Ecological analysis of collectivity of alcohol consumption in England: importance of average drinker

BMJ 1997;314:1164 (19 April)

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Ecological analysis of collectivity of alcohol consumption in England: importance of average drinker

Helen Colhoun, clinical lecturer,^a Yoav Ben-Shlomo, senior lecturer,^b Wei Dong, lecturer,^a Lulu Bost, statistician,^a Michael Marmot, professor ^a

^a Department of Epidemiology and Public Health, University College London, London WC1E 6BT, ^b Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: Dr Colhoun helen@public-health.ucl.ac.uk

Objective:To assess whether the average consumption of alcoholis associated with the prevalence of heavy drinking, problemdrinking, and abstention in England.
Design:Ecological analysis using data from a cross sectionalhousehold based survey of English adults.
Subjects:Random sample of 32 333 adults from the English populationwho participated in the 1993 and 1994 health surveys for England.
Main outcome measures:Association, expressed as the correlationcoefficient, between the regional mean and median alcohol consumptionand the regional prevalence of heavy drinking, problem drinking,and abstention.
Results:Mean consumption of alcohol in light to moderate drinkerswas strongly positively associated with the prevalence of heavydrinking (r=0.75 in men and r=0.62 in women for drinking morethan 21 and 14 units per week respectively). A similar associationwas found between median consumption and prevalence of heavydrinking. Abstention was not significantly associated with mean consumptionin drinkers (r=0.08 for men and r=-0.29 for women). Both themedian and mean consumption in drinkers were positively associatedwith the prevalence of problem drinking as defined by the CAGEquestionnaire on alcohol use (r=0.53 for men and r=0.42 forwomen for the association with mean consumption).
Conclusion:Factors that increase the average consumption ofalcohol in the population may result in an increase in the prevalenceof heavy drinking and related problems.

Key messages

Regional mean alcohol consumption of those who do not drink heavily is strongly correlated with the regional prevalence of heavy drinking
Regional mean consumption is also associated with the regional prevalence of problem drinking as defined by the CAGE questionnaire
These observations imply that factors increasing mean consumption in light to moderate drinkers are likely to result in an increase in heavy drinking and related problems
The regional prevalence of abstention is not strongly associated with regional mean consumption, so any increase in problems from heavy drinking resulting from an increase in mean consumption cannot be assumed to be offset by beneficial effects on cardiovascular disease from reduced abstention

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