Epidemiology, Hot Spots and Socio-Demographic Risk Factors of Alcohol Consumption in Indian Men and Women: Analysis of National Family Health Survey-4, A Nationally Representative Cross Sectional Study

BackgroundAlcohol consumption is a serious health crisis in India that needs urgent attention. An estimated 160 million Indians consume alcohol. Despite the widespread alcohol use across India, there is no information on the alcohol hot spots. Along with hot spots, understanding the Socio-Demographic Indices (SDI) affecting alcohol consumption in Indian men and women will help guide public health policies on alcohol use. MethodsData from National Family Health Survey-4 carried out from 2015-2016 with a sample size of 103 411 men and 699 686 women were used for the analysis. Epidemiology of alcohol use was mapped by Geographic Information System, and hot spots were identified by spatial statistics (Getis-OrdGi*). Bivariate analyses and binary logistic regression were used to analyse SDI. ResultsIndia has three major alcohol hot spots: (1) North East (NE) states, (2) Eastern Peninsular states formed by Chhattisgarh, Odisha, Jharkhand and Telangana, and (3) Southern states of Tamil Nadu and Kerala. Among these hot spots, the districts of Tamil Nadu, Telangana and Assam fall under high risk category. Hot spot analysis strongly correlated with region-wise analysis of SDI. South (Men aOR - 1.0, 95% CI: 39.1 - 42.1) and NE India (Men aOR - 0.6, 95% CI: 38.4 - 42.6; Women aOR - 2.05, 95% CI: 6.4 - 7.5) have higher odds of alcohol use. Schedule tribe men (aOR-1.67, 95% CI: 1.53-1.82) and women (aOR-5.99, 95% CI: 4.71-7.63) have higher odds of alcohol consumption. Compared to other religions, Muslim men (aOR: 0.11) and women (aOR: 0.06) consume less alcoholConclusionsHot spots and, high risk districts of alcohol consumption identified in this study can guide public health policies for targeted intervention. Except for religion and social category, other socio-economic factors have a low to moderate effect on alcohol consumption. India does not have concrete anti-alcohol policies at the national level. Alcohol use is at the discretion of individual states and union territories, and appears to be the major determinant of alcohol use in India. Stringent anti-alcohol policies strictly enforced across India is the key to control alcohol use.