Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
Popul Health Metr. 2021 Nov 3;19(1):43. doi: 10.1186/s12963-021-00270-3.
Alcohol use has widespread effects on health and contributes to over 200 detrimental conditions. Although the pattern of heavy episodic drinking independently increases the risk for injuries and transmission of some infectious diseases, long-term average consumption is the fundamental predictor of risk for most conditions. Population surveys, which are the main source of data on alcohol exposure, suffer from bias and uncertainty. This article proposes a novel triangulation method to reduce bias by rescaling consumption estimates by sex and age to match country-level consumption from administrative data.
We used data from 17 population surveys to estimate age- and sex-specific trends in alcohol consumption in the adult population of South Africa between 1998 and 2016. Independently for each survey, we calculated sex- and age-specific estimates of the prevalence of drinkers and the distribution of individuals across consumption categories. We used these aggregated results, together with data on alcohol production, sales and import/export, as inputs of a Bayesian model and generated yearly estimates of the prevalence of drinkers in the population and the parameters that characterise the distribution of the average consumption among drinkers.
Among males, the prevalence of drinkers decreased between 1998 and 2009, from 56.2% (95% CI 53.7%; 58.7%) to 50.6% (49.3%; 52.0%), and increased afterwards to 53.9% (51.5%; 56.2%) in 2016. The average consumption from 52.1 g/day (49.1; 55.6) in 1998 to 42.8 g/day (40.0; 45.7) in 2016. Among females the prevalence of current drinkers rose from 19.0% (17.2%; 20.8%) in 1998 to 20.0% (18.3%; 21.7%) in 2016 while average consumption decreased from 32.7 g/day (30.2; 35.0) to 26.4 g/day (23.8; 28.9).
The methodology provides a viable alternative to current approaches to reconcile survey estimates of individual alcohol consumption patterns with aggregate administrative data. It provides sex- and age-specific estimates of prevalence of drinkers and distribution of average daily consumption among drinkers in populations. Reliance on locally sourced data instead of global and regional trend estimates better reflects local nuances and is adaptable to the inclusion of additional data. This provides a powerful tool to monitor consumption, develop burden of disease estimates and inform and evaluate public health interventions.
饮酒对健康有广泛的影响，可导致 200 多种不良后果。尽管重度间歇性饮酒的模式会独立增加受伤和某些传染病传播的风险，但长期平均消费是大多数疾病风险的基本预测因素。人口调查是酒精暴露数据的主要来源，但存在偏倚和不确定性。本文提出了一种新的三角测量方法，通过将性别和年龄调整后的消费估计值与行政数据中的国家消费水平相匹配，从而降低偏倚。
我们使用了 17 项人口调查的数据，估计了 1998 年至 2016 年期间南非成年人口中按性别和年龄划分的酒精消费趋势。我们分别对每个调查进行了计算，得出了饮酒者的性别和年龄特异性流行率以及个体在不同消费类别中的分布情况。我们使用这些汇总结果，以及关于酒精生产、销售和进出口的数据，作为贝叶斯模型的输入，并生成了每年人口中饮酒者的流行率和特征饮酒者平均消费分布的参数估计。
在男性中，饮酒者的流行率从 1998 年的 56.2%（95%CI 53.7%；58.7%）下降到 2009 年的 50.6%（49.3%；52.0%），随后在 2016 年上升到 53.9%（51.5%；56.2%）。平均消费从 1998 年的 52.1 克/天（49.1；55.6）下降到 2016 年的 42.8 克/天（40.0；45.7）。在女性中，目前饮酒者的流行率从 1998 年的 19.0%（17.2%；20.8%）上升到 2016 年的 20.0%（18.3%；21.7%），而平均消费从 32.7 克/天（30.2；35.0）下降到 26.4 克/天（23.8；28.9）。
该方法为协调调查估计的个人饮酒模式与汇总行政数据提供了一种可行的替代方案。它提供了人群中饮酒者的性别和年龄特异性流行率以及饮酒者平均每日消费分布的估计值。依赖本地来源的数据而不是全球和区域趋势估计值，更好地反映了当地的细微差别，并且可以适应额外数据的纳入。这为监测消费、制定疾病负担估计以及为公共卫生干预措施提供信息和评估提供了一个强大的工具。
