Changes in Alcohol Intake by Educational Level Among Older Men and Women in Spain During the 21st Century

Abstract

Background and objectives: Despite alcohol use being very common in older adults, studies are scarce and suggest alcohol use may be increasing. Furthermore, despite the known relationship between education and alcohol consumption, there is limited evidence of educational differences in older adults. Our objective was to describe trends in alcohol consumption in individuals aged ≥65 by sex and educational level in Spain. Research design and methods: In total, 43,157 participants aged ≥65 years were drawn from Spain's national health surveys between 2001 and 2020, representing the noninstitutionalized population. The outcomes were various measures of self-reported past-year alcohol intake. Age-standardized rates and negative binomial regression models were used to examine trends and differences in alcohol intake by educational level, sex, and period (2001-2009 vs 2011-2020). Results: The average daily alcohol intake and prevalence of heavy average drinking (>20/10 g/day) decreased over time, especially among men, whereas moderate average drinking remained unchanged or even increased. Alcohol intake increased with increasing educational levels. All drinking measures showed educational inequalities, and these were greater in women than men. The mean amount of drinking showed the greatest inequality, with adjusted prevalence ratio of 2.6 in women and 1.1 in men between university relative to primary education level. Discussion and implications: Alcohol intake in older adults decreased over time in Spain for heavy average drinking and average drinking amount, although not for moderate average drinking. Consumption remains highest among the highest educational levels, which may negatively affect health. Programs addressing alcohol consumption among older adults are needed to minimize alcohol-related harm.