Problem drinking, wellbeing and mortality risk in Chinese men: findings from the China Kadoorie Biobank
Research Report
Abstract
Aims
To assess the associations of problem alcohol use with wellbeing and mortality in Chinese men.
Design
Population‐based prospective cohort study.
Setting
Ten diverse areas across China.
Participants
A total of 210 259 men aged 30–79 years enrolled into China Kadoorie Biobank between 2004 and 2008.
Measurements
Self‐reported alcohol intake and indicators of problem alcohol use (i.e. alcohol use in the morning, unable to stop alcohol consumption, unable to work due to alcohol intake, negative emotions after alcohol use, having shakes after stopping alcohol use) were assessed by questionnaire at baseline, along with stressful life events (e.g. divorce, income loss, violence) and wellbeing‐related measures (e.g. life satisfaction, sleep problems, depression, anxiety).
Problem alcohol use was defined as reporting at least one of the alcohol use problem indicators. Follow‐up for mortality and hospitalized events was through linkage to death registries and national health insurance systems. Multivariate logistic regression models assessed cross‐sectional relationships between problem alcohol consumption and stressful life events/wellbeing. Cox proportional hazards regression models estimated prospective associations of problem alcohol use with mortality/hospitalized events.
Findings
A third of men were current regular alcohol users (i.e. drank alcohol at least weekly), 24% of whom reported problem alcohol use: 8% of all men.
Experience of stressful life events in the past 2 years, especially income loss, was associated with increased problem alcohol use.
Compared with low‐risk alcohol users (i.e. intake < 200 g/week, no reported problem alcohol use or habitual heavy alcohol consumption episodes), men with problem alcohol consumption had poorer self‐reported health, poorer life satisfaction and sleep problems, and were more likely to have symptoms of depression and anxiety.
Men with two or more problem alcohol use indicators had an approximately twofold higher risk for all‐cause mortality as well as mortality and morbidity from external causes (i.e. injuries), respectively, and 15% higher risk for any hospitalization, compared with low‐risk drinkers.
Conclusion
8% of men in China are problem alcohol users, and this is associated with significantly increased risk of physical and mental health problems and premature death.
Study highlights
In China, the patterns of alcohol use differ importantly from western populations, including a lower prevalence of regular alcohol use especially among women, and the Chinese custom of drinking spirits and consuming alcohol with meals.
The prevalence of alcohol dependence increased from 0.02 to 0.68% between the 1980s and 1990s, paralleled with a sharp increase in per‐capita alcohol consumption from 2.5 litres in 1978 to 7.2 litres in 2016.
In 2010, AUD was the ninth leading cause of disability, and the second most important mental disorder after depression in China. The relationships between problem alcohol use, wellbeing and health have emerged as important public health concerns.
In this large study of Chinese adults, one in four men who consumed alcohol regularly experienced at least one indicator of problem alcohol use.
Problem alcohol intake was more prevalent among men living in rural areas and with lower socio‐economic status. Experience of stressful life events, especially loss of income, was associated with a higher risk of problem alcohol use.
Problem alcohol use was associated with poor wellbeing and higher risk of all‐cause mortality and incident events due to external causes.
The extremely low prevalence of regular drinking in women (~2%) suggested that the burden of problem alcohol use is likely to be highly skewed towards Chinese men.
Summary
This study showed that problem alcohol use was common among Chinese men, especially those with lower socio‐economic status. Problem alcohol consumption was associated with stressful life events, poor wellbeing and excess risks of overall mortality and accidents, injury and violence. Policy and public health actions are needed to tackle the issue of heavy alcohol use in China, especially among men, to reduce the burden of alcohol harm.
