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Letters
12 November 2024
TRENDS IN ALCOHOL USE AFTER THE COVID-19 PANDEMIC: A NATIONAL CROSS-SECTIONAL
STUDYFREE
Authors: Divya Ayyala-Somayajula, MD https://orcid.org/0000-0002-9808-4382,
Jennifer L. Dodge, MPH https://orcid.org/0000-0001-8805-8271, Adam M. Leventhal,
PhD, Norah A. Terrault, MD, MPH, and Brian P. Lee, MD, MAS
https://orcid.org/0000-0003-2108-1287Author, Article, & Disclosure Information
Publication: Annals of Internal Medicine
https://doi.org/10.7326/ANNALS-24-02157
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Background: Alcohol is a leading cause of morbidity and mortality in the United
States (1). The COVID-19 pandemic was associated with increases in
stress-related drinking and alcohol-related deaths (1–3). Analyses of whether
increased alcohol use has persisted since the pandemic and trends among
subpopulations could inform public policy and health care initiatives to
mitigate alcohol-related morbidity and mortality.
Objective: To determine whether increased alcohol use during the pandemic (2020
vs. 2018) was sustained after the pandemic (2022).
Methods: This was a population-based study using cross-sectional data from
serial nationally representative surveys of adults aged 18 years or older who
participated in the National Health Interview Survey (NHIS) from 2018 to 2022.
The survey uses complex sampling to provide estimates that are representative of
the entire U.S. population. Data were collected on demographic, health, and
socioeconomic factors at the family and person levels. The survey was
administered by trained interviewers in face-to-face or telephone interviews.
The primary outcomes of this study were prevalence of any alcohol use and heavy
alcohol use. Adults were categorized as having any alcohol use or heavy alcohol
use within 1 year of the survey per the National Institute on Alcohol Abuse and
Alcoholism definition of heavy drinking (≥5 drinks on any day or ≥15 drinks per
week for males, and ≥4 drinks on any day or ≥8 drinks per week for females) (4).
Prevalence rates per 100 persons and associated 95% CIs were calculated. We
tested for differences in national prevalence of any alcohol use and heavy
alcohol use by year (vs. 2018) using logistic regression. The margins command
was used to calculate pairwise differences in proportions by year with 95% CIs.
NHIS weighting was used for all analyses, which were performed in SAS, version
9.4 (SAS Institute), and Stata MP 17.0 (StataCorp). All data are publicly
available and were deemed to be exempt from review by the Institutional Review
Board of the University of Southern California.
Findings: The study included 24 965 respondents from 2018, 30 829 from 2020, and
26 806 from 2022.
Compared with 2018, there were absolute increases in any alcohol use in 2020
(2.69% [95% CI, 1.28% to 4.10%]) and 2022 (2.96% [CI, 1.58% to 4.33%]).
Numerical increases in any alcohol use occurred in 2020 and 2022 versus 2018
among all subgroups. Point estimates and 95% CIs are shown in Figure 1.
Figure 1. Prevalence of and absolute mean difference in any alcohol use.
The figure shows the absolute mean difference in national prevalence per 100
persons of any alcohol use within the past year among the overall population in
2020 and 2022 compared with 2018. Error bars represent 95% CIs. Alcohol data
were missing for 2036 participants. All estimates are weighted.
* Maine, New Hampshire, Massachusetts, Vermont, Connecticut, Rhode Island, New
York, New Jersey, and Pennsylvania.
† North Dakota, South Dakota, Minnesota, Nebraska, Iowa, Kansas, Missouri,
Wisconsin, Michigan, Illinois, Indiana, and Ohio.
‡ Maryland, Delaware, District of Columbia, West Virginia, Virginia, North
Carolina, South Carolina, Kentucky, Tennessee, Mississippi, Alabama, Georgia,
Florida, Louisiana, Arkansas, Oklahoma, and Texas.
§ Washington, Montana, Idaho, Wyoming, Oregon, California, Nevada, Utah,
Colorado, Arizona, and New Mexico.
‖ Data on rural/urban residence were available only for 2020 and 2022. Estimates
for 2022 versus 2020 were calculated using logistic regression.
Open in viewer
Compared with 2018, there were absolute increases in heavy alcohol use in 2020
(1.03% [CI, 0.55% to 1.51%]) and 2022 (1.18% [CI, 0.70% to 1.67%]). Numerical
increases in heavy alcohol use occurred in 2020 and 2022 versus 2018 among all
subgroups except among American Indians and Asians in 2022. Point estimates and
95% CIs are shown in Figure 2.
Figure 2. Prevalence of and absolute mean difference in heavy alcohol use.
The figure shows the absolute mean difference in national prevalence per 100
persons of heavy alcohol use within the past year among the overall population
in 2020 and 2022 compared with 2018. Error bars represent 95% CIs. Alcohol data
were missing for 2036 participants. All estimates are weighted.
* Maine, New Hampshire, Massachusetts, Vermont, Connecticut, Rhode Island, New
York, New Jersey, and Pennsylvania.
† North Dakota, South Dakota, Minnesota, Nebraska, Iowa, Kansas, Missouri,
Wisconsin, Michigan, Illinois, Indiana, and Ohio.
‡ Maryland, Delaware, District of Columbia, West Virginia, Virginia, North
Carolina, South Carolina, Kentucky, Tennessee, Mississippi, Alabama, Georgia,
Florida, Louisiana, Arkansas, Oklahoma, and Texas.
§ Washington, Montana, Idaho, Wyoming, Oregon, California, Nevada, Utah,
Colorado, Arizona, and New Mexico.
‖ Data on rural/urban residence were available only for 2020 and 2022. Estimates
for 2022 versus 2020 were calculated using logistic regression.
Open in viewer
Discussion: This nationally representative study suggests that the prevalence of
any alcohol use and heavy alcohol use during the COVID-19 pandemic (2020 vs.
2018) showed absolute increases of 2.7% (relative increase, 4.0%) and 1.0%
(relative increase, 20.2%) and that the increases were sustained in 2022.
Our results provide national data to draw further attention to the potential
alcohol-related public health effects that may remain from the pandemic. A
previous study reported increases in alcohol use via breathalyzer measurements
from 2020 to 2021, but that study was limited by potential selection bias and
was done while the pandemic was ongoing (2). Our study suggests that these
increases persisted in 2022 and that certain subgroups may have had greater
increases in heavy alcohol use. Potential causes of this sustained increase
include normalization of and adaptation to increased drinking due to stress from
the pandemic and disrupted access to medical services (1). Close follow-up is
needed to determine whether increases in heavy alcohol use persist.
This study had limitations. The NHIS includes only nonmilitary
noninstitutionalized adults and thus excludes certain populations that may be
more vulnerable to harmful alcohol use. Self-reported alcohol use may be
underreported, although quantity and frequency self-report measures are standard
for reliable and valid assessment of alcohol consumption in population surveys
(5). The variables are also at risk for misclassification and response bias.
Nevertheless, this is a national survey administered over 50 years with careful
selection of questions from validated instruments, and it uses complex sampling
to provide accurate population estimates.
In conclusion, our results highlight an alarming public health issue that may
require a combination of policy changes. Increased screening efforts for harmful
drinking with systematic integration and rapid linkage to behavioral health
treatments by health care professionals, in tandem with community-based
interventions for at-risk populations, should be considered to mitigate the
public health consequences of the pandemic-related increase in alcohol use.
SUPPLEMENTAL MATERIAL
Author Disclosures (annals-24-02157_supplement-disclosureforms.pdf)
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* 518.42 KB
REFERENCES
1.
White AM, Castle IP, Powell PA, et al. Alcohol-related deaths during the
COVID-19 pandemic. JAMA. 2022;327:1704-1706. [PMID: 35302593] doi:
10.1001/jama.2022.4308
Crossref
PubMed
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* a [...] and mortality in the United States
* b [...] drinking and alcohol-related deaths
* c [...] and disrupted access to medical services
2.
Houston PD, Vittinghoff E, Marcus GM. Changes in alcohol consumption during the
COVID-19 pandemic: a longitudinal cohort study using smart-breathalyzer data.
Sci Rep. 2024;14:3304. [PMID: 38332308] doi: 10.1038/s41598-024-53757-y
Crossref
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* a [...] drinking and alcohol-related deaths
* b [...] and was done while the pandemic was ongoing
3.
Substance Abuse and Mental Health Services Administration. 2022 National Survey
on Drug Use and Health (NSDUH) Releases. Accessed at
www.samhsa.gov/data/release/2022-national-survey-drug-use-and-health-nsduh-releases
on 18 October 2024.
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4.
National Institute on Alcohol Abuse and Alcoholism. Drinking Levels and Patterns
Defined. Accessed at
www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
on 18 October 2024.
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Google Scholar
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McKenna H, Treanor C, O'Reilly D, et al. Evaluation of the psychometric
properties of self-reported measures of alcohol consumption: a COSMIN systematic
review. Subst Abuse Treat Prev Policy. 2018;13:6. [PMID: 29394950] doi:
10.1186/s13011-018-0143-8
Go to Citation
Crossref
PubMed
Google Scholar
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COMMENTS
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INFORMATION & AUTHORS
InformationAuthors
INFORMATION
PUBLISHED IN
Annals of Internal Medicine
HISTORY
Published online: 12 November 2024
KEYWORDS
1. Alcohol consumption
2. Alcoholism
3. COVID-19 pandemic
4. Liver diseases
5. Morbidity
6. Mortality
7. Pandemics
8. Prevention, policy, and public health
9. Public policy
COPYRIGHT
© 2024 American College of Physicians.
AUTHORS
AFFILIATIONSEXPAND ALL
DIVYA AYYALA-SOMAYAJULA, MD HTTPS://ORCID.ORG/0000-0002-9808-4382
Division of Gastrointestinal and Liver Diseases, Sidney Kimmel Medical College,
Thomas Jefferson University, Philadelphia, Pennsylvania
View all articles by this author
JENNIFER L. DODGE, MPH HTTPS://ORCID.ORG/0000-0001-8805-8271
Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, and
Department of Population and Public Health Sciences, University of Southern
California, Los Angeles, California
View all articles by this author
ADAM M. LEVENTHAL, PHD
Department of Population and Public Health Sciences and Institute for Addiction
Science, University of Southern California, Los Angeles, California
View all articles by this author
NORAH A. TERRAULT, MD, MPH
Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, and
Institute for Addiction Science, University of Southern California, Los Angeles,
California
View all articles by this author
BRIAN P. LEE, MD, MAS HTTPS://ORCID.ORG/0000-0003-2108-1287
Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, and
Institute for Addiction Science, University of Southern California, Los Angeles,
California
View all articles by this author
Disclosures: Disclosure forms are available with the article online.
Reproducible Research Statement: Study protocol and statistical code: Available
on reasonable request from Dr. Lee (e-mail, Brian.lee@med.usc.edu). Data set:
Data are publicly available at
www.cdc.gov/nchs/nhis/data-questionnaires-documentation.htm.
Corresponding Author: Brian P. Lee, MD, MAS, Division of Gastroenterology and
Liver Diseases, Keck School of Medicine, University of Southern California, 2250
Alcazar Street, Room 135G, Los Angeles, CA 90033; e-mail, Brian.lee@med.usc.edu.
This article was published at Annals.org on 12 November 2024.
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Divya Ayyala-Somayajula, Jennifer L. Dodge, Adam M. Leventhal, et al. Trends in
Alcohol Use After the COVID-19 Pandemic: A National Cross-Sectional Study. Ann
Intern Med. [Epub 12 November 2024]. doi:10.7326/ANNALS-24-02157
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Open all in viewer
Figure 1. Prevalence of and absolute mean difference in any alcohol use.
The figure shows the absolute mean difference in national prevalence per 100
persons of any alcohol use within the past year among the overall population in
2020 and 2022 compared with 2018. Error bars represent 95% CIs. Alcohol data
were missing for 2036 participants. All estimates are weighted.
* Maine, New Hampshire, Massachusetts, Vermont, Connecticut, Rhode Island, New
York, New Jersey, and Pennsylvania.
† North Dakota, South Dakota, Minnesota, Nebraska, Iowa, Kansas, Missouri,
Wisconsin, Michigan, Illinois, Indiana, and Ohio.
‡ Maryland, Delaware, District of Columbia, West Virginia, Virginia, North
Carolina, South Carolina, Kentucky, Tennessee, Mississippi, Alabama, Georgia,
Florida, Louisiana, Arkansas, Oklahoma, and Texas.
§ Washington, Montana, Idaho, Wyoming, Oregon, California, Nevada, Utah,
Colorado, Arizona, and New Mexico.
‖ Data on rural/urban residence were available only for 2020 and 2022. Estimates
for 2022 versus 2020 were calculated using logistic regression.
Go to FigureOpen in Viewer
Figure 2. Prevalence of and absolute mean difference in heavy alcohol use.
The figure shows the absolute mean difference in national prevalence per 100
persons of heavy alcohol use within the past year among the overall population
in 2020 and 2022 compared with 2018. Error bars represent 95% CIs. Alcohol data
were missing for 2036 participants. All estimates are weighted.
* Maine, New Hampshire, Massachusetts, Vermont, Connecticut, Rhode Island, New
York, New Jersey, and Pennsylvania.
† North Dakota, South Dakota, Minnesota, Nebraska, Iowa, Kansas, Missouri,
Wisconsin, Michigan, Illinois, Indiana, and Ohio.
‡ Maryland, Delaware, District of Columbia, West Virginia, Virginia, North
Carolina, South Carolina, Kentucky, Tennessee, Mississippi, Alabama, Georgia,
Florida, Louisiana, Arkansas, Oklahoma, and Texas.
§ Washington, Montana, Idaho, Wyoming, Oregon, California, Nevada, Utah,
Colorado, Arizona, and New Mexico.
‖ Data on rural/urban residence were available only for 2020 and 2022. Estimates
for 2022 versus 2020 were calculated using logistic regression.
Go to FigureOpen in Viewer
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* Kenzie Teno, MPH,
* Patricia A. Ryan, MS,
* Maya L. Monroe, MPH,
* Libby Reeg, MPH,
* Sue Kim, MPH,
* Kathryn Como-Sabetti, MPH,
* Erica Bye, MPH,
* Sarah Shrum Davis, MPH,
* Nancy Eisenberg, MPH,
* Alison Muse, MPH,
* Grant Barney, MPH,
* Nancy M. Bennett, MD, MS,
* Christina B. Felsen, MPH,
* Laurie Billing, MPH,
* Jess Shiltz, MPH,
* Melissa Sutton, MD, MPH,
* Nasreen Abdullah, MD, MPH,
* H. Keipp Talbot, MD,
* William Schaffner, MD,
* Mary Hill, MPH,
* Ryan Chatelain, MPH,
* Jonathan Wortham, MD,
* Christopher Taylor, PhD,
* Aron Hall, DVM,
* Alicia M. Fry, MD,
* Lindsay Kim, MD, and
* Fiona P. Havers, MD, MHS
* Race/Ethnicity Trends Among U.S. Internal Medicine Residency Applicants and
Matriculants: A Cross-Sectional Study
* Joanna Liao, BS,
* Thamanna Nishath, MSPH,
* Sangeetha Thevuthasan, BS,
* Edwin Nieblas-Bedolla, MPH,
* Briana Christophers, AB,
* Helene Starks, PhD, MPH,
* Molly Jackson, MD*,
* Genevieve Pagalilauan, MD*
* Asthma Disparities in the United States Narrowed During the COVID-19
Pandemic: Findings From a National Survey, 2019 to 2022
* Adam Gaffney, MD, MPH,
* David U. Himmelstein, MD,
* Steffie Woolhandler, MD, MPH
* Identifying Trends in Undiagnosed Diabetes in U.S. Adults by Using a
Confirmatory Definition
* Elizabeth Selvin, PhD, MPH,
* Dan Wang, MS,
* Alexandra K. Lee, PhD, MSPH,
* Richard M. Bergenstal, MD, and
* Josef Coresh, MD, PhD
* Should the Hemoglobin A1c Diagnostic Cutoff Differ Between Blacks and Whites?
* Yusuke Tsugawa, MD, MPH,
* Kenneth J. Mukamal, MD, MPH,
* Roger B. Davis, ScD,
* William C. Taylor, MD, and
* Christina C. Wee, MD, MPH
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FiguresTables
View figure
Figure 1
Figure 1. Prevalence of and absolute mean difference in any alcohol use.
The figure shows the absolute mean difference in national prevalence per 100
persons of any alcohol use within the past year among the overall population in
2020 and 2022 compared with 2018. Error bars represent 95% CIs. Alcohol data
were missing for 2036 participants. All estimates are weighted.
* Maine, New Hampshire, Massachusetts, Vermont, Connecticut, Rhode Island, New
York, New Jersey, and Pennsylvania.
† North Dakota, South Dakota, Minnesota, Nebraska, Iowa, Kansas, Missouri,
Wisconsin, Michigan, Illinois, Indiana, and Ohio.
‡ Maryland, Delaware, District of Columbia, West Virginia, Virginia, North
Carolina, South Carolina, Kentucky, Tennessee, Mississippi, Alabama, Georgia,
Florida, Louisiana, Arkansas, Oklahoma, and Texas.
§ Washington, Montana, Idaho, Wyoming, Oregon, California, Nevada, Utah,
Colorado, Arizona, and New Mexico.
‖ Data on rural/urban residence were available only for 2020 and 2022. Estimates
for 2022 versus 2020 were calculated using logistic regression.
View figure
Figure 2
Figure 2. Prevalence of and absolute mean difference in heavy alcohol use.
The figure shows the absolute mean difference in national prevalence per 100
persons of heavy alcohol use within the past year among the overall population
in 2020 and 2022 compared with 2018. Error bars represent 95% CIs. Alcohol data
were missing for 2036 participants. All estimates are weighted.
* Maine, New Hampshire, Massachusetts, Vermont, Connecticut, Rhode Island, New
York, New Jersey, and Pennsylvania.
† North Dakota, South Dakota, Minnesota, Nebraska, Iowa, Kansas, Missouri,
Wisconsin, Michigan, Illinois, Indiana, and Ohio.
‡ Maryland, Delaware, District of Columbia, West Virginia, Virginia, North
Carolina, South Carolina, Kentucky, Tennessee, Mississippi, Alabama, Georgia,
Florida, Louisiana, Arkansas, Oklahoma, and Texas.
§ Washington, Montana, Idaho, Wyoming, Oregon, California, Nevada, Utah,
Colorado, Arizona, and New Mexico.
‖ Data on rural/urban residence were available only for 2020 and 2022. Estimates
for 2022 versus 2020 were calculated using logistic regression.
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