Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada.
Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada.
Drug Alcohol Rev. 2020 Sep;39(6):624-631. doi: 10.1111/dar.13053. Epub 2020 Apr 6.
The monitoring of the harmful use of alcohol is a key focus of global health efforts, including the Sustainable Development Goals. The current indicator of harmful alcohol use for Sustainable Development Goals is the national adult (15+ years) alcohol per capita consumption (APC) in litres of pure alcohol. Recently, the age-standardised prevalence of heavy episodic drinking (HED) has been advanced as an alternative indicator.
This narrative review is composed of a review of advantages and disadvantages of both indicators and an empirical analysis of their associations with alcohol-attributable health harm.
APC is greatly associated with harm and is available for almost all countries on a yearly basis as it is largely derived from routinely collected statistics. HED is based on responses to population surveys not routinely performed for most countries. These surveys commonly exclude heavy drinking populations (e.g. army personnel, institutionalised, homeless). Even when included within the sampling frame, heavy drinkers are less likely to participate than other groups. The questions used to measure HED are susceptible to biases due to issues with respondents' comprehension, recall and misreporting. Furthermore, in a regression analysis of 182 countries, APC was better at predicting alcohol-attributable harm than HED. APC was also correlated with changes in the alcohol-attributable burden of disease (from 2010 to 2016), while HED was not.
Based on these factors, APC was found to be the preferred indicator.
APC should be retained as the main indicator of the harmful use of alcohol.
监测酒精的有害使用是全球卫生工作的一个关键重点，包括可持续发展目标。可持续发展目标中衡量有害酒精使用的当前指标是国家成年人（15 岁及以上）人均酒精消费量（APC），以升纯酒精计。最近，重度间歇性饮酒（HED）的年龄标准化流行率已被作为替代指标提出。
本叙述性评论由对这两个指标的优缺点的审查以及对它们与酒精相关健康危害的关联的实证分析组成。
APC 与危害有很大关联，并且几乎所有国家每年都可以获得，因为它主要源自定期收集的统计数据。HED 基于人群调查的回应，而这些调查并非大多数国家常规进行。这些调查通常排除了大量饮酒人群（例如军人、机构化人群、无家可归者）。即使包括在抽样框架内，重度饮酒者也比其他群体更不可能参与。用于测量 HED 的问题容易受到受访者理解、回忆和错误报告等问题的偏差影响。此外，在对 182 个国家的回归分析中，APC 在预测酒精相关危害方面优于 HED。APC 还与 2010 年至 2016 年期间酒精相关疾病负担的变化相关，而 HED 则不然。
基于这些因素，发现 APC 是首选指标。
应保留 APC 作为衡量酒精有害使用的主要指标。
