Nation-wide trends in prevalence and mortality of high-risk drinking among adult men with and without disabilities in South Korea between 2009 and 2017.

Abstract

Background and aims: Excessive alcohol consumption contributes substantially to the global burden of disease, yet population-level evidence on disparities in high-risk drinking among people with disabilities remains limited. We aimed to estimate and compare trends in the prevalence of high-risk drinking and all-cause mortality associated with drinking behavior among men with disabilities and those without disabilities.

Design: Nation-wide serial cross-sectional study.

Setting: South Korea, using linked administrative national health check-up and mortality databases.

Participants: A total of 7 551 340 adult men who participated in the National Health Insurance Service health check-up program in 2017, including 450 536 men with registered disabilities and 7 100 804 men without disabilities.

Measurements: High-risk drinking was defined as consumption of seven or more standard drinks per occasion at least twice per week, based on self-reported health check-up questionnaires. Age-standardized prevalence of high-risk drinking was estimated annually from 2009 to 2017. Associations between disability characteristics and high-risk drinking were estimated using multivariable logistic regression in 2017. All-cause mortality occurring within 2017 was ascertained through deterministic linkage to the national death registry using unique personal identifiers.

Findings: In 2017, age-standardized prevalence of high-risk drinking was 17 141 per 100 000 among men with disabilities and 23 226 per 100 000 among men without disabilities. Among men aged 20-49 years, prevalence was 29 710 per 100 000 in those with mild disabilities and 26 332 per 100 000 in those without disabilities. In 2017, compared with men without disabilities, mild disability was associated with higher odds of high-risk drinking [adjusted odds ratio (aOR) = 1.12, 95% confidence interval (CI) = 1.11-1.13], whereas brain injury was associated with lower odds (aOR = 0.61, 95% CI = 0.58-0.65). In 2017, age-standardized mortality rates were 131.4 per 100 000 among non-drinkers, 99.2 among high-risk drinkers, 77.3 among moderate drinkers and 59.9 among low-risk drinkers. Across drinking categories, several disability groups had adjusted odds ratios greater than 1.0 for all-cause mortality compared with those for men without disabilities within the same drinking category.

Conclusion: High-risk drinking prevalence among South Korean men was lower among those with disabilities than among those without disabilities from 2009 to 2017, with declining trends in both groups. High-risk drinking prevalence among South Korean men appears to differ by disability characteristics. Mortality odds ratios within drinking categories vary by disability type and severity when compared with men without disabilities in the same drinking category.