The Socio-economic Gradient of Alcohol Use: An Analysis of Nationally Representative Survey Data from 55 Low and Middle income Countries: Socio-economic Gradient of Alcohol Use in 55 Low- and Middle-Income Countries.

Yuanwei Xu*, Pascal Geldsetzer, Jennifer Manne-Goehler, Michaela Theilmann, Maja-Emilia Marcus, Zhaxybay Zhumadilov, Sarah Quesnel-Crooks, Omar Mwalim, Sahar Saeedi Moghaddam, Sogol Koolaji, Khem B Karki, Farshad Farzadfar, Narges Ebrahimi, Albertino Damasceno, Krishna K Aryal, Kokou Agoudavi, Rifat Atun, Till Winfried Barnighausen, Justine Davies, Lindsay JaacksSebastian Vollmer, Charlotte Probst

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

BACKGROUND: Alcohol is a leading risk factor for over 200 conditions and an important contributor to socio-economic health inequalities. However, little is known about the associations between individual’s socio-economic circumstances and alcohol consumption, especially heavy episodic drinking (HED [≥five drinks on one occasion]) in low- or middle-income countries. We investigated the association between individual and household level socio-economic status (SES), and alcohol drinking habits in these settings.
METHODS: We identified all available nationally representative surveys conducted in low- and middle-income countries between 2005 and 2017 reporting on alcohol use (N=55) and pooled their individual-level data (N=336,287). 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 SES (individual educational attainment and household wealth) and alcohol use (current drinking and HED amongst current drinkers).
FINDINGS: Among males, the highest prevalence of both current drinking and HED was found in lower-middle-income countries (L-MIC; current drinking: 49·9%, 95% confidence interval [CI] 48·7%-51·2%, 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 (LIC; 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 SES. However, in U-MICs, current drinkers with low SES were more likely to engage in HED than those with high SES; the opposite was observed in LICs, and no association between SES 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: YX acknowledges funding by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - project RTG 1723. PG was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR003143.
Original languageEnglish
Pages (from-to)e1268-e1280
JournalThe Lancet
Volume10
Early online date29 Aug 2022
DOIs
Publication statusPublished - 1 Sept 2022

Keywords / Materials (for Non-textual outputs)

  • alcohol use
  • current drinking
  • heavy episodic drinking
  • socio-economic status
  • low- and middle-income countries

Fingerprint

Dive into the research topics of 'The Socio-economic Gradient of Alcohol Use: An Analysis of Nationally Representative Survey Data from 55 Low and Middle income Countries: Socio-economic Gradient of Alcohol Use in 55 Low- and Middle-Income Countries.'. Together they form a unique fingerprint.

Cite this