The six-year outcome of alcohol use disorders in men: A population based study from India

Abhijit Nadkarni,Helen A Weiss,Aresh Naik,Bhargav Bhat,Vikram Patel

doi:10.1016/j.drugalcdep.2016.02.039

Abhijit Nadkarni, Helen A Weiss + Show 3 more

Open Access

https://doi.org/10.1016/j.drugalcdep.2016.02.039

Copy DOI

Abstract

BackgroundDespite the large and growing public health problem of alcohol use disorders (AUD) in India there is a dearth of evidence about the longitudinal outcomes in AUD. The aim of this study is to describe the course and outcomes of AUD in a population based sample of men in India. MethodsA community cohort of 1899 adult (18–49 years at baseline) men who participated in a cross-sectional survey in Goa, India between 2006 and 08, were re-interviewed face to face 6 years later (2012–14). A range of outcomes including social problems (e.g., workplace problems, domestic violence), morbidity (e.g., range of physical and mental health problems), biological parameters (e.g., mean corpuscular volume [MCV], gamma-glutamyl transpeptidase [GGT]) and mortality were measured at follow up. For the association of AUD at baseline with outcomes at follow-up, multivariable logistic regression was used to estimate odds ratios (OR). Analyses were weighted to account for baseline sampling design, age distribution, rural and urban sample sizes, number of adults aged 18–49 years in the household (at baseline), and non-response (at baseline). Results1514 (79.7%) were seen at follow-up; a loss to follow up of 20.3%. At follow up, 3.7% of baseline non-drinkers and 15.0% of baseline casual drinkers had AUD. 46.9% of baseline hazardous drinkers and 55.4% baseline harmful drinkers continued to have AUD at follow up. Of those with AUD at baseline, 21.8% had stopped drinking at follow-up. Compared to being abstinent, harmful drinking at baseline was associated with several outcomes at follow-up: workplace/social problems, hypertension, death, tobacco use, suicidality, anxiety disorders, and raised GGT (p<0.002). Hazardous drinking at baseline was associated with tobacco use and raised GGT and MCV (p<0.002) at follow-up. ConclusionOur findings of high persistent and new AUD in the community and the association with a range of long term adverse events are an important addition to the limited evidence about the course and outcomes of AUD in India, which have the potential for informing health policy.

Highlights

Alcohol Use Disorders (AUD) comprise a range of heterogeneous conditions related to excessive alcohol consumption and is recognised by the World Health Organization (WHO) as a distinct disorder; with hazardous drinking, harmful drinking and dependent drinking reflecting progressively more serious forms of the condition (Reid et al, 1999; WHO, 1994)
The only variable significantly associated with lost to follow-up (LTFU) was living in urban areas
Having alcohol use disorders (AUD) at baseline was not associated with LTFU

Summary

Introduction

Alcohol Use Disorders (AUD) comprise a range of heterogeneous conditions related to excessive alcohol consumption and is recognised by the World Health Organization (WHO) as a distinct disorder; with hazardous drinking, harmful drinking and dependent drinking reflecting progressively more serious forms of the condition (Reid et al, 1999; WHO, 1994). The overall epidemiological picture of alcohol use in India is that almost half of all drinkers drink hazardously, and the signature pattern of hazardous drinking is one of heavy drinking, daily or almost daily drinking, under-socialized, solitary drinking of mainly spirits, drinking to intoxication and expectancies of drinkrelated dis-inhibition (Benegal, 2005) This results in high rates of alcohol-attributable mortality and prevalence of AUD relative to the per capita volume of alcohol consumed (Rehm et al, 2009). Harmful drinking at baseline was associated with several outcomes at follow-up: workplace/social problems, hypertension, death, tobacco use, suicidality, anxiety disorders, and raised GGT (p < 0.002). Conclusion: Our findings of high persistent and new AUD in the community and the association with a range of long term adverse events are an important addition to the limited evidence about the course and outcomes of AUD in India, which have the potential for informing health policy

Objectives

Methods

Results

Conclusion