Estimates of compliance with Canada's guidelines for low and moderate risk alcohol consumption: the importance of adjustment for underreporting in self-report surveys.

Abstract

Alcohol is a leading cause of premature mortality; however, awareness of this and of some specific risks is low. Survey-based estimates of drinking at risk levels suffer from substantial underreporting. We show that alcohol use reported in the 2019 Canadian Alcohol and Drug Survey (CADS) accounted for just 38.06% of recorded alcohol consumption. This contributes to alcohol's risks being minimized, by researchers, the public, and policymakers. The new Canada's Guidance on Alcohol and Health (CGAH) defines "moderate risk" as 3 to 6 drinks/week for men and women. Employing published methods to correct for underreporting in the CADS, we estimate that in 2019 the proportion of drinkers at moderate risk of long-term harm to be 50.43% (up from 23.34% without adjustment). We further estimate that, collectively, these drinkers consumed 90.17% of all drinks consumed that year. Similarly, 92.82% of drinks were consumed on days when upper limits for short-term harm (2 drinks/day) were exceeded (up from 65.02% without adjustment). We conclude that adjustments for underreporting of alcohol use in Canada need to be incorporated routinely in public health monitoring. This might help mitigate the widespread underestimation of risky alcohol use as well as the neglect of this public health issue by policymakers.