Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression

Abstract

Objective: Historically, alcohol use and related harms are more prevalent in men than in women. However, emerging evidence suggests the epidemiology of alcohol use is changing in younger cohorts. The current study aimed to systematically summarise published literature on birth cohort changes in male-tofemale ratios in indicators of alcohol use and related harms. Methods:We identified 68 studies that met inclusion criteria. We calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcoholrelated harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1568 sex ratios. Random-effects meta-analyses produced pooled sex ratios within these 3 categories separately for each birth cohort.Findings: There was a linear decrease over time in the sex ratio for all 3 categories of alcohol use and related harms. Among those born in the early 1900s, males were 2.2 (95% CI 1.9 to 2.5) times more likely than females to consume alcohol, 3.0 (95% CI 1.5 to 6.0) times more likely to drink alcohol in ways suggestive of problematic use and 3.6 (95% CI 0.4 to 30.3) times more likely to experience alcohol-related harms. Among cohorts born in the late 1900s, males were 1.1 (95% CI 1.1 to 1.2) times more likely than females to consume alcohol, 1.2 (95% CI 1.1 to 1.4) times more likely to drink alcohol in ways suggestive of problematic use and 1.3 (95% CI 1.2 to 1.3) times more likely to experience alcohol-related harms.Conclusions: Findings confirm the closing malefemale gap in indicators of alcohol use and related harms. The closing male-female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.Alcohol use and alcohol-related harms are among the most significant risk factors for burden of disease. Overall, they resulted in around 5 million deaths globally in 2010, and were responsible for more than 161 million years of life lost, equating to 5% of total global health burden.1 Historically, the prevalence of alcohol use and related harms has been between 2 and 12 times higher in men than women.2-7 However, there is emerging evidence to suggest that the gap between men and women in alcohol use and related harms is closing among recently born cohorts. [8][9][10][11] Understanding sex-specific birth cohort trends in the epidemiology of alcohol use is vital as they point to key environmental and social mechanisms associated with population shifts in alcohol use patterns. For example, studies have attributed these generational shifts in sex-specific drinking to changes in traditional gender roles over Strengths and limitations of this study ▪ Prior to this study, the evidence around gender convergence in alcohol use and alcohol-related harms was fragmented. This study systematically summarised all available literature and provided a quantification of the rate of gender convergence through the derivation of a single metric -the m...

Evidence for Sex Convergence in Prevalence of Cannabis Use: A Systematic Review and Meta-Regression

“…Figure 1 shows the number of articles obtained using the search strategy and the number of records excluded, with reasons. The present study had a parallel aim of examining evidence for the closing male-female gap in indicators of alcohol use, and the screening protocol was designed to screen records for both alcohol and cannabis, which were reported together in many cases (Slade et al, 2016). The electronic search strategy identified 1,445 unique records, and an additional 20 records (approximately 1%) were retrieved by examining literature reviews and reference lists of key articles.…”

“…Flowchart of systematic review procedure for identifying citations reporting indicators of alcohol or cannabis use and related harms by sex and cohort. a Alcohol indicators were analyzed separately and are reported elsewhere (Slade et al, 2016). Figure 1 shows the number of articles obtained using the search strategy and the number of records excluded, with reasons.…”

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