finding the missing units: identifying under-reporting of alcohol consumption in england health...
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Finding the missing units:identifying under-reporting of alcohol consumption in England
Health Surveys User Group meeting 5th July 2011
Sadie Boniface
MRC PhD student (2010-2013)
Department of Epidemiology & Public Health
Reported alcohol consumption is typically only 40-60% of alcohol sales
• Studies worldwide, 1970s-present
• Persistent over time
How is this estimated?
• Reported alcohol consumption (average weekly) =
12.2 units per week per adult 16+
General Lifestyle Survey 2008• Alcohol sales =
20.58 units per week per adult 16+
HMRC 2008/9
Consumption as a % of sales =
Missing 8 units a week for every adult
Where is the missing 40%?
• Drunk by under 16s
• Drunk by people living in institutions (army, hospital, students) or homeless
• Drunk by foreign visitors to England
• Stored to be drunk in future
• Used in cooking
• Wasted/thrown away
Plus…– Deliberate under-reporting
– Accidental under-reporting• Under-estimating units drunk at home
• Forgetting units drunk at home and in public
Public health consequences
J-shaped relationship between alcohol & mortality
Do we all under-estimate equally, or are some people less accurate than others?
Using Health Survey for England (HSE) 2008
What if everyone was only reporting 60% of their consumption?
•Units consumed on heaviest drinking day in the last week
(n=9,608, 99.3% of those who drank in the last week)
•New estimates of…– Drinking above recommended limits (>4/3 units/day)– Binge drinking (>8/6 units/day)
…based on alcohol consumption revised to achieve 100% sales coverage
Revised alcohol consumption in HSE 2008
Using HSE 2008
• Drinking above recommended limits and binge drinking by…
AgeEffect of the revision increases
with age
75-80% drink above recommended limits
up to age 55-64
Binge drinking around 70% 16-24s, 50% 55-64s
Using HSE 2008
• Drinking above recommended limits and binge drinking by…
RegionHighest proportion drinking above recommended limits = North East 85% women and 83% men
60% binged in North,
50% in South
Using HSE 2008
• Drinking above recommended limits and binge drinking by…
Income85% women and 82% men above recommended limits in richest
quintile, compared to 46% women and 70% men in poorest
59% men in richest quintile binged compared to 48% in poorest (consistently around 50% in women)
Using HSE 2008
• Drinking above recommended limits and binge drinking by…
Area deprivation
80% women and 75% men above
recommended limits in each IMD quintile
60% women and 58% men binged in most deprived quintile, less common in less deprived quintiles
In reality, under-reporting will vary
Socio-demographic factors
Drink type
Drinking venue
Total alcohol consumption
AgeEducation
Social class Gender
e.g. wine/spirits harder to measure than beer
2/3 of all alcohol is now consumed in the off-
trade
Heavier drinkers = less accurate?
Exploring under-reporting
• Under-estimating units drunk at home– Quantitative work: questionnaire
& pouring task– Pilot completed (May 2011)– Data collection ongoing
• Forgetting units drunk at home & in public- Qualitative work: participant observation of drinkers
