nhms_2019.pdf

Non-Communicable Diseases: Risk Factors and other Health Problems 145 Alcohol Consumption

National Health and Morbidity Survey 2019 Technical Report − Volume I 146 Alcohol Consumption Contributors to this section: Tania Gayle Robert Lourdes, Muhammad Fadhli Mohd Yusoff, Norli Abdul Jabbar, Rozanim Kamarudin, Mohd Hatta Abdul Mutalip, Wan Shakira Rodzlan Hasani, Nor Azizi Abu Bakar, Nur Liana Ab Majid, Halizah Mat Rifin, Jane Ling Miaw Yn, Thamil Arasu Saminathan, Hasimah Ismail Introduction Alcohol is a psychoactive substance with dependence- producing properties that has been widely used in many cultures for centuries. Globally, the harmful use of alcohol causes 3 million deaths every year and this represents 5.3% of all deaths. Drinking alcohol is associated with a risk of developing health problems such as mental and behavioral disorders, including alcohol dependence, major noncommunicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases, as well as injuries resulting from violence, road crashes and collisions [1]. According to a recent study, between the year 1990 and 2017, the global adult per-capita consumption of alcohol increased from 5.9 L to 6.5 L and it is forecasted to reach 7.6 L by 2030. In 2017, 20% of adults were heavy episodic drinkers compared to the year 1990 when it was estimated at 18.5% and this prevalence is expected to increase to 23% in 2030 [2]. In Malaysia, the previous National Health and Morbidity Survey (NHMS) done in the year 2011 and 2015 reported a current drinker prevalence of 12.8% and 8.4% respectively among those aged 18 years and above. [3]. Objective General Objective To determine the prevalence of alcohol drinkers in Malaysia. Specific Objectives

1. To determine the prevalence of current alcohol drinkers in Malaysia by socio-demographic subgroups.
2. To determine the prevalence of ever alcohol drinkers in Malaysia by socio-demographic subgroups.
3. To determine the proportion of binge drinkers among current drinkers (≥ 18 years old) in Malaysia.
4. To determine the proportion of heavy episodic drinkers among current drinkers (≥ 18 years old) in Malaysia.
5. To determine types of drinkers (≥ 18 years old) according to the AUDIT risk stratification score among current drinkers (low risk, risky and probable dependence) Methods Data on alcohol drinkers was obtained from respondents aged 13 years and above using a self-administered questionnaire. The questionnaire used comprised the validated Alcohol Use Disorder Identification Test (AUDIT) and 5 additional screening questions for ever drinkers, current drinkers, types of alcoholic beverages consumed and also alcohol consumption in the past 1 month. The AUDIT is a 10-item screening tool developed by the World Health Organization (WHO) to assess alcohol consumption, drinking behaviors and alcohol-related problems. Those who scored 0 to 7 on the Audit are considered to be low risk drinkers, a score of 8 to 19 were risky drinkers and those who scored 20 and above were said to have probable alcohol dependence. Variable Definition
6. Current drinkers was defined as those who have consumed any alcoholic beverage in the past 12 months.
7. Ever drinkers was defined as those who have consumed any alcoholic beverage in their lifetime.
8. Binge drinking was defined as those who consumed 6 or more standard alcoholic drinks at one sitting.
9. Heavy Episodic Drinking (HED) was defined as those who consumed 6 or more standard alcoholic drinks at one sitting at least weekly.
10. Lifetime abstainers was defined as those who have never consumed alcohol.
11. Abstainers in the past 12 months was defined as those who did not drink any alcohol in the past 12 months.
12. One standard drink of alcohol was defined as calculated based on the percentage of alcohol and also the volume of the beverage (Further details can be referred to Code book NHMS 2019).

Non-Communicable Diseases: Risk Factors and other Health Problems 147 Findings 9.1 Alcohol Consumption Among Those Aged 18 Years and Above Out of 10,472 respondents aged 18 years and above, 93.8% (n=9,818) responded to the Alcohol consumption questionnaire. The prevalence of current drinkers was 11.8% (95% CI: 10.04, 13.81) while the prevalence of abstainers in the past 12 months was 88.2%. Among the current drinkers, the alcohol consumption was significantly higher among males [16.9%, 95% CI: 14.41, 19.82] compared to females [6.4%, 95% CI: 4.95, 8.13]. Current alcohol drinking was common in urban areas [12.1%, 95% CI: 10.03, 14.56], among Bumiputera Sarawak [43.9%, 95% CI: 35.59, 52.59], followed by Chinese [26.4%, 95% CI: 21.98, 31.37], Bumiputera Sabah [22.1%, 95% CI: 13.30, 34.35] and Indians [18.1% (95% CI: 14.05, 23.05)], those with tertiary education [13.7%, 95% CI: 10.81, 17.15], those aged 35 to 39 years old [14.7%, 95% CI: 10.98, 19.35], single adults [15.7%, 95% CI: 12.25, 19.80] and those with a household income of RM10,000 and above [24.0%, 95% CI: 16.45, 33.63]. The prevalence of ever drinkers among adults aged 18 years and above was 14.4% (95% CI: 12.50, 16.48) while the prevalence of lifetime abstainers among those aged 18 and above was 85.6%. 9.2 Alcohol Consumption Among Those Aged 13 Years and Above Out of 11,530 respondents aged 13 years and above, 94.1% (n=10,846) responded to the Alcohol Consumption questionnaire. The prevalence of current drinkers among those aged 13 years and above was 11.1% (95% CI: 9.46, 13.07). Among the current drinkers, alcohol consumption was significantly higher in males [15.8%, 95% CI: 13.48, 18.54] compared to females [6.2%, 95% CI: 4.79, 7.95]. Current alcohol drinking was common in urban areas [11.4%, 95% CI: 9.44, 13.78], among Bumiputera Sarawak [42.7%, 95% CI: 33.90, 51.90], followed by Chinese [25.3%, 95% CI: 21.03, 30.06], Bumiputera Sabah [21.7%, 95% CI: 13.04, 33.74] and Indians [16.7% (95% CI: 12.99, 21.28)], those with tertiary education [13.7%, 95% CI: 10.80, 17.14], those aged 35 to 39 years old [14.7%, 95% CI: 10.98, 19.35] and with a household income of RM10,000 and above [22.5%, 95% CI: 15.56, 31.32]. The prevalence of ever drinkers among the 13 year olds and above was 13.5% (95% CI: 11.67, 15.46) while the prevalence of lifetime abstainers among them was 86.5%. The prevalence of current drinkers was 11.1% (95% CI: 9.46, 13.07) while the prevalence of abstainers in the past 12 months was 88.9%. 9.3 Binge Drinking Among Those Aged 18 Years and Above The proportion of binge drinkers among current drinkers was 45.8% (95% CI: 39.15, 52.65). Binge drinking was common among males [49.5%, 95% CI: 41.43, 57.52], rural residents [48.1%, 95% CI: 39.23, 57.02], elders aged 70 to 74 years [59.9, 95% CI: 26.41, 86.11], Bumiputera Sabah [77.8% , 95% CI: 68.23, 85.11), Malays [63.3%, 95% CI: 40.78, 81.17] and Indians [53.6% (95% CI: 38.96, 67.57)], those unemployed [59.0%, 95% CI: 42.57, 73.62] and those with a household income of RM1000- Rm1999 [ 58.4%, 95% CI: 48.16, 67.90]. The prevalence of binge drinking among the population in Malaysia was 5.4% (95% CI: 4.36, 6.69), with an estimated population of 1,150,861 adults aged 18 years old and above. 9.4 Heavy Episodic Drinkers Among Those Aged 18 Years and Above The proportion of HED among the current drinkers was 8.4% (95% CI: 5.81, 12.13). HED were more common among urban dwellers [8.7% (95% CI: 5.61,13.18)], males [10.3% (95% CI: 7.15, 14.66)], Bumiputera Sabah [16.7% (95% CI: 8.91, 29.14)] and Indians [12.0% (95% CI: 5.56, 24.06)] widowers/ divorcees [21.3% 95% CI: 7.79, 46.54)], those with a household income of RM1000- Rm1999 [11.8% (95% CI: 7.30, 18.55)]. The prevalence of HED among the population was 1.0% (95% CI: 0.7, 1.5), with an estimated population of 212,144 adults aged 18 years and above in Malaysia. 9.5 AUDIT Risk Stratification Related to Pattern of Drinking In general, most off the current drinkers aged 18 years and above, were categorized as low risk drinkers with a proportion of 81.5% (95% CI: 75.32, 86.36). The proportion of risky drinkers was 17.6% (95% CI: 12.79, 23.71) while the proportion of drinkers with probable alcohol dependence was 0.9% (95% CI: 0.33, 2.64).
National Health and Morbidity Survey 2019 Technical Report − Volume I 148 Conclusion This study showed that that males had a significantly higher prevalence (15.8%) of alcohol consumption as compared to females (6.2%). Sarawak, Sabah and Wilayah Persekutuan Kuala Lumpur had the highest prevalence of current drinkers in Malaysia. We also found that there was a reduction in the proportion of binge drinkers and HED compared to NHMS 2015 that is from 59.4% to 45.8% and 10.8% and 8.4% respectively. To conclude, we can say that from this study, we found the target group for intervention in reducing the harmful use of alcohol (binge drinking and HED) to be males, Bumiputera Sabah and those with a household income of RM1000-RM1999. Therefore, specific programs have to be tailored to address this particular group. Recommendations

1. Health education is the utmost important in advocating healthy living and prevention of the harmful use of alcohol by utilizing various media platforms. The tagline of “Stay Healthy without Alcohol” may be used widely to promote and advocate of healthy lifestyles.
2. Awareness of the adverse health and social outcomes of the harmful use of alcohol should target schools, institutions of higher learning and communities at large including employees in government or private sectors.
3. To further expand and strengthen the current alcohol consumption Screening, Brief Intervention and Referral to Therapy program (SBIRT) services in the primary care.
4. The education on alcohol and the management in primary care and community should be included in the medical school curriculum.
5. Increase excise taxes of alcoholic beverages in order to reduce the accessibility to the drinks. This is among the “best buys” recommended by WHO to reduce the harmful use of alcohol.
6. Campaigns on the harmful use of alcohol during certain festivals have to be upscaled to prevent binge drinking.
7. To reduce the accessibility of alcoholic beverages by limiting points of sale in order to prevent exposure to the younger generation and non-drinkers. However, this needs further supporting evidence for implementation. Table 9.1: Harmful Alcohol Consumption Trend in Malaysia 2011 2015 2019 Binge Drinkers 50.2 59.4 45.8 Heavy Episodic Drinkers 18.3 10.8 8.4 Risky Drinkers 21.2 28.4 17.6 References

Fact sheet Alcohol WHO; https://www.who.int/news-room/fact-sheets/ detail/alcohol; 21st September 2018. 2. Manthey J. Et al; Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study. The Lancet Vol 393; Published June 22, 2019. http://dx.doi.org/10.1016/S0140-6736(18)32744-2 3. Institute for Public Health (2011). National Health and Morbidity Survey 2011 (NHMS 2011). Vol. II: Non-Communcable Diseases; 2011: 188 pages

Non-Communicable Diseases: Risk Factors and other Health Problems 149 Table 9.2: Prevalence of Current Drinkers Among Adults Aged 18 Years and Above in Malaysia by Socio-Demographic Characteristics (n=9,818) Sociodemographic Characteristics Current Drinkers (18 Years and Above) Count Estimated Population Prevalence (%) 95% CI Lower Upper MALAYSIA 780 2,511,485 11.8 10.04 13.81 State Johor 48 207,793 8.6 5.78 12.49 Kedah 23 59,611 4.6* 2.30 9.15 Kelantan 6 9,248 0.8* 0.21 3.19 Melaka 10 16,542 2.8* 0.84 8.72 Negeri Sembilan 24 31,516 4.5 2.47 7.97 Pahang 22 31,904 3.1* 1.59 6.08 Pulau Pinang 43 175,958 14.0* 6.72 26.97 Perak 37 142,501 9.2 5.22 15.76 Perlis 5 775 0.5* 0.14 1.70 Selangor 72 456,211 10.0 6.02 16.02 Terengganu 3 950 0.1* 0.03 0.62 Sabah 143 517,407 20.1 13.35 29.15 Sarawak 196 601,692 32.5 25.81 39.90 WP Kuala Lumpur 83 251,082 19.3 11.65 30.35 WP Labuan 63 8,060 12.7 8.15 19.32 WP Putrajaya 2 237 0.4* 0.07 2.37 Location Urban 522 2,013,021 12.1 10.03 14.56 Rural 258 498,465 10.7 8.09 13.96 Sex Male 553 1,854,109 16.9 14.41 19.82 Female 227 657,376 6.4 4.95 8.13 Age Group (Years) 18-19 25 91,665 10.2 6.03 16.68 20-24 76 395,327 13.8 8.85 20.80 25-29 89 398,940 13.3 10.00 17.51 30-34 94 310,974 11.7 8.70 15.53 35-39 100 348,000 14.7 10.98 19.35 40-44 72 242,089 13.2 9.70 17.75 45-49 81 236,638 14.2 10.47 19.06 50-54 60 128,499 8.4 6.14 11.31 55-59 66 166,243 12.4 9.44 16.18 60-64 55 88,689 8.0 5.79 11.00 65-69 30 53,660 6.7 4.10 10.68 70-74 12 20,646 3.8* 1.83 7.52 75 & above 20 30,114 4.6 2.68 7.70 Ethnicity Malaya 36 79,151 0.7 0.45 1.18 Chinese 299 1,207,545 26.4 21.98 31.37 Indian 115 224,949 18.1 14.05 23.05 Bumiputera Sabah 133 302,883 22.1 13.30 34.35 Sociodemographic Characteristics Current Drinkers (18 Years and Above) Count Estimated Population Prevalence (%) 95% CI Lower Upper Bumiputera Sarawak 145 420,982 43.9 35.59 52.59 Others 52 275,975 12.3 7.05 20.46 Marital Status Single 229 946,993 15.7 12.25 19.80 Married 512 1,494,696 10.9 9.20 12.84 Widow(er)/Divorcee 39 69,796 4.6 2.79 7.53 Education Level No Formal Education 37 69,818 6.4 4.16 9.77 Primary Education 155 512,325 12.5 9.12 16.88 Secondary Education 368 1,159,521 11.2 9.15 13.61 Tertiary Education 217 767,026 13.7 10.81 17.15 Occupation Government Employee 50 137,615 8.8 6.30 12.16 Private Employee 353 1,312,918 16.0 13.03 19.48 Self Employed 179 582,563 15.8 11.92 20.53 Unpaid Worker/ Homemaker 80 180,076 5.1 3.58 7.09 Retiree 31 70,541 8.9 5.90 13.13 Student 14 43,967 5.9* 3.05 10.95 Not Workingb 73 183,806 6.8 5.06 9.13 Household Income Group Less than RM 1,000 66 132,850 7.7 5.24 11.29 RM 1,000 - RM 1,999 146 390,694 9.6 7.17 12.62 RM 2,000 - RM 3,999 231 747,109 11.7 9.11 14.85 RM 4,000 - RM 5,999 103 361,470 10.8 7.74 15.00 RM 6,000 - RM 7,999 71 326,983 16.7 11.47 23.60 RM 8,000 - RM 9,999 27 102,000 11.4 6.28 19.68 RM 10,000 and above 106 386,288 24.0 16.45 33.63 Household Income Quintile Quintile 1 130 298,871 7.9 5.83 10.51 Quintile 2 156 512,391 12.6 9.22 17.01 Quintile 3 141 422,708 10.6 8.08 13.76 Quintile 4 119 398,153 10.8 7.90 14.65 Quintile 5 204 815,271 18.2 14.03 23.37 Household Income Category Bottom 40% 473 1,410,538 10.8 9.10 12.85 Middle 40% 173 711,705 13.8 10.17 18.45 Top 20% 104 325,149 17.8 13.20 23.58 *Prevalence with high RSE, interpret with caution a - Malay includes Orang Asli b - Not working includes Unemployed, and Old Age