Summary Characteristics of the sample
Table 1 shows the detailed distribution of SCCs, past month alcohol intake and socio-economic characteristics of respondents before the survey. Overall, 4.47% of the respondents had severe SCCs, however, with gendered differences. There was a slightly higher proportion of males (4.83%) having severe SCs than females (4.34%). Although 17.11% of the respondents had drunk alcohol in the past month, there were significant gendered differences with a higher proportion in males (31.55%) than in females (12.07%). Most of the respondents were aged 20–29 (34.62%); more males (33.95%) compared to females (34.85%) were found in this age group. The larger proportion (37.14%) of the respondents had attained JSS/JHS/Middle education, with more males (38.23%) compared to females (36.76%) attaining this educational level. Generally, a higher proportion (62.69%) were currently married with gendered differences. More females (65.37%) were currently married compared to males (55.03%).
Most of the respondents (51.54%) had health insurance, although the proportion was significantly higher among females (56.28%) compared to males (37.98%). Also, a larger proportion of the respondents (24.23%) belonged to the richest wealth quintile, with more males (25.03%) being in this richest quintile compared to females (23.95%). A slightly higher proportion of the respondents (50.45%) were urban residents, with more females (50.96%) compared to males (48.99%) being urban dwellers. Lastly, most of the respondents (23.98%) resided in Ashanti Region, with the proportion of males (24.57%) being higher than their female counterparts (23.77%).
Table 1 Summary statistics of study variables
Study Variables
|
Males
|
Females
|
Total
|
|
n = 4,358 (25.88%)
|
n = 12,483 (74.12%)
|
N = 16841 (100%)
|
Dependent variable
|
|
|
|
Subjective Cognitive Complaints
|
|
|
|
None
|
3345 (76.76)
|
9557 (76.56)
|
12902 (76.61%)
|
Some
|
802 (18.41)
|
2385 (19.10)
|
3187 (18.92%)
|
A lot/Cannot at all
|
211 (4.83)
|
541 (4.34)
|
752 (4.47%)
|
Independent variable
|
|
|
|
Drunk alcohol in the past month
|
|
|
|
No
|
2983 (68.45)
|
10976 (87.93)
|
13959 (82.89%)
|
Yes
|
1375 (31.55)
|
1507 (12.07)
|
2882 (17.11%)
|
Control variables
|
|
|
|
Age (years)
|
|
|
|
< 20
|
522 (11.98)
|
1039 (8.32)
|
1561 (9.27%)
|
20–29
|
1479 (33.95)
|
4351 (34.85)
|
5830 (34.62%)
|
30–39
|
1265 (29.02)
|
4080 (32.69)
|
5345 (31.74%)
|
40+
|
1092 (25.05)
|
3014 (24.14)
|
4106 (24.38%)
|
Education
|
|
|
|
Pre-primary or None
|
504 (11.58)
|
2652 (21.24)
|
3156 (18.74%)
|
Primary
|
450 (10.33)
|
2169 (17.38)
|
2619 (15.55%)
|
JSS/JHS/Middle
|
1666 (38.23)
|
4588 (36.76)
|
6254 (37.14%)
|
SSS/SHS/Secondary
|
1234 (28.31)
|
2242 (17.96)
|
3476 (20.64%)
|
Higher
|
503 (11.54)
|
831 (6.66)
|
1334 (7.92%)
|
Marital status
|
|
|
|
Currently married
|
2398 (55.03)
|
8160 (65.37)
|
10558 (62.69%)
|
Formerly married
|
197 (4.53)
|
1353 (10.83)
|
1550 (9.20%)
|
Never married
|
1762 (40.44)
|
2970 (23.80)
|
4732 (28.10%)
|
Health Insurance
|
|
|
|
Yes
|
1655 (37.98)
|
7025 (56.28)
|
8680 (51.54%)
|
No
|
2703 (62.02)
|
5458 (43.72)
|
8161 (48.46%)
|
Wealth Quintile
|
|
|
|
Poorest
|
749 (17.19)
|
2060 (16.50)
|
2809 (16.68%)
|
Poorer
|
666 (15.29)
|
2262 (18.12)
|
2928 (17.39%)
|
Middle
|
871 (19.98)
|
2507 (20.08)
|
3378 (20.06%)
|
Richer
|
981 (22.50)
|
2665 (21.35)
|
3646 (21.65%)
|
Richest
|
1091 (25.03)
|
2990 (23.95)
|
4081 (24.23%)
|
Urban-rural residence
|
|
|
|
Urban
|
2135 (48.99)
|
6362 (50.96)
|
8497 (50.45%)
|
Rural
|
2223 (51.01)
|
6121 (49.04)
|
8344 (49.55%)
|
Region of residence
|
|
|
|
Western
|
446 (10.23)
|
1237 (9.91)
|
1683 (9.99%)
|
Central
|
352 (8.09)
|
1183 (9.48)
|
1535 (9.11%)
|
Greater Accra
|
578 (13.26)
|
1703 (13.64)
|
2281 (13.54%)
|
Volta
|
340 (7.81)
|
949 (7.61)
|
1289 (7.65%)
|
Eastern
|
565 (12.97)
|
1497 (11.99)
|
2062 (12.24%)
|
Ashanti
|
1071 (24.57)
|
2967 (23.77)
|
4038 (23.98%)
|
Brong Ahafo
|
378 (8.68)
|
1145 (9.17)
|
1523 (9.04%)
|
Northern
|
390 (8.95)
|
1156 (9.26)
|
1546 (9.18%)
|
Upper East
|
132 (3.03)
|
361 (2.89)
|
493 (2.93%)
|
Upper West
|
105 (2.41)
|
286 (2.29)
|
391 (2.32%)
|
Note. JHS: Junior High School; SHS: Senior High School
|
Summary of bivariate and multivariate analyses
In both unadjusted and adjusted models, drinking alcohol in the past month was positively associated with SCCs among both males and females (see Table 2). In the adjusted model, however, the magnitude of the association was slightly higher among males [APOR = 1.38, 95% CI: 1.07, 1.79] than females [APOR = 1.24, 95% CI: 1.06, 1.46] (Table 2). This confirmed the study’s hypothesis that past month alcohol intake would be associated with high levels of SCCs in Ghanaian men and women. Furthermore, in the multivariable model, gendered differences were seen in the association between the control variables and SCCs (Table 2).
Age was a significant correlate of SCCs among females but not among males. Specifically, compared to females below 20 years, females who were 40 years and above had a higher likelihood of reporting SCCs [APOR = 1.71, 95% CI: 1.31, 2.24].
Although formal education was a significant correlate of SCCs in both male and female models, some differences exist in their contribution to the model. In the male model, men with pre-primary or none [APOR = 2.36, 95% CI: 1.36, 4.09] and primary [APOR = 2.65, 95% CI: 1.390, 5.05] education were more likely to report severe experiences of SCCs compared to their male counterparts with higher education. In the female model, females with pre-primary or none [APOR = 2.64, 95% CI:1.90, 3.65], primary [APOR = 2.76, 95% CI:1.99, 3.83], JSS/JHS/Middle [APOR = 2.28, 95% CI:1.71, 3.03] and SSS/SHS/Secondary [APOR = 1.56, 95% CI:1.16, 2.11] education were more positively associated with SCCs compared than their female counterparts with higher education (Table 2).
Health insurance had a significant correlation with SCCs among males but not females. Males without health insurance were more likely to have SCCs compared to insured males [APOR = 1.40, 95% CI:1.07, 1.82]. The urban-rural residence was also a significant correlate of SCCs, although this was found in males and not females. Specifically, rural men were less likely to report SCCs compared to urban men [APOR = 0.60, 95% CI: 0.38, 0.95].
Lastly, region of residence was a significant correlate of SCCs but with some gender differences. Compared to their Greater Accra counterparts, males residing in Central [APOR = 2.39, 95% CI:1.26, 4.54], Volta [APOR = 3.27, 95% CI:1.77, 6.06], Eastern [APOR = 4.01, 95% CI:2.16, 7.43], and Ashanti [APOR = 5.30, 95% CI:2.67, 10.53] regions were more likely to report SCCs. On the other hand, compared to their Greater Accra counterparts, women residing in the Western [APOR = 0.67, 95% CI:0.50, 0.91], Ashanti [APOR = 0.50, 95% CI: 0.37, 0.68], and Northern [APOR = 0.45, 95% CI: 0.32, 0.65] regions were less likely to report SCCs (see Table 2). Marital status and wealth quintile were statistically non-significant correlates of SCCs.
Table 2 Drinking alcohol regressed on SCCs amongst men and women, controlling for other covariates.
Study Variables
|
Males
|
Females
|
Independent variable
|
POR
[95% CI]
|
APOR
[95% CI]
|
POR
[95% CI]
|
APOR
[95% CI]
|
Past month alcohol intake
|
|
|
|
|
No
|
Ref.
|
Ref.
|
Ref.
|
Ref.
|
Yes
|
1.45*
[1.07, 1.97]
|
1.38*
[1.07, 1.79]
|
1.41***
[1.20, 1.66]
|
1.24**
[1.06, 1.46]
|
Control variables
|
|
|
|
|
Age (years)
|
|
|
|
|
< 20
|
Ref.
|
Ref.
|
Ref.
|
Ref.
|
20–29
|
1.21
[0.92, 1.60]
|
1.31
[0.95, 1.81]
|
0.99
[0.81, 1.23]
|
1.07
[0.85, 1.35]
|
30–39
|
0.96
[0.71, 1.30]
|
0.98
[0.66, 1.47]
|
1.17
[0.94, 1.44]
|
1.21
[0.94, 1.54]
|
40+
|
1.15
[0.82, 1.61]
|
1.12
[0.71, 1.76]
|
1.80***
[1.44, 2.25]
|
1.71***
[1.31, 2.24]
|
Education
|
|
|
|
|
Pre-primary or None
|
1.77**
[1.16, 2.69]
|
2.36**
[1.36, 4.09]
|
3.01***
[2.27, 3.98]
|
2.64***
[1.90, 3.65]
|
Primary
|
2.63***
[1.53, 4.52]
|
2.65**
[1.39, 5.05]
|
3.43***
[2.59, 4.56]
|
2.76***
[1.99, 3.83]
|
JSS/JHS/Middle
|
2.13**
[1.25, 3.64]
|
1.70
[0.91, 3.18]
|
2.62***
[2.02, 3.42]
|
2.28***
[1.71, 3.03]
|
SSS/SHS/Secondary
|
1.73*
[1.05, 2.84]
|
1.62
[0.94, 2.79]
|
1.62**
[1.21, 2.16]
|
1.56**
[1.16, 2.11]
|
Higher
|
Ref.
|
|
Ref.
|
Ref.
|
Marital status
|
|
|
|
|
Currently married
|
0.99
[0.81, 1.21]
|
1.06
[0.77, 1.46]
|
1.27**
[1.10, 1.46]
|
0.85
[0.72, 1.02]
|
Formerly married
|
2.05*
[1.14, 3.70]
|
1.52
[0.76, 3.05]
|
1.78***
[1.45, 2.18]
|
1.09
[0.86, 1.37]
|
Never married
|
Ref.
|
Ref.
|
Ref.
|
Ref.
|
Health Insurance
|
|
|
|
|
Yes
|
Ref.
|
Ref.
|
Ref.
|
Ref.
|
No
|
1.69***
[1.33, 2.16]
|
1.40*
[1.07, 1.82]
|
1.15*
[1.02, 1.30]
|
0.99
[0.87, 1.12]
|
Wealth Quintile
|
|
|
|
|
Poorest
|
1.46
[0.99, 2.16]
|
1.74
[0.98, 3.10]
|
1.68***
[1.40, 2.02]
|
1.26
[0.97, 1.65]
|
Poorer
|
1.50*
[1.05, 2.16]
|
1.48
[0.85, 2.59]
|
1.50***
[1.22, 1.84]
|
1.13
[0.89, 1.42]
|
Middle
|
1.48*
[1.05, 2.09]
|
1.18
[0.78, 1.78]
|
1.56***
[1.29, 1.89]
|
1.19
[0.96, 1.48]
|
Richer
|
1.44
[0.93, 2.23]
|
1.07
[0.69, 1.65]
|
1.21*
[1.02, 1.44]
|
1.03
[0.86, 1.24]
|
Richest
|
Ref.
|
Ref.
|
Ref.
|
Ref.
|
Urban-rural residence
|
|
|
|
|
Urban
|
Ref.
|
Ref.
|
Ref.
|
Ref.
|
Rural
|
0.86
[0.53, 1.40]
|
0.60*
[0.38, 0.95]
|
1.28**
[1.09, 1.50]
|
1.04
[0.87, 1.25]
|
Region of residence
|
|
|
|
|
Western
|
0.67
[0.33, 1.34]
|
0.69
[0.34, 1.43]
|
0.78
[0.58, 1.04]
|
0.67**
[0.50, 0.91]
|
Central
|
2.42**
[1.30, 4.50]
|
2.39**
[1.26, 4.54]
|
1.17
[0.89, 1.52]
|
0.99
[0.74, 1.31]
|
Greater Accra
|
Ref.
|
Ref.
|
Ref.
|
Ref.
|
Volta
|
3.66***
[2.04, 6.56]
|
3.27***
[1.77, 6.06]
|
1.65**
[1.22, 2.23]
|
1.28
[0.92, 1.79]
|
Eastern
|
3.95***
[2.14, 7.28]
|
4.01***
[2.16, 7.43]
|
1.49**
[1.13, 1.98]
|
1.25
[0.94, 1.67]
|
Ashanti
|
5.00***
[2.50, 10.00]
|
5.30***
[2.67, 10.53]
|
0.56***
[0.42, 0.76]
|
0.50***
[0.37, 0.68]
|
Brong Ahafo
|
1.66
[0.93, 2.98]
|
1.59
[0.88, 2.89]
|
0.87
[0.64, 1.19]
|
0.73
[0.51, 1.04]
|
Northern
|
0.66
[0.34, 1.30]
|
0.55
[0.27, 1.13]
|
0.62**
[0.44, 0.88]
|
0.45***
[0.32, 0.65]
|
Upper East
|
1.31
[0.71, 2.40]
|
1.16
[0.60, 2.25]
|
1.59***
[1.22, 2.06]
|
1.21
[0.90, 1.63]
|
Upper West
|
0.79
[0.41, 1.52]
|
0.63
[0.32, 1.24]
|
1.23
[0.93, 1.61]
|
0.893
[0.66, 1.21]
|
Model details
|
|
|
|
|
Strata
|
|
20
|
|
20
|
PSUs
|
|
660
|
|
660
|
Population size
|
|
4358
|
|
12483
|
Design df
|
|
640
|
|
640
|
F (25, 616) =
|
|
8.52
|
|
12.04
|
Prob > F
|
|
0.0001
|
|
0.0001
|
Note. JHS: Junior High School; SHS: Senior High School; PSU: Primary sampling units; POR: proportional odds ratio; APOR: adjusted proportional odds ratio; 95% CI: 95% Confidence interval. * p < 0.05, ** p < 0.01, *** p < 0.001
|