Department of Epidemiology and Public Health, UCL 1-19 Torrington Place, London, WC1E 7HB, UK.
BMC Public Health. 2019 Jul 8;19(1):902. doi: 10.1186/s12889-019-7240-0.
Alcohol guidelines enable individuals to make informed choices about drinking and assist healthcare practitioners to identify and treat at-risk drinkers. The UK Low Risk Drinking Guidelines were revised in 2016 and the weekly guideline for men was reduced from 21 to 14 units per week. This study sought to retrospectively establish 1) the number of additional at-risk male drinkers in England, 2) which demographic characteristics were associated with being an at-risk drinker under the previous versus new guidelines.
Average weekly alcohol consumption for men aged 16+ from the cross-sectional nationally representative Health Survey for England were used to 1) calculate annual population prevalence estimates for newly defined at-risk (> 14 to ≤21 units/week) male drinkers from 2011 to 2015 (N = 3487-3790), and 2) conduct logistic regression analyses for at-risk vs low risk male drinkers under the previous (> 21 vs ≤21 units/week) and new (> 14 vs ≤14 units/week) guidelines to assess characteristics associated with being at-risk drinkers under each guideline using 2015 data (N = 2982).
Population prevalence estimates of newly defined at-risk drinkers ranged from 10.2% (2014 = 2,182,401 men)-11.2% (2011 = 2,322,896 men). Under the new guidelines, men aged 55-74 (OR = 1.63,95% CI = 1.25-2.12); men in managerial/professional occupations (OR = 1.64,95% CI = 1.34-2.00); current smokers (OR = 2.26,95% CI = 1.73-2.94), ex-regular smokers (OR = 2.01,95% CI = 1.63-2.47) and ex-occasional smokers (OR = 1.85,95% CI = 1.25-2.74); men from the North East (OR = 2.08,95% CI = 1.38-3.13) and North West (OR = 1.91,95% CI = 1.41-2.60) of England all had greater odds, and non-white men had reduced odds (OR = 0.53,95% CI = 0.34-0.80) of being at-risk drinkers, as they had under the previous guidelines. Under the new guidelines only: a higher percentage of at-risk drinkers aged 16-34 (32% vs 19%) attenuated the odds of men aged 35-54 being at-risk (OR = 1.18,95% CI = 0.92-1.51); a higher percentage of married at-risk drinkers (37% vs 24%) attenuated the odds of single men being at-risk (OR = 1.28,95% CI = 0.99-1.67); men from the West Midlands (OR = 1.68,95% CI = 1.17-2.42) and London (OR = 1.53,95% CI = 1.03-2.28) had greater odds of being at-risk drinkers.
The change to the Low Risk Drinking Guidelines would have resulted in more than 2 million additional male at-risk drinkers in England. Most groups with greater odds of being at-risk drinkers under the new guidelines were those already known to be drinking the most, strengthening the case for targeted screening and education. Additionally, under the new guidelines, a marked proportion of 16-35 year olds and married men were at-risk and men in the West Midlands and London had greater odds of being at-risk drinkers. These groups may benefit from specific education around the new Low Risk Drinking Guidelines.
酒精指南使个人能够做出明智的饮酒选择，并帮助医疗保健从业者识别和治疗高危饮酒者。英国低风险饮酒指南于 2016 年进行了修订，男性每周的低风险饮酒量从 21 单位减少到 14 单位。本研究旨在回顾性地确定：1）英格兰新增高危男性饮酒者的数量；2）与旧指南相比，新指南中哪些人口统计学特征与高危饮酒者有关。
使用来自英格兰全国代表性健康调查的 16 岁以上男性的平均每周酒精摄入量，计算 2011 年至 2015 年期间新定义的高危 (>14 至≤21 单位/周)男性饮酒者的年度人群患病率估计值 (n=3487-3790)；并对旧 (>21 比≤21 单位/周)和新 (>14 比≤14 单位/周)指南下的高危与低危男性饮酒者进行逻辑回归分析，使用 2015 年的数据 (n=2982)，评估每个指南下与高危饮酒者相关的特征。
新定义的高危饮酒者的人群患病率估计值在 10.2%（2014 年=2182401 名男性）到 11.2%（2011 年=2322896 名男性）之间。根据新指南，55-74 岁的男性 (OR=1.63,95%CI=1.25-2.12)；经理/专业人员职业的男性 (OR=1.64,95%CI=1.34-2.00)；当前吸烟者 (OR=2.26,95%CI=1.73-2.94)、前定期吸烟者 (OR=2.01,95%CI=1.63-2.47)和前偶尔吸烟者 (OR=1.85,95%CI=1.25-2.74)；英格兰东北部 (OR=2.08,95%CI=1.38-3.13)和西北部 (OR=1.91,95%CI=1.41-2.60)的男性，以及非白人男性的风险更高 (OR=0.53,95%CI=0.34-0.80)，而与旧指南相比，这些特征与高危饮酒者有关。根据新指南，只有：16-34 岁的高危饮酒者比例增加(32%比 19%)，降低了 35-54 岁男性的高危风险 (OR=1.18,95%CI=0.92-1.51)；已婚高危饮酒者的比例增加(37%比 24%)，降低了单身男性的高危风险 (OR=1.28,95%CI=0.99-1.67)；西米德兰兹 (OR=1.68,95%CI=1.17-2.42)和伦敦 (OR=1.53,95%CI=1.03-2.28)的男性更有可能成为高危饮酒者。
低风险饮酒指南的改变将导致英格兰新增 200 多万高危男性饮酒者。在新指南下，具有更高高危饮酒者风险的大多数群体是那些已经知道饮酒最多的群体，这进一步说明了有针对性的筛查和教育的必要性。此外，根据新指南，相当一部分 16-35 岁的男性和已婚男性处于高危状态，西米德兰兹和伦敦的男性成为高危饮酒者的几率更高。这些群体可能受益于新的低风险饮酒指南的专门教育。
