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. 2014 Oct 1;9(10):e108355.
doi: 10.1371/journal.pone.0108355. eCollection 2014.

Drinking patterns and alcohol use disorders in São Paulo, Brazil: the role of neighborhood social deprivation and socioeconomic status

Camila Magalhães Silveira  1 , Erica Rosanna Siu  2 , James C Anthony  3 , Luis Paulo Saito  2 , Arthur Guerra de Andrade  4 , Andressa Kutschenko  2 , Maria Carmen Viana  2 , Yuan-Pang Wang  2 , Silvia S Martins  5 , Laura Helena Andrade  2
Affiliations

Drinking patterns and alcohol use disorders in São Paulo, Brazil: the role of neighborhood social deprivation and socioeconomic status

Camila Magalhães Silveira et al. PLoS One. .

Abstract

Background: Research conducted in high-income countries has investigated influences of socioeconomic inequalities on drinking outcomes such as alcohol use disorders (AUD), however, associations between area-level neighborhood social deprivation (NSD) and individual socioeconomic status with these outcomes have not been explored in Brazil. Thus, we investigated the role of these factors on drink-related outcomes in a Brazilian population, attending to male-female variations.

Methods: A multi-stage area probability sample of adult household residents in the São Paulo Metropolitan Area was assessed using the WHO Composite International Diagnostic Interview (WMH-CIDI) (n = 5,037). Estimation focused on prevalence and correlates of past-year alcohol disturbances [heavy drinking of lower frequency (HDLF), heavy drinking of higher frequency (HDHF), abuse, dependence, and DMS-5 AUD] among regular users (RU); odds ratio (OR) were obtained.

Results: Higher NSD, measured as an area-level variable with individual level variables held constant, showed an excess odds for most alcohol disturbances analyzed. Prevalence estimates for HDLF and HDHF among RU were 9% and 20%, respectively, with excess odds in higher NSD areas; schooling (inverse association) and low income were associated with male HDLF. The only individual-level association with female HDLF involved employment status. Prevalence estimates for abuse, dependence, and DSM-5 AUD among RU were 8%, 4%, and 8%, respectively, with excess odds of: dependence in higher NSD areas for males; abuse and AUD for females. Among RU, AUD was associated with unemployment, and low education with dependence and AUD.

Conclusions: Regular alcohol users with alcohol-related disturbances are more likely to be found where area-level neighborhood characteristics reflect social disadvantage. Although we cannot draw inferences about causal influence, the associations are strong enough to warrant future longitudinal alcohol studies to explore causal mechanisms related to the heterogeneous patterns of association and male-female variations observed herein. Hopefully, these findings may help guide future directions for public health.

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Conflict of interest statement

Competing Interests: The authors have read the journal’s policy and have the following conflicts: The main coordination center activities, at Harvard University, were supported by the United States National Institutes of Mental Health (R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, the Eli Lilly and Company Foundation, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, Bristol-Myers Squibb, and Shire. The authors confirm that this does not alter their adherence to PLOS ONE policies on sharing data and materials.

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