The socioeconomic gradient of alcohol use: an analysis of nationally representative survey data from 55 low-income and middle-income countries,The Lancet Global Health

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The socioeconomic gradient of alcohol use: an analysis of nationally representative survey data from 55 low-income and middle-income countries
The Lancet Global Health ( IF 19.9 ) Pub Date : 2022-08-09 , DOI: 10.1016/s2214-109x(22)00273-x
Yuanwei Xu ₁ , Pascal Geldsetzer ₂ , Jen Manne-Goehler ₃ , Michaela Theilmann ₄ , Maja-E Marcus ₅ , Zhaxybay Zhumadilov ₆ , Sarah Quesnel-Crooks ₇ , Omar Mwalim ₈ , Sahar Saeedi Moghaddam ₉ , Sogol Koolaji ₉ , Khem B Karki ₁₀ , Farshad Farzadfar ₁₁ , Narges Ebrahimi ₉ , Albertino Damasceno ₁₂ , Krishna K Aryal ₁₃ , Kokou Agoudavi ₁₄ , Rifat Atun ₁₅ , Till Bärnighausen ₁₆ , Justine Davies ₁₇ , Lindsay M Jaacks ₁₈ , Sebastian Vollmer ₅ , Charlotte Probst ₁₉

Affiliation

School of Economics and Management, Gottfried Wilhelm Leibniz University of Hannover, Hannover, Germany; Faculty of Management and Economics, Ruhr University Bochum, Bochum, Germany.
Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany.
Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan.
Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
Ministry of Health, Zanzibar City, Tanzania.
Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal.
Ministry of Health, Lome, Togo.
Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Harvard Center for Population and Development Studies, Harvard University, Cambridge, Boston, MA, USA; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany; Africa Health Research Institute, Somkhele, South Africa.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Global Academy of Agriculture and Food Security, The University of Edinburgh, Easter Bush Campus, Midlothian, UK.
Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.

Background

Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals’ socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-income countries. We investigated the association between individual and household level socioeconomic status, and alcohol drinking habits in these settings.

Methods

In this pooled analysis of individual-level data, we used available nationally representative surveys—mainly WHO Stepwise Approach to Surveillance surveys—conducted in 55 low-income and middle-income countries between 2005 and 2017 reporting on alcohol use. Surveys from participants aged 15 years or older were included. Logistic regression models controlling for age, country, and survey year stratified by sex and country income groups were used to investigate associations between two indicators of socioeconomic status (individual educational attainment and household wealth) and alcohol use (current drinking and HED amongst current drinkers).

Findings

Surveys from 336 287 participants were included in the analysis. Among males, the highest prevalence of both current drinking and HED was found in lower-middle-income countries (L-MICs; current drinking 49·9% [95% CI 48·7–51·2] and HED 63·3% [61·0–65·7]). Among females, the prevalence of current drinking was highest in upper-middle-income countries (U-MIC; 29·5% [26·1–33·2]), and the prevalence of HED was highest in low-income countries (LICs; 36·8% [33·6–40·2]). Clear gradients in the prevalence of current drinking were observed across all country income groups, with a higher prevalence among participants with high socioeconomic status. However, in U-MICs, current drinkers with low socioeconomic status were more likely to engage in HED than participants with high socioeconomic status; the opposite was observed in LICs, and no association between socioeconomic status and HED was found in L-MICs.

Interpretation

The findings call for urgent alcohol control policies and interventions in LICs and L-MICs to reduce harmful HED. Moreover, alcohol control policies need to be targeted at socially disadvantaged groups in U-MICs.

Funding

Deutsche Forschungsgemeinschaft and the National Center for Advancing Translational Sciences of the US National Institutes of Health.

中文翻译：

饮酒的社会经济梯度：对 55 个低收入和中等收入国家的全国代表性调查数据的分析

背景

酒精是 200 多种疾病的主要危险因素，也是造成社会经济健康不平等的重要因素。然而，人们对个人社会经济状况与饮酒之间的关系知之甚少，特别是在低收入或中等收入国家中，偶尔饮酒（HED；一次≥5杯）。我们调查了个人和家庭层面的社会经济地位与这些环境中饮酒习惯之间的关联。

方法

在对个人层面数据的汇总分析中，我们使用了现有的国家代表性调查（主要是世卫组织逐步监测方法），这些调查于 2005 年至 2017 年间在 55 个低收入和中等收入国家进行，报告了饮酒情况。调查包括 15 岁或以上参与者的调查。使用逻辑回归模型控制按性别和国家收入组分层的年龄、国家和调查年份，以调查社会经济地位（个人受教育程度和家庭财富）和饮酒（当前饮酒者和当前饮酒者中的HED）两项指标之间的关联。

发现

分析中纳入了 336 287 名参与者的调查。在男性中，当前饮酒和 HED 患病率最高的地区是中低收入国家（L-MIC；当前饮酒率为 49·9% [95% CI 48·7–51·2]，HED 为 63·3%） [61·0–65·7]）。在女性中，目前饮酒的流行率在中高收入国家最高（U-MIC；29·5% [26·1–33·2]），而HED的流行率在低收入国家最高（U-MIC；29·5% [26·1–33·2]）。 LIC；36·8% [33·6–40·2]）。在所有国家收入群体中，当前饮酒流行率存在明显的梯度，社会经济地位高的参与者中饮酒流行率较高。然而，在 U-MIC 中，当前社会经济地位较低的饮酒者比社会经济地位较高的参与者更有可能参与 HED；在低收入国家中观察到相反的情况，并且在低收入国家中没有发现社会经济地位与 HED 之间存在关联。