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Prevalence and Risk Factors of Alcohol Dependence, and Association with Smoking in China: Findings from a National Cross-Sectional Study
20 Pages Posted: 21 Oct 2022
More...Abstract
Background: Alcohol dependence represents a chronic and relapsing disease. Little is known about its prevalence, risk factors, association with smoking and overall burden in China.
Methods: The 2018 nationally representative China Health Literacy Survey (CHLS) included 87,028 participants aged 20-69 years, including 83,968 who provided information on smoking history and alcohol consumption, with the alcohol dependence assessed using CAGE test. Logistic regression was conducted to explore the association between alcohol dependence and other variables. We further estimated the total number of cases of alcohol dependence and co-use of smoking and drinking alcohol in China by applying present study findings to national population census data.
Results: Overall, among current alcohol users, the prevalence of CAGE-questionnaire-defined alcohol dependence was 29.8%, significantly higher in men than in women (30.8% vs. 21.8%), translating into an overall prevalence of 7.3% (13.2% in men, 1.3% in women) in the general population. The prevalence of current alcohol and tobacco co-users was 14.1%, higher in men than women (27.3% vs. 0.6%) and highest in mild-aged (32%). Among man, the adjusted ORs (95% CI) for alcohol dependence were 1.54 (1.31, 1.08) for daily drinking alcohol, and 1.14 (1.08, 1.28) for current smoker. In addition, the risk of alcohol dependence was significantly associated with certain socioeconomic status (lower-income, rural residents) among males, but not among females. Furthermore, there was a dose-response association between smoking intensity and alcohol dependence among men, but not among women. In China, there were 72.6 million (95% CI: 65.1-80.9) alcohol dependent adults, and 139.9 million (95% CI: 128.3-152.3) co-users of alcohol and tobacco in 2018.
Conclusion: In China, alcohol dependence is highly prevalent, approximately three out of ten alcohol being additive, which is strongly associated with tobacco dependence. Therefore, comprehensive tobacco control and smoking cessation strategy is advocated, especially in the middle-income and low-income areas in China.
Funding Information: This study was supported by Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS 2021-I2M-1-010), Ministry of Finance of the People's Republic of China, and National Natural Science Foundation of China (grant no 81720108001).
Declaration of Interests: The authors declared no conflicts of interest.
Ethics Approval Statement: The study protocol was approved by the Ethics Review Committees of the China Health Education Center (Beijing, China). All participants provided signed informed consent.
Keywords: Alcohol dependence, Smoking, Prevalence, Associated factors
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