell. Reasons for change in alcohol consumption in later life: Findings from the Whitehall II cohort Plos One 2015 Very few studies examine why people change their consumption in later life 6,011 participants (72% men) from Whitehall II Study aged 60–85 years 17

18 Britton & Bell. Reasons for change in alcohol consumption in later life: Findings from the Whitehall II cohort Plos One 2015

19 Britton & Bell. Reasons for change in alcohol consumption in later life: Findings from the Whitehall II cohort Plos One 2015

Reasons for change: Results 40% men and 41% women reduced their consumption 12% men and 9% women increased their consumption Most common reasons for decreases were health precaution (45% men) and fewer social occasions (46% men) Most common reasons for increases were more social occasions (54% women) and fewer responsibilities (38% men) 20 Britton & Bell. Reasons for change in alcohol consumption in later life: Findings from the Whitehall II cohort Plos One 2015

Reasons for change: Results Those in lowest social position were less likely to increase consumption Those in highest social position more less likely to reduce as a health precaution Women were more likely to increase consumption in response to stress/depression than men 21 Britton & Bell. Reasons for change in alcohol consumption in later life: Findings from the Whitehall II cohort Plos One 2015

There are many reasons why people change their drinking as they age The reasons vary by social position and gender, amongst other things 22 Britton & Bell. Reasons for change in alcohol consumption in later life: Findings from the Whitehall II cohort Plos One 2015

4. Does previous drinking matter when estimating (chronic) harm? 23 All cause mortality Coronary heart disease Inflammatory markers Atherosclerosis Cognitive functioning Pulse wave velocity

Alcohol trajectories and CHD Data from the Whitehall II cohort of civil servants – 24 years of alcohol consumption, (n=6,870 men) Joint latent class models for longitudinal and time to event data 24 Bell et al. Longitudinal typologies of alcohol consumption and coronary heart disease: a 24 year prospective cohort study of middle-aged men 2016 In preparation

Findings – Predicted typologies in Whitehall II men 25 Bell et al. Association of longitudinal typologies of alcohol consumption and coronary heart disease: a 24 year prospective cohort study of middle-aged men 2016 In preparation

Findings – Typologies and CHD probabilities 26 Bell et al. Association of longitudinal typologies of alcohol consumption and coronary heart disease: a 24 year prospective cohort study of middle-aged men 2016 In preparation

20 year alcohol trajectories and atherosclerosis Whitehall II cohort and 1946 birth cohort (n=5,403) Created 5 alcohol typologies ( above and below UK Guidelines ): 1.Stable non-drinkers 2.Stable moderate 3.Stable hazardous 4.Non-stable drinkers 5.Former drinkers 27 Britton et al. Twenty-year trajectories of alcohol consumption and atherosclerotic thickening in early old age: findings from two British population cohort studies Under review

Cross-sectional 28 Britton et al. Twenty-year trajectories of alcohol consumption and atherosclerotic thickening in early old age: findings from two British population cohort studies Under review Reference: (stable) moderate drinkers

Cross-sectional 29 Trajectory based Britton et al. Twenty-year trajectories of alcohol consumption and atherosclerotic thickening in early old age: findings from two British population cohort studies Under review Reference: (stable) moderate drinkers

Does previous drinking matter when estimating harm? 30 Drinking is not a stable behaviour Previous drinking trajectories vary by gender, social position etc.. Past drinking appears to have an effect on some chronic conditions Where possible, take a life-course approach

Acknowledgements All participants & study team members Funding: Contact details: 31