What is the best indicator of the harmful use of alcohol? A narrative review

The authors of a study say that 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. A narrative review, published in April in the Drug and Alcohol Review, assesses the advantages and disadvantages of both indicators and gives 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.
Source: Rehm, J., Crépault, J.‐F., Wettlaufer, A., Manthey, J. and Shield, K. (2020), What is the best indicator of the harmful use of alcohol? A narrative review. Drug Alcohol Rev.