Trends in socioeconomic inequalities in behavioural non-communicable disease risk factors: analysis of repeated cross-sectional health surveys in England between 2003 and 2019.

BACKGROUND: Previous studies have shown that those in lower socioeconomic positions (SEPs) generally have higher levels of behavioural non-communicable disease (NCD) risk factors. However, there are limited studies examining recent trends in inequalities. This study examined trends in socioeconomic inequalities in NCD behavioural risk factors and their co-occurrence in England from 2003-19. METHODS: This time-trend analysis of repeated cross-sectional data from the Health Survey for England examined the relative index of inequalities (RII) and slope index of inequalities (SII) in four NCD behavioural risk factors: smoking; drinking above recommended limits; insufficient fruit and vegetables consumption; and physical inactivity. FINDINGS: Prevalence of risk factors has reduced over time, however, this has not been consistent across SEPs. Absolute and relative inequalities increased for physical inactivity; relative inequalities also increased for smoking; for insufficient fruit and vegetable consumption, the trends in inequalities depended on SEPs measure. Those in lower SEPs experienced persistent socioeconomic inequalities and clustering of behavioural risk factors. In contrast, those in higher SEPs had higher prevalence of excessive alcohol consumption; this inequality widened over the study period. INTERPRETATION: Inequalities in smoking and physical inactivity are persisting or widening. The pattern of higher drinking in higher SEPs obscure the fact that the greatest burden of alcohol-related harm falls on lower SEPs. Policy attention is required to tackle increasing inequalities in smoking prevalence, low fruit and vegetable consumption and physical inactivity, and to reduce alcohol harm.

Trends in cardiovascular disease risk factors by BMI category among adults in England, 2003-2018.

OBJECTIVE: This study aimed to estimate trends in cardiovascular disease risk factors by BMI category among adults in England (n = 115,860). METHODS: Risk factors included cigarette smoking, hypertension, total diabetes, and raised total cholesterol. Risk factor prevalence was computed in the following four 4-year time periods: 2003-2006; 2007-2010; 2011-2014; and 2015-2018. Change was computed as the difference between the first and last time periods, expressed in percentage points (PP). RESULTS: Hypertension remained at a stable level among men with normal weight but decreased among men with obesity (-4.1 PP; 95% CI: -7.1 to -1.0). Total diabetes remained at a stable level among adults with normal weight but increased among adults with obesity (men: 3.5 PP, 95% CI: 1.2 to 5.7; women: 3.6 PP, 95% CI: 1.8 to 5.4). Raised total cholesterol decreased in all BMI groups but fell more sharply among women with obesity (-21 PP; 95% CI: -25 to -17) versus their counterparts with normal weight (-16 PP; 95% CI: -18 to -14). CONCLUSIONS: Greater reductions in hypertension and raised total cholesterol among adults with overweight and obesity partially reflect improvements in screening, treatment, and control among those at highest cardiovascular risk. Higher levels of risk factor prevalence among adults with overweight and obesity, in parallel with rising diabetes, highlight the importance of national prevention efforts to combat the public health impact of excess adiposity.

The association between alcohol consumption and sleep disorders among older people in the general population.

The relationship between alcohol consumption and sleep disturbance is complex. The association of alcohol dependence with insomnia is likely to be bidirectional in nature. Alcohol use is common among older people in many societies and the prevalence of insomnia tends to increase with age, therefore this group warrants particular consideration. We explored the cross sectional and long term (30 years) associations between alcohol drinking (volume and hazardous drinking) and sleep duration and insomnia in a general population study of older adults (6,117 male and female civil servants followed for 30 years). For men, drinking more than 21 units (approximately 168 grams) of alcohol per week, compared with not drinking, was associated with waking several times a night (odds ratio 1.30, confidence intervals 1.02-1.66). Men who maintained a heavy volume of drinking over the three decades of observation, or who had an unstable consumption pattern, tended to have worse sleep profiles in terms of waking tired and waking several times. Sustained male hazardous drinking (as measured by the AUDIT-C scale) was also associated with worse sleep profiles. Findings for women were not so clear. In this population based setting, drinking high volumes of alcohol may contribute to the prevalence of sleep problems in older age, particularly for men. People in this age group should be discouraged from using alcohol as a sleep aid.