Social determinants of hazardous alcohol use in a Ugandan population cohort

Abstract

Background There is a limited population-based data on hazardous alcohol use and associated social determinants in many African countries. Objectives To examine patterns of hazardous alcohol use across a range of social determinants of health in Uganda, with a particular focus on gender differences. Methods This cross-sectional study used data collected in 2021–2022 from an open population cohort spanning urban, semi-urban, and rural communities. Alcohol use was assessed with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Covariates were selected according to the WHO’s Social Determinants of Health framework. Poisson regression with robust variance was used for data analysis. Results Of the 3459 participants, 2085 (60%) were women. Overall, the prevalence of hazardous alcohol use was 5% among women and 18% among men. Strong positive associations with hazardous use were found for individuals residing in semi-urban areas (female aPR 2.1 [95% CI 1.3–3.3], male aPR 1.8 [95% CI 1.4–2.5]), past-year perpetration of intimate partner violence (female aPR 2.2 [95% CI 0.8–5.6], male aPR 1.4 [95% CI 0.9–2.2]), smoking, middle age for men (aPR 1.6 [95% CI 1.2–2.2]), and employment as a vendor in a restaurant or bar for women (aPR 1.5 [95% CI 1.0–2.2]). Strong negative associations were found for high educational attainment, Muslim or Pentecostal religion, and living in a marriage or union for women (aPR 0.7 [95% CI 0.5–1.0]). Conclusions Hazardous alcohol use was prevalent, especially among men, in a representative Ugandan population sample. Specific target groups for public health and clinical interventions were identified, such as women working in the hospitality sector. Residents of semi-urban communities may encounter unique risks for hazardous alcohol use, compared with rural and highly urban populations.

Keywords

• alcohol consumption
• alcohol use prevalence
• social factors
• socioeconomic factors
• urbanity
• low- and middle-income country
• sub-saharan africa