THE SOCIOECONOMIC GRADIENT OF ALCOHOL USE: AN ANALYSIS OF NATIONALLY REPRESENTATIVE SURVEY DATA FROM 55 LOW-INCOME AND MIDDLE-INCOME COUNTRIES
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Date
2022
Authors
Xu, Yuanwei
Geldsetzer, Pascal
Manne-Goehler, Jen
Theilmann, Michaela
Marcus, Maja-E
Zhumadilov, Zhaxybay
Quesnel-Crooks, Sarah
Mwalim, Omar
Moghaddam, Sahar Saeedi
Koolaji, Sogol
Journal Title
Journal ISSN
Volume Title
Publisher
The Lancet Global Health
Abstract
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.
Description
Keywords
Type of access: Open Access, alcohol, low-income countries, middle-income countries, survey
Citation
Xu, Y., Geldsetzer, P., Manne-Goehler, J., Theilmann, M., Marcus, M. E., Zhumadilov, Z., Quesnel-Crooks, S., Mwalim, O., Moghaddam, S. S., Koolaji, S., Karki, K. B., Farzadfar, F., Ebrahimi, N., Damasceno, A., Aryal, K. K., Agoudavi, K., Atun, R., Bärnighausen, T., Davies, J., . . . Probst, C. (2022). 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, 10(9), e1268–e1280. https://doi.org/10.1016/s2214-109x(22)00273-x