Monthly Archives: July 2019

Closing the Gap: Gender Disparities in Alcohol Use Disorder and Suicide Rates 

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While alcohol use disorders and suicide are topics often avoided due to their sensitivity and difficulty to encapsulate in words, they are everpresent in the lives of millions of Americans. Suicide alone accounted for over 47,000 deaths in 2017 alone, and is ranked overall as the 10th leading cause of death among Americans. But, adding context to this issue brings it more clearly into focus; suicide is the second leading cause of death among those aged 10-34. Some of the youngest of us are at the highest risk for ending their own lives. And, looking at those suffering from alcohol use disorders, the population of victims soars. The NIAAA estimates that 16 million americans have AUD. With such numbers being direct victims, it’s inarguable that we can ignore these challenges. 

While anyone from any background, gender, ethnicity, or culture can suffer from either or both suicidal tendencies and alcohol use disorder, we know that a higher rate of men suffer than women. In 2017 alone, men were 3.54 times – not percent, but multiplied – more likely to die by suicide than women. Men are also almost 2 times more likely to have AUD. Because of this reality, many treatment methods have been created by and, perhaps subconsciously, for men. Until recently, we have operated under the assumption that alcohol use, long term, impacts all genders in the same way. But now we know that we were wrong. By being less efficient at metabolizing alcohol, women suffer the negative consequences of alcohol abuse more quickly and with a lower volume of alcohol than men. When we take AUD into account in terms of death by suicide, then, what does the gender gap look like? In line with the new research showing that women are physiologically more susceptible to the effects of AUD, we may hypothesize that the same would occur psychologically. But, the question remains. By how much?   

Without taking into account the impact of AUD, men are 293.75% more likely to die by suicide. When we look at alcohol-attributable suicides, however, we see that enormous gap shrink to only 55.24%. This suggests that while the rate amongst men still remains higher, excessive alcohol use creates a greater impact on death via suicide amongst women. 

Our current culture is one that is both acknowledging women drinking – and drinking more- while simultaneously encouraging the behavior. While the awareness might create an openness for women to discuss AUD and recognize harmful patterns in their own drinking, the encouragement to drink more dwarfs this silver lining. 

The necessary response, I believe, is clear; gender and culture-sensitive AUD treatment methods and programs must be developed and made available to all those suffering. It would be an irresponsible and cruel act to divert all of our energy and resources to studying and treating AUD in women, leaving men behind. The next steps should be ones of equity as we continue to uncover the many variables that can affect one’s risk of suicide. 

 

Alcohol Use And Binge Drinking Among Georgia Women

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Consumption of past month Alcohol Use and Binge Drinking among women in Georgia

Excessive alcohol consumption among women are of special concern to public health. In Georgia, excessive drinking of alcohol results in 2,555 deaths and 79,183 years of potential life lost each year (1). Many adverse health outcomes associated with excessive alcohol consumption in women which include cancer, heart disease, stroke, liver cirrhosis, preterm birth (5,7), fetal alcohol syndrome (3), and unintentional and intentional injuries (2).  Although studies have been conducted on alcohol consumption of women in U.S., there is limited data on alcohol drinking patterns or changes in demographic shifts for alcohol drinking patterns among women in Georgia. Therefore, this study was conducted to compare alcohol consumption patterns of women in Georgia reported in 2011 with those reported in 2016.

The study used secondary data from telephone interviews of 14362 adults aged ≥18 years residing in Georgia; that participated in the Behavioral Risk Factor Surveillance System (BRFSS) survey in 2011 and 2016. Overall, 8977 women were analyzed. Measures focused on alcohol use and binge drinking and on the intensity of binge drinking in the past 30 days.  Prevalence and 95% confidence intervals (CIs) for past month alcohol use (in the past 30 days) and binge drinking (4+ drinks on more than one occasion) by the study population were estimated overall and then analyzed. Among the surveyed women (N=8977), overall past month alcohol use showed a significant decrease in relative risk (2.5%, p<0.0001, Table1) from 2011 to 2016.  However, significant increase in relative risk of past month alcohol use from 2011 to 2016 were found among women 65 years and older (41.8%, p <0.0001, Table 1) when compared to other age groups.  Similarly, significant decline in the relative risk (12.6 %, p<0.0001, Table 2) of binge drinking among surveyed women from 2016 to 2011.  However, significant increase in relative risk of binge drinking among women 65 years and older (145%, p<0.0001, Table 2) when compared to other groups from 2011 to 2016.

 

Alcohol is a risk factor for women for adverse health conditions.  Overall, the findings showed that past month prevalence of alcohol use among women significantly decreased from 43.6% in 2011 to 42.5% in 2016 for Georgia. This is lower than the national estimates of past month alcohol use (57%) and 2016 (54%) in 2013.  However, significant increase in the relative risk of past month alcohol use (41.8%) and binge drinking (percent change: 145 %) was seen among subgroup populations, particularly notable among women who are 65 years and older. Older adults are at particular risk for falls and injuries (6) and the unintentional injury death rate (8) ED-treated falls (9) hospitalized fall rates (2) and fall-related traumatic brain injury deaths (10). In 1990, those over the age of 65 comprised 13 percent of the U.S. population; by the year 2030, older adults are expected to account for 22 percent of the population. (U.S. Bureau of the Census 1996). As the population age 60 and older increases, there could be the potential for increase in the rate of alcohol consumption patterns leading to alcohol-related risks in this age group.

References

  1. Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI) [database]. Accessed Dec 13, 2013.
  2. DeGrauw X, Annest JL, Stevens JA, Xu L, Coronado V. Unintentional injuries treated in

hospital emergency departments among persons aged 65 years and older, United States, 2006-2011 J Safety Res. 2016;56:105-109.

  1. Ethen MK, Ramadhani TA, Scheuerle AE, et al. Alcohol consumption by women before and during pregnancy. Matern Child Health J 2009; 13:274–85.
  2. Grant, B. F., Chou, S. P., Saha, T. D., Pickering, R. P., Kerridge, B. T., June Ruan, W., Zhang. (2017). Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry, 74(9), 911.
  3. Hingson R, White A. New research findings since the 2007 Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking: A review. J Stud Alcohol Drugs. 2014;75(1):158-169. PMID: 24411808.
  4. Kramarow E, Chen LH, Hedegaard H, Warner M. Deaths from Unintentional Injury Among Adults Aged 65 and Over: United States, 2000-2013. NCHS Data Brief 199. Hyattsville, MD: National Center for Health Statistics, 2015.
  5. Rehm J, Baliunas D, Borges GLG, et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction. 2010;105(5):817-843.
  6. Stevens JA, Rudd RA. Circumstances and contributing causes of fall deaths among persons aged 65 and older: United States, 2010. J Am Geriatr Soc. 2014;62(3):470-475.
  7. Sung KC, Liang FW, Cheng TJ, Lu TH, Kawachi I. Trends in unintentional fall-related traumatic brain injury death rates in older adults in the United States, 1980-2010: a join point analysis Neurotrauma. 2015;32(14):1078-1082.
  8. White A, Castle IJ, Chen CM, et al. Converging patterns of alcohol use and related outcomes among females and males in the United States, 2002 to 2012. Alcohol Clin Exp Res. 2015;39(9):1712-1726. PMID: 2633187

 

Table 1: Prevalence of and Percent change in 1- month Alcohol Use for Women in Georgia, U.S. by Sociodemographic characteristics, 2011 and 2016

Characteristic                 BRFSS Survey

                    2011

                  N=5958

               BRFSS Survey

                      2016

                       N=3019

 

 % Change
  % (95% CLa) p-value % (95% CLa) p-value  
Total 43.6 (41.7-45.5) <0.0001 42.5% (40.1-45.0) <0.0001 -2.5
Age          
18-24 49.8(41.0-58.6)   46.0(39.6-52.4)   -7.6
25-44 52.0(48.6-55.3)   56.3(52.8-59.7)   8.2
44-65 42.1(39.7-44.5)   48.6(45.8-51.5)   15.4
65+ 23.4(21.0-25.7) <0.0001 33.2(30.6-35.9) <0.0001 41.8
Race /Ethnicity          
White/Non-Hispanic 46.2(44.0-48.5)   45.8(42.6-48.9)   -0.9
Black/Non-Hispanic 41.2(37.2-45.1)   39.8(35.2-44.4)   -3.3
Hispanic 33.1(24.4-41.7)   33.9(24.9-42.9)   2.4
Other 41.0(30.8-51.1) 0.0102 34.1(21.9-46.3) 0.0140 -16.8
Education          
No High School 22.6(17.4-27.9)   29.7(24.5-35.0)   31.4
High School 38.0(34.2-41.7)   39.3(35.9-42.7)   3.4
Attended College 44.7(41.1-48.3)   52.5(49.1-56.0)   17.4
College or technical school graduate 62.6(59.7-65.4) <0.0001 64.5(61.8-67.3) <0.0001 3.0
Income          
<$15,000 39.9(34.8-45.1)   23.7(17.3-30.2)   -4.0
$15,000-$25,000 44.6(40.7-48.6)   28.0(22.7-33.4)   -3.7
$25,000-$35,000 44.4(39.5-49.2)   41.5(33.1-49.9)   -6.5
$35,000-$50,000 51.1(46.7-55.5)   46.5(39.6-53.4)   -9
>=$50,000 63.7(61.4-66.0) <0.0001 63.4(59.4-67.4) <0.0001 -0.4

 

 

Table 2: Prevalence of and Percent change in binge drinking** for Women in Georgia, U.S. by Sociodemographic characteristics, 2011 and 2016

 

Characteristic                 BRFSS Survey

                    2011

                  N=5922

               BRFSS Survey

                      2016

                       N=2986

 

 % Change
  % (95% CLa) p-value % (95% CLa) p-value  
Total 11.1 (9.6-12.5) <0.0001 9.7(8.2-11.2) <0.0001 -12.6
Age          
18-24 22.8(15.6-30.1)   13.8(7.6-20.0)   -39.4
25-44 14.9(12.4-17.5)   13.4(10.4-16.4)   -10.0
45-64 7.4(6.0-8.7)   8.3(6.2-10.5)   12.1
65+ 1.1(0.6-1.6) <0.0001 2.7(1.6-3.9) <0.0001 145
Race /Ethnicity          
White/Non-Hispanic 12.2(10.4-14.0)   9.6(7.7-11.5)   -21.3
Black/Non-Hispanic 8.2(5.9-10.6)   9.8(6.8-12.8)   16.3
Hispanic 10.8(4.5-7.1)   9.4(4.0-14.9)   -12.9
Other 17.0(7.1-27.0) 0.0419 9.0(2.3-15.8) 0.9968 -47.0
Education          
No High School 9.5(5.3-13.8)   7.0(2.4-11.7)   -26.3
High School 10.2(7.5-13.0)   5.8(3.5-8.0)   -43.1
Attended College 10.6(8.1-13.2)   11.4(8.5-14.3)   7.5
College or technical school graduate 13.6(11.3-15.9) 0.1584 13.2(10.4-16.0) 0.0002 -2.94
Income          
<$15,000 9.3(5.4-13.3)   9.2(5.5-13.0)   -1.07
$15,000-$25,000 11.2(7.7-14.8)   13.8(10.5-17.1)   23.2
$25,000-$35,000 7.4(3.6-11.2)   9.2(5.5-13.0)   24.3
$35,000-$50,000 9.7(6.6-12.9)   17.3(12.9-21.7)   78.3
>=$50,000 13.2(11.0-15.5) 0.0773 17.0(14.7-19.3) 0.0003 28.7

 

a- CL means Confidence Limits

** Binge Drinking in women defined as women having 4+ drinks on one occasion

 

Table 3: Intensity of Binge Drinking Prevalence and Percent change by Age category for Women in Georgia, 2011

  Past 30 days, average # of drinks had on days you drank
Age categories 1 drink 2 drinks 3-4 drinks 5 drinks or more
  % (95% CLa) % (95% CLa) % (95% CLa) % (95% CLa)
18-24 40.1(27.7-52.6) 21.3(11.2-31.4) 20.1(10.7-29.6) 18.5(9.1-27.9)
25-44 45.8(41.1-50.4) 30.4(26.2-34.6) 16.6(12.8-20.4) 7.2(4.5-9.9)
45-64 54.6(50.8-58.4) 30.4(27.8-33.8) 11.1(8.4-13.7) 3.9(1.9-5.9)
65+ 70.2(64.7-75.6) 23.2(18.1-28.3) 4.6(2.2-7.0) 2.0(0.4-3.6)

p-value: <0.0001; a- CL means Confidence Limits

 

 

 

 

Table 4: Intensity of Binge Drinking Prevalence and Percent change by Age category for Women in Georgia, 2016

  Past 30 days, average # of drinks had on days you drank
Age categories 1 drink 2 drinks 3-4 drinks 5 drinks or more
  % (95% CLa) % (95% CLa) % (95% CLa) % (95% CLa)
18-24 42.7(28.9-56.5) 23.1(12.3-33.9) 23.7(11.8-15.6) 10.5(2.4-18.6)
25-44 47.7(41.1-54.2) 36.5(30.1-42.9) 12.4(8.2-16.7) 3.4(1.2-5.6)
45-64 49.9(44.1-55.6) 33.2(27.7-38.6) 11.1(7.5-14.7) 5.9(2.4-9.3)
65+ 71.8(65.7-77.8) 20.1(14.9-25.3) 6.4(3.3-9.6) 1.7(0.0-4.4)

p-value:0.0017; a- CL means Confidence Limits

 

Differences in heavy alcohol consumption and depression among Non-Hispanic Black women compared to Non-Hispanic White women in the United States

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Have you ever wondered what the differences in alcohol dependence and depression were among Non-Hispanic black women compared to Non-Hispanic white women? 

  Well have no fear, Quonesha is here (to inform you)! 

Depression and alcohol use disorder affects many Americans nationwide. Evidence suggests that depression and alcoholism are closely associated as there are at least 30-40% of those with alcohol dependence that experience some type of depressive disorder (Hobden, Bryant, Sanson-Fisher, Oldmeadow, Carey 2018); however, there is conflicting evidence that suggests whether depression causes alcohol dependence or if alcohol dependence is the cause of depression (Boden & Fergusson 2011).

Although the prevalence of alcohol dependence affects many racial groups, Non-Hispanic black women are known to be less likely than persons of other racial groups, such as Non-Hispanic whites, to use and abuse alcohol. In contrast, the prevalence of depression is higher among Non-Hispanic black women (9.2%) compared to Non-Hispanic white women (7.9%) (Klein, Sterk, Elfison, 2016 & Caetano, Baruah, Chartier, 2011).

For a further look into previous research studies, I decided to take it upon myself to conduct my own study that examined the differences in heavy alcohol consumption and depression among Non-Hispanic black women compared to Non-Hispanic white women.

To conduct this study, I used data from 2015-2016 National Health and Nutrition Examination Survey (NHANES)  to examine the differences in heavy alcohol consumption and depression among Non-Hispanic black women compared to Non-Hispanic white women residing in the United States. There were 971 (32.6%) Hispanic women, 651 (21.8%) Non-Hispanic black women, 910 (30.6%) Non-Hispanic white women, and 444 (15%) women of other racial groups present in this research study; however, Non-Hispanic black women and Non-Hispanic white women where used for this study.

Heavy alcohol consumption was measured by women that consumed more than eight drinks per week or more than three drinks per occasion, and mental health status was measured using a depression screening that asked participants a series of questions regarding depression. To analyze the data, i decided to perform Chi-square tests of independence and logistic regressions to predict the relationship between the independent variable, race, and the dependent variables, heavy alcohol consumption and depression. 

There were significant differences among Non-Hispanic black women compared to Non-Hispanic white women, regarding heavy alcohol consumption (p-value: 0.002). However, there were no significant differences among Non-Hispanic black women compared to Non-Hispanic white women, regarding depression (p-value: 0.288) and depression and heavy alcohol consumption (p-value: 0.242).

Additionally, the logistic regression analysis found that there were significant differences between the two groups regarding heavy alcohol consumption (p-value: 0.007, O.R: 1.51, 95% C.I: 1.13, 1.99). However, there were no significant differences among the two groups regarding depression (p-value: 0.259, O.R: 1.16, 95% C.I: 0.88, 1.55) and depression and heavy alcohol consumption (p-value: 0.271, O.R: 1.34, 95% C.I: 0.77, 2.32). 

  Depressed* Heavy alcohol consumption* *Depressed and heavy alcohol consumption
  **N (%) P-value Odds Ratio

(95% CI)

 **N (%) P-value Odds Ratio (95% CI) **N (%) P-value Odds Ratio

(95% CI)
Total 370 (25.9) N/A N/A

 

 381 (35.4) N/A N/A

 

 134 (34.8) N/A N/A

 
†Race/ Ethnicity

    Non-Hispanic Black women

    Non-Hispanic White women

  

 

132 (3.6)

 

238 (22.2)

  

 

 

0.288

  

 

1.00 (ref)

 

1.16 (0.88,1.55)

  

 

120 (3.9)

 

261 (31.5)

  

 

 

0.002¢

  

 

1.00 (ref)

 

1.51 (1.13,1.99)

  

 

43 (4.0)

 

91 (30.8)

  

 

 

0.242

  

 

1.00 (ref)

 

1.34

(0.77, 2.32)
       

 

The results from this study both contradict and support previous studies. The analyzed data indicates that there were significant differences among Non-Hispanic black women compared to Non-Hispanic white women regarding heavy alcohol consumption, which supports previous studies. However, there were no significant differences among Non-Hispanic black women compared to Non-Hispanic white women regarding depression and depression and heavy alcohol consumption, which contradicts previous studies. Additional research is clearly needed to better understand the etiology and patterns of alcohol use and depression among women across and within racial and ethnic groups. 

I also think that a better understanding of the underlying causes of alcoholism and depression among the two groups will inform public health officials to develop effective prevention programs and interventions that are specifically targeted towards each group (Withbrodt, Mulia, Zemore, Kerr 2014 & Assari 2014).  Affordable alcohol rehabilitation centers that provide mental health services with certified clinicians should be placed in areas with increased rates of alcohol abuse and depressive disorders to make certain that every individual, regardless of race, can receive the same treatment.

.

 

https://www.alcohol.org/women/

https://www.alcoholrehabguide.org/resources/dual-diagnosis/alcohol-and-depression/

 

Assari S. (2014). Separate and Combined Effects of Anxiety, Depression and Problem Drinking on Subjective Health among Black, Hispanic and Non-Hispanic White Men. International journal of preventive medicine, 5(3), 269–279.

Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906-     914.

Caetano, R., Baruah, J., & Chartier, K. G. (2011). Ten-Year Trends (1992 to 2002) in Sociodemographic Predictors and Indicators of Alcohol Abuse and Dependence Among Whites, Blacks, and Hispanics in the United States. Alcoholism: Clinical and Experimental Research.

Hobden, B., Bryant, J., Sanson-Fisher, R., Oldmeadow, C., & Carey, M. (2018). Co-occurring depression and alcohol misuse is under-identified in general practice: A cross-sectional study. Journal of Health Psychology, 23(8), 1085–1095.

Klein, H., Sterk, C. E., & Elifson, K. W. (2016). The Prevalence of and Factors Associated with Alcohol-Related Problems in a Community Sample of African American Women. Journal of Addiction, 2016, 1-11.

Witbrodt, J., Mulia, N., Zemore, S. E., & Kerr, W. C. (2014). Racial/Ethnic Disparities in Alcohol-Related Problems: Differences by Gender and Level of Heavy Drinking. Alcoholism: Clinical and Experimental Research,38 (6), 1662-1670.