Changes on Risky Drinking after the COVID-19 Outbreak in Brazil: Results from Three Consecutive Web Surveys
Research paper
Focus of the present research
There is a lack of studies evaluating trends on alcohol consumption in low- and middle-income countries. Therefore the present study aimed to fill this gap by evaluating the changes in high risk alcohol use during three different moments of the pandemic. The changes were assessed among the Brazilian general population as well as compared between individuals reporting or not chronic diseases and reporting or not mental health disorders.
This is the first study to bring information with longitudinal data from a continental middle-income country in Latin America after the COVID-19 outbreak. Although there was a decrease in high risk alcohol use prevalence, the economic consequences of the pandemic and the dismantling of the unified health system, make the monitoring of alcohol use trends crucial for public health policies.
Previous research
Alcohol harm is a public health problem and a risk factor for morbidity and mortality worldwide. For these reasons, reducing per capita alcohol use is one of the United Nations’ sustainable development goals. At the beginning of the COVID-19 pandemic there was huge concern that the crisis could lead to an increase on alcohol consumption. In 2022 a systematic review evaluated the changes on alcohol consumption during the pandemic and found heterogenous results. Studies showed significant decreases in total alcohol consumption and binge alcohol use and significant increase in the frequency of alcohol use and alcohol use disorder (AUD) in some countries but not in others.
In Brazil cross-sectional studies presented inconclusive results regarding alcohol consumption during the COVID-19 pandemic either reporting its reduction or increase. However none of those studies was longitudinal and only Nin et al. investigated alcohol consumption through a validated scale (ASSIST). The mixed results may be explained by different methodologies and by the substantial risk of recall bias (since the changes on alcohol consumption relied on self-reports from retrospective behavior).
Considering the burden of the pandemic on the health system, evaluating the use of alcohol among people with comorbidities brings important information for planning contingency strategies in health. Moreover investigating the pattern of alcohol consumption during a pandemic may orient the development of prevention strategies to face future challenges like the COVID-19 pandemic.
Despite the great relevance of this topic, few studies were conducted in Latin America during the COVID-19 pandemic. The largest was conducted in Colombia and Mexico and found a decrease on alcohol use among patients at primary health services but the authors acknowledge that this may reflect a decrease in the number of patients seeking such services. Manthey and colleagues reported a reduction of alcohol use in Colombia’s and Mexico’s primary care patients, suggesting the lack of social gatherings, a set of evidence-based, high-impact alcohol policies, and economic losses as possible explanations.
Key findings
The study shows that the prevalence of high risk alcohol use decreased in Brazil between April 2020 and March 2021.
The study also shows that people reporting chronic diseases presented a lower prevalence of high risk alcohol use.
And the study shows that people reporting mental health disorders present a higher prevalence of high risk alcohol use (compared with those without chronic and mental health problems, respectively).
It is noteworthy that these changes reflect the year after Brazil’s first COVID-19 case was diagnosed and not pre-post pandemic changes.
- The overall prevalence of high risk alcohol use in Brazil between April 2020 and March 2021 declined, since the country’s first COVID-19 case.
- The decline over time, started at 45.8% in April 2020, decreasing to 35.3% in August 2020, and further dropping to 33.7% in January 2021.
- High risk alcohol use was more frequent among men, younger people, people with higher educational attainment, and people with worse lifestyle.
Among people with chronic diseases, the prevalence of high risk alcohol use was 45.05% in April 2020 and 33.11% in January 2021.
Among people without chronic diseases, the prevalence of high risk alcohol use was 47.86% in April 2020 and 35.67% in January 2021.
Among people with mental health disorders, the prevalence of high risk alcohol use was 51.50% in April 2020 and 32.34% in January 2021.
Among people without mental health disorders, the prevalence of high risk alcohol use was 42.89% in April 2020 and 35.35% in January 2021.
- People with chronic diseases had a lower prevalence of high risk alcohol use.
- People with mental health disorders demonstrated a higher prevalence of high risk alcohol use.
- Brazilian results align with research from other parts of the world.
- Alcohol use and high risk alcohol consumption at the general population level decreased during the pandemic globally.
- The study suggests that the initial stages of the pandemic may have seen a surge in alcohol use as a coping mechanism for stress and anxiety. However, over time, it reverted to pre-pandemic levels.
Explanation for high risk alcohol use trends in Brazil
The study’s results do not capture pre-pandemic alcohol use in Brazil. But the researchers assume that there was an increase in alcohol consumption in the beginning of the pandemic as reported by Nin et al. possibly reflecting a coping mechanism by people to use alcohol to deal with high levels of stress/ anxiety. This was then followed by a fall in alcohol use towards the pre-pandemic mean.
In addition, changes in on/off-premises alcohol consumption may have influenced alcohol use volumes and patterns. For instance, in February-March 2021 Brazil experienced the second COVID-19 wave and although the levels of anxiety/stress could be lower than in 2020 there was a second increase in proportion of people staying at home. Previous research suggests that the decreased opportunities of social events affected the decline in high risk alcohol use.
The higher prevalence of high risk alcohol use among people with mental health disorders corroborates previous reports pointing to a higher probability of alcohol use disorder in people with psychiatric comorbidities. The reasons behind this frequent comorbidity are still debated, be it because of a direct or indirect causal effect of AUD on other psychiatric disorders or the other way around; because of shared environmental and genetic causes or shared psychopathological mechanisms.
Abstract
Introduction
High risk alcohol use is linked with an increased risk of chronic and infectious diseases, injuries, and violence. This study aimed to assess changes in high risk alcohol use in Brazil after the COVID-19 outbreak, both overall and among people with self-reported chronic diseases and mental health disorders.
Methods
The researchers conducted three independent, anonymous web surveys in Brazil including adult participants:
- S1 (April/2020, n=19,257),
- S2 (August/2020, n=1,590), and
- S3 (January/2021, n=859).
Participants were recruited through adapted snowball sampling and sponsored social network advertisements.
High risk alcohol use was assessed using the Alcohol Use Disorder Identification Test-Concise (AUDIT-C), designed to identify individuals at risk of alcohol-related problems.
Logistic regression analyses with bootstrapping (B=2,000) were performed, with stratification by sex, age, education, employment, household size, and the presence of chronic and mental health conditions, as well as lifestyle factors, to address sample imbalances.
Results
The estimated prevalence of high risk alcohol use was 45.8% in S1, 35.3% in S2, and 33.7% in S3.
Participants with chronic diseases consistently presented lower high risk alcohol use prevalence across all three surveys, compared to those without such conditions. Conversely, individuals with mental health disorders presented higher high risk alcohol use prevalence than those without such diagnoses in S1 and S2, but not in S3.
Discussion
Despite the decrease in high risk alcohol use prevalence, monitoring of alcohol consumption trends remains essential for shaping effective public health policies. Additionally, the observed variations among individuals reporting chronic and mental health disorders highlight the need for targeted interventions in future crises.