Predictors of transitions across stages of alcohol use and disorders in an adult population with heterogeneous ethnic restrictions regarding drinking.

Abstract

To disaggregate associations with alcohol use disorder relative to those with early alcohol use stages in an adult population. We estimated prevalence rates and socio-demographic correlates for the opportunity to drink and transitions into life-time alcohol use, regular use and alcohol use disorder. A retrospective, cross-sectional population survey within a family panel study. Chitwan in Nepal, an ethnically diverse setting with heterogeneous ethnic restrictions regarding alcohol. A total of 10 714 individuals aged 15-59 years (response rate=93%). The Nepal-specific Composite International Diagnostic Interview assessed life-time alcohol use opportunity, any use, regular use, disorder and socio-demographic characteristics. Seventy per cent [95% confidence interval (CI)=69.08-70.82%] of the population had the opportunity to drink, 38.06% (95% CI=37.14-38.99%) had life-time alcohol use, 32.37% (95% CI=31.48-33.27%) had regular alcohol use and 6.04% (95% CI= 5.60-6.50%) developed an alcohol use disorder. Compared with high-caste Hindus, all other ethnicities had greater odds of early stage transitions [odds ratios (OR) ranged from 1.31, 95% CI=1.16-1.47 to 1.98, 95% CI=1.81-2.18)], but not of development of disorder. Male sex was associated with greater odds of all transitions, from opportunity (OR=5.71, 95% CI=5.41-6.03) to development of disorder (OR=1.95, 95% CI=1.35-2.81). The youngest cohort had higher odds of all transitions, from opportunity (OR=4.86, 95% CI=4.47-5.29) to development of disorder (OR=9.34, 95% CI=6.88-12.70). Higher education was associated with lower odds of all transitions except opportunity [from use (OR=0.77, 95% CI=0.71-0.83) to the development of disorder (OR=0.73, 95% CI=0.59-0.89)]. The prevalence of life-time alcohol use among adults in Nepal appears to be low, but the overall prevalence of disorder is similar to other countries. Socio-demographic correlates of early alcohol use transitions differ from those associated with later transitions; while sex and age cohort were associated with all transitions, ethnicity was associated with early transitions (opportunity, life-time use, regular use), but not later transitions (use and regular use to disorder).