. 2022 Sep;10(9):e1268-e1280.

doi: 10.1016/S2214-109X(22)00273-X.

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

Yuanwei Xu¹, Pascal Geldsetzer², Jen Manne-Goehler³, Michaela Theilmann⁴, Maja-E Marcus⁵, Zhaxybay Zhumadilov⁶, Sarah Quesnel-Crooks⁷, Omar Mwalim⁸, Sahar Saeedi Moghaddam⁹, Sogol Koolaji⁹, Khem B Karki¹⁰, Farshad Farzadfar¹¹, Narges Ebrahimi⁹, Albertino Damasceno¹², Krishna K Aryal¹³, Kokou Agoudavi¹⁴, Rifat Atun¹⁵, Till Bärnighausen¹⁶, Justine Davies¹⁷, Lindsay M Jaacks¹⁸, Sebastian Vollmer¹⁹, Charlotte Probst²⁰

Affiliations

¹ School of Economics and Management, Gottfried Wilhelm Leibniz University of Hannover, Hannover, Germany; Faculty of Management and Economics, Ruhr University Bochum, Bochum, Germany. Electronic address: yuanweii.xu@gmail.com.
² Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.
³ 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.
⁴ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany.
⁵ Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
⁶ Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan.
⁷ Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
⁸ Ministry of Health, Zanzibar City, Tanzania.
⁹ Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
¹⁰ Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
¹¹ Non-Communicable Diseases Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
¹² Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
¹³ Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal.
¹⁴ Ministry of Health, Lome, Togo.
¹⁵ 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.
¹⁶ 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.
¹⁷ 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.
¹⁸ Global Academy of Agriculture and Food Security, The University of Edinburgh, Easter Bush Campus, Midlothian, UK.
¹⁹ Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany. Electronic address: svollmer@uni-goettingen.de.
²⁰ 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.

PMID: 35961350
PMCID: PMC9582994
DOI: 10.1016/S2214-109X(22)00273-X

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

Yuanwei Xu et al. Lancet Glob Health. 2022 Sep.

. 2022 Sep;10(9):e1268-e1280.

doi: 10.1016/S2214-109X(22)00273-X.

Authors

Affiliations

¹ School of Economics and Management, Gottfried Wilhelm Leibniz University of Hannover, Hannover, Germany; Faculty of Management and Economics, Ruhr University Bochum, Bochum, Germany. Electronic address: yuanweii.xu@gmail.com.
² Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.
³ 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.
⁴ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany.
⁵ Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
⁶ Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan.
⁷ Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
⁸ Ministry of Health, Zanzibar City, Tanzania.
⁹ Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
¹⁰ Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
¹¹ Non-Communicable Diseases Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
¹² Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
¹³ Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal.
¹⁴ Ministry of Health, Lome, Togo.
¹⁵ 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.
¹⁶ 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.
¹⁷ 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.
¹⁸ Global Academy of Agriculture and Food Security, The University of Edinburgh, Easter Bush Campus, Midlothian, UK.
¹⁹ Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany. Electronic address: svollmer@uni-goettingen.de.
²⁰ 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.

PMID: 35961350
PMCID: PMC9582994
DOI: 10.1016/S2214-109X(22)00273-X

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.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests RA reports grants or contracts from Novo Nordisk, Roche, Novartis, and UICC; and payment or honoraria from Merck & Co, Novartis, and F Hoffmann-La Roche. TB is a board member of the Virchow Foundation for Global Health, Berlin; is a co-chair for Global Health Hub Germany; is a representative of the United Nations Western European and Others Group on the UNAIDS, Global Evaluation Expert Advisory Committee; is a standing review panel member in the National Institutes of Health section on Population and Public Health Approaches to HIV/AIDS; is a board member for the UNAIDS Unified Budget, Results and Accountability Framework; is a council member for the World Health Summit; is member of the Governing Council, Berlin, Germany; is a committee member on the German National Committee on the Future of Public Health Research and Education. All other authors declare no competing interests.

Figures

**Figure 1:**
Population-weighted prevalence of alcohol use by country income groups (A), level of education (B), and household wealth quintile (C), and sex LIC=low-income country. L-MIC=lower-middle-income country. U-MIC=upper-middle-income country.

**Figure 2:**
Country-level odds ratio of current drinking among participants with no formal schooling relative to participants with high school or higher schooling LMIC=low-income and middle-income countries.

**Figure 3:**
Country-level odds ratio of heavy episodic drinking among individuals with no formal schooling relative to participants with high school or higher schooling LMIC=low-income and middle-income countries.

See this image and copyright information in PMC

Comment in

The socioeconomic gradient of alcohol use.
Parry CDH, Amul GGH. Parry CDH, et al. Lancet Glob Health. 2022 Sep;10(9):e1212-e1213. doi: 10.1016/S2214-109X(22)00307-2. Lancet Glob Health. 2022. PMID: 35961330 No abstract available.

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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

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MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous