Silveira Camila Magalhães, Siu Erica Rosanna, Anthony James C, Saito Luis Paulo, de Andrade Arthur Guerra, Kutschenko Andressa, Viana Maria Carmen, Wang Yuan-Pang, Martins Silvia S, Andrade Laura Helena
Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil; Program of the Interdisciplinary Group of Studies on Alcohol and Drugs (GREA), Department and Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
PLoS One. 2014 Oct 1;9(10):e108355. doi: 10.1371/journal.pone.0108355. eCollection 2014.
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.
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.
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.
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.
在高收入国家开展的研究调查了社会经济不平等对饮酒结果的影响，如酒精使用障碍（AUD），然而，巴西尚未探讨地区层面的邻里社会剥夺（NSD）和个体社会经济地位与这些结果之间的关联。因此，我们在巴西人群中调查了这些因素对与饮酒相关结果的作用，并关注了男女差异。
使用世界卫生组织综合国际诊断访谈（WMH-CIDI）对圣保罗大都市区成年家庭居民进行多阶段区域概率抽样评估（n = 5,037）。估计重点在于经常饮酒者（RU）中过去一年酒精相关问题[低频率重度饮酒（HDLF）、高频率重度饮酒（HDHF）、滥用、依赖和DMS-5酒精使用障碍]的患病率及相关因素；得出优势比（OR）。
在个体层面变量保持不变的情况下，作为地区层面变量衡量的较高NSD显示，在所分析的大多数酒精相关问题中存在超额优势。RU中HDLF和HDHF的患病率估计分别为9%和20%，在较高NSD地区存在超额优势；受教育程度（负相关）和低收入与男性HDLF相关。与女性HDLF唯一的个体层面关联涉及就业状况。RU中滥用、依赖和DSM-5酒精使用障碍的患病率估计分别为8%、4%和8%，超额优势如下：男性在较高NSD地区存在依赖超额优势；女性存在滥用和酒精使用障碍超额优势。在RU中，酒精使用障碍与失业相关，低教育程度与依赖和酒精使用障碍相关。
在地区层面邻里特征反映社会劣势的地方，更有可能发现有酒精相关问题的经常饮酒者。尽管我们无法推断因果影响，但这些关联足够强，足以保证未来进行纵向酒精研究，以探索与本文观察到的异质关联模式和男女差异相关的因果机制。希望这些发现有助于为未来的公共卫生指导方向。
