Health Survey for England, 2021 part 1

The health risks associated with drinking alcohol include accidents, injuries, cancer, heart disease and reduced life expectancy (Source: Department of Health). These risks tend to increase with higher consumption.

Since 2016, UK guidelines have focused on regular weekly consumption, with the recommendation that men and women should not normally consume more than 14 units of alcohol a week, and that this should include some days where no alcohol is drunk (Source: Department of Health). Guidance on single drinking episodes focuses on reducing risks rather than specific quantities. 

The Health Survey for England (HSE) has asked about drinking alcohol since it began in 1993. Since 2011, the questionnaire has included the following areas covered by this report:

• Frequency of drinking in the last 12 months (including those who never drink)
• The frequency of drinking different types of drink and the amounts of each drunk on a typical day in the last 12 months (providing average weekly consumption)
• Number of drinking days in the last week

These questions were asked as part of the interview. In 2019, all young adults aged between 16 and 24 answered questions about drinking alcohol in a computer-assisted self-completion interview (CASI) which guaranteed that their answers were confidential. In 2021, young adults were asked about drinking as part of the telephone interview.

Alcohol consumption is reported in terms of units of alcohol; one unit of alcohol is 10ml by volume of pure alcohol. Table A shows the conversion factors used currently. Those who drank bottled or canned beer, lager, stout or cider were asked in detail about what they drank, and this information was used to estimate the amount in pints.

The HSE measures average weekly consumption and does not take into account varying patterns of consumption, for example, at different times of year. By definition, it does not reflect occasions when consumption might be higher or lower than usual, for instance, holidays, celebrations or periods of fasting.

Measures of usual weekly consumption are presented in line with the current guidelines for sensible drinking. 

• Lower risk (up to 14 units for men and women)
• Increasing risk (above 14 and up to 50 units for men, above 14 and up to 35 units for women)
• Higher risk (above 50 units a week for men, above 35 units for women).

One unit of alcohol is 10ml by volume of pure alcohol.

In 2021, 79% of participants reported that they had drunk alcohol in the last 12 months, and 49% reported that they drank alcohol at least once a week. A higher proportion of men than women had drunk alcohol in the last 12 months (82% and 76% respectively). 57% of men and 43% of women drank alcohol at least once a week.

The proportion who drank alcohol in the last 12 months increased with age, from 62% of 16 to 24 year olds to 85% of 55 to 74 year olds, and was lower in the oldest age group (77% of those aged 75 and over). There was a similar pattern for drinking at least once a week. Those aged 16 to 24 were least likely to drink at least once a week (31%) and those aged between 55 and 64 years old were the most likely to do so (59%).  

For more information: Table 10.

These estimates are based on typical consumption across the year and do not represent consumption in any specific week.

In 2021, a minority of adults, 21%, had not drunk alcohol in the last 12 months. 57% of adults drank at levels which put them at lower risk of alcohol-related harm, that is 14 units or less each week. 21% of adults drank at increasing or higher risk of alcohol-related harm (more than 14 units per week).

Among those adults that drank alcohol, the average (mean) amount drunk was 11.6 units of alcohol in a typical week (14.7 units for men and 8.5 units for women).

There were some differences between men and women in typical weekly alcohol consumption, with women more likely not to drink or drink at lower levels than men.

• 19% of men and 24% of women did not drink alcohol in the last 12 months.
• 54% of men and 61% of women drank at levels that put them at lower risk of alcohol-related harm.
• A higher proportion of men (28%) than women (15%) drank at increasing or higher risk levels (over 14 units in the last week for both men and women.
• Men were more likely than women to drink at increasing risk levels (23% and 13% respectively).
• 5% of men drank over 50 units a week and 2% of women usually drank over 35 units a week (higher risk levels) in a week.

The proportions of men and women who usually drank more than 14 units in a week varied across age groups, increasing up to the age of 55 to 64 (28% of all adults, 36% and 21% of men and women respectively). The proportions drinking at these levels then declined among both sexes, from the age of 75 and above for men and age 65 and above for women. Across all age groups, men were more likely than women to drink at increasing or higher risk levels.

For more information: Table 11.

Regional data are shown in the data tables, both as observed and age-standardised estimates. Observed data show the actual prevalence rate found in the survey. Age-standardised data take into account the different age profiles within regions enabling comparisons between regions. 

There were differences between regions in weekly alcohol consumption estimates. After controlling for age, the highest proportion of non-drinkers in the last 12 months was in the West Midlands (30%) and the lowest in the South West (14%).

Among men, the highest proportion of non-drinkers was in the West Midlands (28%) and the lowest proportion was in Yorkshire and the Humber (10%). Among women, the highest proportions were in London and the West Midlands (32% for both), and the lowest proportion was in the South West (14%).

The proportions of men and women who drank more than 14 units of alcohol per week also varied across regions.

Men living in the East Midlands were the most likely to drink alcohol at this level (35%), those living in the West Midlands were the least likely (21%). Women living in the East Midlands and South West were the most likely to drink more than 14 units of alcohol (21% for both), those living in the West Midlands were the least likely (10%).

For more information: Table 12.

The HSE uses the measure of equivalised household income, which takes into account the number of adults and dependent children in the household as well as overall household income. Households are divided into quintiles (fifths) based on this measure. The age profile of the income quintiles has been age-standardised to account for differences in age profiles between households. For information about how equivalised income is calculated, see the Methods report.

The proportion of non-drinkers increased as the household income decreased from 11% of non-drinkers in the highest income quintile to 33% in the lowest income quintile.

The proportions of men and women who reported drinking over 14 units of alcohol weekly increased with household income. Among men, the highest proportion of those who drank 14 or more units was in highest income households: 35%, compared with 22% in the lowest income households. Similarly, among women, the highest proportion of those who drank alcohol at increased or higher levels was in the highest income households: 24%, compared with 9% in the lowest income households.

This variation in weekly alcohol consumption by household income was accounted for by differences in the proportions of men and women drinking at increased levels of risk (that is, over 14 units and up to 50 units for men and over 14 units and up to 35 units for women) rather than the smaller proportions in the higher risk category.

For more information: Table 13.

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see Methods report.

There was a difference in the proportion of non-drinkers across the Index of Multiple Deprivation (IMD) quintiles. The most deprived IMD quintile had the highest proportion of non-drinkers (33%). The lowest proportions of non-drinkers were in the two least deprived IMD quintiles. 18% of adults in the least deprived IMD quintile and 17% of adults in the next IMD quintile were non-drinkers.

The lowest proportion of adults drinking at increasing or higher risk (over 14 units of alcohol a week) was in the most deprived quintile. 18% of men and 9% of women in the most deprived quintile drank at increasing or higher risk. The proportions of both men and women drinking over 14 units per week was highest in the two least deprived IMD quintiles (29% of men in the least deprived and 34% of men in the next IMD quintile drank over 14 units per week, 17% of women in the least deprived and 18% of women in the next IMD quintile drank over 14 units per week).

For more information: Table 14.

Findings from the 2021 survey are not directly comparable with previous HSEs due to changes in survey methodology and response rates.

Between 2011 and 2019, the proportion of adults who did not drink in the last 12 months was between 17% and 20%. The proportion who usually drank 14 units or less each week was between 56% and 60%. 

There were marked differences between 2021 and 2019 in the proportions of young people aged between 16 and 24 who said that they had not drunk alcohol in the last 12 months. This proportion apparently increased from 28% in 2019 to 38% in 2021.  It is not possible to determine whether these findings represent real behaviour change within this age group. Questions about drinking alcohol were asked in different ways, using self-completion questionnaires in 2019 and a telephone interview in 2021, which may have been perceived as less confidential, and there were also differences in survey response rates.

For more information: Table 15.

More than half (55%) of all adults reported drinking alcohol in the last week, and 11% of participants drank alcohol on five or more days. 

A higher proportion of men (61%) than women (49%) drank alcohol in the last week. This was true across all age groups.

The proportions who reported drinking in the last week increased with age from 37% of 16 to 24 year olds to 63% of those aged between 55 and 64 years old, and were lower in the older age groups (61% of those aged 65 to 74 and 49% of those aged 75 and over).

The proportions of those who drank alcohol on five or more days in the last week increased from 3% of 16 to 24 year olds to 18% of adults aged 55 and over.

The mean number of days on which adults drank alcohol in the last week was 2.9 and was higher among men than women (3.1 days and 2.7 days respectively). As with the proportion of adults drinking alcohol, the mean number of days increased with age, from 2.2 days among adults aged 16 to 24 to 3.7 days among adults aged 75 and over.

For more information: Table 16.

In 2021, men were more likely than women to drink more than the recommended daily limit (29% compared with 24%). The proportion of all adults who drank more than three units (women) or four units (men) on any day in the last week increased with age from 22% of 16 to 24 year olds to 32% of 55 to 64 year olds and then gradually decreased to 11% of participants aged 75 and over.

For more information: Table 17.

Trends in the maximum amount of alcohol drunk on any day in the last week between 1998 and 2019 are shown in Table 17, with estimates for 2021. The methodology used to estimate the number of units of alcohol changed in 2006 and more details can be found in the Appendix to the 2019 HSE report on Adult's health-related behaviours. 

Table 17 shows both the original and revised estimates for 2006, and the revised estimates for 2007 onwards. The revised methodology has been used to measure trends in subsequent years. The categories shown reflect daily consumption limits recommended until 2016: no more than three units for women and no more than four units for men.

Since 2009, there has been a gradual decrease in the maximum daily alcohol consumption in the last week. The proportion of adults who drank more than three units (women) or four units (men) on any day in the last week fell from 37% in 2009 to 30% in 2019. The decline was largely accounted for by changes in consumption among men. The proportion of men drinking more than four units on any day in the last week decreased from 43% in 2009 to 33% in 2019. Over the same period, the proportion of women who had drunk more than three units on any day in the last week was 31% in 2009, and varied thereafter between 25% and 28% with no clear pattern.

In 2021, 29% of men had drunk more than four units on any day in the last week. 24% of women had drunk more than three units in the last week. Findings from 2021 are not directly comparable with those from previous years because of changes in survey methodology and response, and caution is advised if making inferences about whether behaviour has changed.

For more information: Table 17.