Ecological analysis of collectivity of alcohol consumption in England: Importance of average drinker

Objective: To assess whether the average consumption of alcohol is associated with the prevalence of heavy drinking, problem drinking, and abstention in England. Design: Ecological analysis using data from a cross sectional household based survey of English adults. Subjects: Random sample of 32 333 adults from the English population who participated in the 1993 and 1994 health surveys for England. Main outcome measures: Association, expressed as the correlation coefficient, between the regional mean and median alcohol consumption and the regional prevalence of heavy drinking, problem drinking, and abstention. Results: Mean consumption of alcohol in light to moderate drinkers was strongly positively associated with the prevalence of heavy drinking (r = 0.75 in men and r = 0.62 in women for drinking more than 21 and 14 units per week respectively). A similar association was found between median consumption and prevalence of heavy drinking, Abstention was not significantly associated with mean consumption in drinkers (r = 0.08 for men and r = -0.29 for women). Both the median and mean consumption in drinkers were positively associated with the prevalence of problem drinking as defined by the CAGE questionnaire on alcohol use (r = 0.53 for men and r = 0.42 for women for the association with mean consumption). Conclusion: Factors that increase the average consumption of alcohol in the population may result in an increase in the prevalence of heavy drinking and related problems.