Globally, alcohol consumption contributes to 3 million deaths each year, and to the loss of health of several millions of people. The consumption of alcohol is causally linked to over 200 health conditions, including liver diseases, road injuries, violence, several types of cancers, cardiovascular diseases, suicides, tuberculosis, and HIV/AIDS. In the Region of the Americas, alcohol is responsible for 5.5% of total deaths and 6.7% of total disability-adjusted life years. For the same amount of liter per capita of alcohol consumed, those living in low and middle income countries have a relative higher rate of alcohol-related deaths and disabilities compared to high income countries. Alcohol consumption worsens inequalities between and within countries, affecting more the poor and disadvantaged. Detailed information is available on the topic The burden of selected alcohol-related diseases.

 

Level of alcohol consumption

The most important and commonly used indicator of the level of alcohol consumption is the total (recorded and unrecorded) alcohol per capita consumption (APC) in liters of pure alcohol per person per year. APC is a population-level measure of volume that quantifies the average amount of absolute or pure alcohol consumed by the average person in a given period of time. It is a useful foundation for understanding alcohol use in a given location. 

This data visualization presents the level of alcohol consumption in countries of the Americas through two key indicators: alcohol total per capita consumption (APC), and alcohol drinkers only per capita consumption in liters of pure alcohol per person in a year in people aged 15 years and over.

Level of Consumption

Total (recorded and unrecorded) alcohol per capita consumption

In the Region of the Americas in 2019,

  • the total alcohol per capita consumption (APC) in adults was 7.6 liters (1.3-fold higher than the global level [5.8 L]).
  • the total APC ranges from 10.4 liters per person in Barbados to 1.6 liters per person in Guatemala.
  • the level of consumption in men (11.9 liters per person) is higher than in women (3.5 liters per person).
  • the total APC in both sexes combined decreased 7.3% from 8.2 liters/person in 2000 to 7.6 liters/person in 2019.

Countries with the highest level of total alcohol per capita consumption in both sexes combined:

  1. Barbados
  2. The United States of America
  3. Saint Lucia
  4. Argentina
  5. Antigua and Barbuda
  6. Grenada
  7. Chile
  8. Canada

Total (recorded and unrecorded) alcohol drinkers only per capita consumption

In the Region of the Americas in 2016,

  • the total alcohol drinkers only per capita consumption (APC) in adults by country varies from 19.9 liters per person in Paraguay to 8.9 liters per person in Guatemala.
  • the level of consumption in men (range: 25.7 to 11.2 liters per person) is higher than in women (9.2 to 4.2 liters per person).

Countries with the highest level of total alcohol drinkers only per capita consumption for both sexes combined:

  1. Paraguay
  2. Brazil
  3. Saint Lucia
  4. Barbados
  5. Grenada
  6. Dominica
  7. Saint Vincent and the Grenadines

DATA CLASSIFICATION

In the map and the bar chart, the data is presented in five discrete classes based on the quantile classification method, where each class contains 20% of the total countries. The quintiles are labeled sequentially from Q1 as the first quintile including the lowest fifth (1% to 20%) of the countries to Q5, the fifth quintile representing the class with the highest fifth (81% to 100%) of the countries.

INDICATOR DEFINITION

Indicator name: Alcohol, total (recorded and unrecorded) alcohol per capita (15 years old or older) consumption in liters of pure alcohol in a given year

Short name: Alcohol per capita consumption (APC)

Data type: Rate (liters per person)

Topic: Risk factors

Rationale: The total alcohol per capita consumption (total APC) comprises both the recorded and the unrecorded APC, which together provide a more accurate estimate of the level of alcohol consumption in a country, and as a result, portray trends of alcohol consumption in a more precise way.

Definition: Total alcohol per capita consumption (APC) is defined as the total (sum of recorded and unrecorded alcohol) amount of alcohol consumed per person (15 years of age or older) over a calendar year, in liters of pure alcohol, adjusted for tourist consumption.

The estimates for the total alcohol consumption are produced by summing the per capita (15+ years of age and older) recorded alcohol consumption and an estimate of per capita (15+) unrecorded alcohol consumption for a calendar year. Tourist consumption takes into account tourists visiting the country and inhabitants visiting other countries.

Method of measurement:

Recorded alcohol consumption refers to alcohol consumed according to the official statistics at the country level based on production, import, export, and sales or taxation data. When government national statistics are not available, country-specific alcohol industry statistics in the public domain based on interviews or fieldwork are used; otherwise, data from the Food and Agriculture Organization of the United Nations' statistical database (FAOSTAT) are used, or data from alcohol industry statistics in the public domain based on desk review.

Unrecorded alcohol consumption refers to alcohol that is not taxed and is outside the usual system of governmental control, such as home or informally produced alcohol (legal or illegal), smuggled alcohol, surrogate alcohol (which is alcohol not intended for human consumption), or alcohol obtained through cross-border shopping (which is recorded in a different jurisdiction). When nationally representative empirical data (which are often general population surveys in countries where alcohol is legal) are not available, specific other empirical investigations, or expert opinion supported by periodic surveys of experts at the country level using modified Delphi-technique, are used.

The liters of alcohol consumed by tourists (15 years of age or older) in a country is based on the number of tourists who visited a country, the average amount of time they spent in the country, and how much these people drink on average in their countries of origin (estimated based on per capita consumption of recorded and unrecorded alcohol). Furthermore, tourist alcohol consumption also accounts for the inhabitants of a country consuming alcohol while visiting other countries (based on the average time spent outside of their country (for all people 15 years or older) and the amount of alcohol consumed in their country of origin). These estimations assume the following: (1) that people drink the same amounts of alcohol when they are tourists as they do in their home countries, and (2) that global tourist consumption is equal to 0 (and thus tourist consumption can be either net negative or positive). Tourist consumption is based on UN statistics, and data are provided by IHME.

Method of estimation:

The total APC in 2018 was calculated from a three-year average of recorded (for 2016, 2017, and 2018) per capita consumption and applying unrecorded proportion (for 2017) and tourist consumption (for 2017). For recorded alcohol consumption, if data did not already exist for 2016, 2017, and/or 2018, the relevant years were projected using a linear regression model employing recorded alcohol per capita consumption data since 2012.

Unrecorded alcohol consumption was estimated as a percentage of total alcohol consumption. Country-level proportions of unrecorded alcohol consumption were estimated using regression analysis. Fractional response random intercepts regression models which accounted for clustering of data points within countries were used to estimate what percentage of total alcohol consumption was due to unrecorded alcohol consumption. Univariate models were fitted for alcohol consumption statistics (the prevalence of drinking, recorded liters of alcohol consumed per capita per year, patterns of drinking scores, value-added and excise taxation of alcoholic beverages, presence of a written national alcohol policy, presence of national legislation to prevent illegal production and/or the sale of the informally produced alcoholic beverages, and alcohol prohibition measures) and other predictors (urbanization, migration rates, malnutrition, sanitation, education levels, and per capita gross domestic product adjusted for purchasing power parity). Backward and forward selection (using a significance cut-off level of 0.2) was used in combination with out-of-sample predictions (multiple random 10% sub-samples) and plausibility checks to assess model fit. Covariate data were obtained from the Institute for Health Metrics and Evaluation and the World Bank.

Tourist consumption of alcohol refers to liters of pure alcohol purchased and consumed by tourists in a given country. This figure is adjusted for the alcohol purchased and consumed when people are visiting countries other than their home country. Positive figures denote the total alcohol consumption of outbound tourists being greater than total alcohol consumption by inbound tourists, negative numbers the opposite.

Unit of Measure: Litres of pure alcohol per person (15 years or older) per year


Indicator name: Alcohol, heavy episodic drinking (population) past 30 days

Short name: Heavy episodic drinking (HED)

Data type: Percent

Topic: Risk factors

Rationale: Heavy episodic drinking is part of the key indicators which provide information regarding the patterns of alcohol consumption in a given country. More specifically, it identifies the proportion of the population which consumes high levels of alcohol on single occasions, and consequently highlights
the population which particularly has a higher risk of experiencing alcohol-related acute harm but also developing chronic health complications.

Definition: Heavy episodic drinking is defined as the proportion of adults (15+ years) who have had at least 60 grams or more of pure alcohol on at least one
occasion in the past 30 days. Consumption of 60 grams of pure alcohol is approximately equivalent to 6 standard alcoholic drinks.

Numerator: The (appropriately weighted) number of respondents (15+ years) who reported drinking 60 grams or more of pure alcohol on at least one occasion in the past 30 days.

Denominator: The total number of participants (15+ years) responding to the corresponding question(s) in the survey plus abstainers.

Disaggregation: Sex, Age

Method of measurement: A representative sample of the adult population (15+ years) of the country is asked to answer questions in a survey. The first priority in the decision tree is given to internationally comparative, nationally representative surveys (in this order of preference: WHS, STEPS, GENACIS, and ECAS).

Method of estimation: Weighted percentages of survey respondents, where abstainers were coded as having 0 occasions.

Method of estimation of global and regional aggregates: Survey estimates weighted by population size of countries.

Preferred data sources: Population-based surveys

Expected frequency of data dissemination: Every 3-5 years

Expected frequency of data collection: Every 3-5 years

Preferred data sources: Internationally comparative, nationally representative population-based surveys.

  1. World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018. Available online (accessed February 1, 2020).
  2. Regional Status Report on Alcohol and Health in the Americas 2020. Pan American health Organization. 2020. Available online (accessed February 1, 2021)
  3. Pan American Health Organization. Topic: Alcohol. Pan American Health Organization. Available online (accessed February 1, 2021) 
  4. PAHO. Methodological Notes, NMH Data Portal. Pan American Health Organization. 2021.
 

Patterns of alcohol consumption

In addition to the amount of alcohol consumption, specific patterns of alcohol consumption increase the risk of morbidity and mortality. For example, the consumption of 60 grams or more of pure alcohol on at least one occasion increases the risk for diseases and diverse alcohol-related harms. 

Heavy episodic drinking (HED) is defined as the proportion of adult drinkers aged 15 years and older who have consumed 60 grams or more of pure alcohol on at least one occasion at least once a month.

This visualization presents indicators of the patterns of alcohol consumption including HED in drinkers aged 15 years and older, and in adolescents aged 15-19 years by sex and country in 2016.

Heavy episodic drinking among drinkers aged 15 years and older

In 2016, heavy episodic drinking (HED) among drinkers varies widely between countries, from a high of 31.0% in Trinidad and Tobago to a low of 9.1% in Guatemala. 

HED is consistently higher in men than in women in every country of the region, and this gender difference is positively correlated with the prevalence of HED (countries with high HED show a high difference in HED between men and women).

Countries with the highest level of heavy episodic drinking in the Americas, 2016:

  1. Trinidad and Tobago
  2. United States of Americas
  3. Saint Kitts and Nevis
  4. Barbados
  5. Peru
  6. Saint Lucia
  7. Grenada

Heavy episodic drinking among adolescent drinkers aged 15-19 years and older

In 2016, the prevalence of heavy episodic drinking (HED) among adolescent drinkers varies from a high of 59.8% in Trinidad and Tobago to 39.7% in Guatemala. 

The prevalence of HED in adolescents is consistently higher in boys than in girls in every country of the region, and the gender difference remains almost constant irrespective of the level of prevalence of HED by country. 

Countries with the highest level of heavy episodic drinking among adolescent drinkers in the Americas, 2016:

  1. Trinidad and Tobago
  2. Saint Kitts and Nevis
  3. Barbados
  4. Saint Lucia
  5. Grenada
  6. Peru
  7. Brazil

INDICATOR DEFINITION

Indicator name: Alcohol, heavy episodic drinking (population) past 30 days

Short name: heavy episodic drinking among drinkers (HED)

Data type: Percent

Topic: Risk factors

Rationale: Heavy episodic drinking is part of the key indicators which provide information regarding the patterns of alcohol consumption in a given country. More specifically, it identifies the proportion of the population which consumes high levels of alcohol at single occasions, and consequently highlights the population which particularly has a higher risk of experiencing alcohol-related acute harm but also developing chronic health complications.

Definition: Heavy episodic drinking is defined as the proportion of adults (15+ years) who have had at least 60 grams or more of pure alcohol on at least one occasion in the past 30 days. A consumption of 60 grams of pure alcohol corresponds approximately to 6 standard alcoholic drinks. Numerator: The (appropriately weighted) number of respondents (15+ years) who reported drinking 60 grams or more of pure alcohol on at least one occasion in the past 30 days. Denominator: The total number of participants (15+ years) responding to the corresponding question(s) in the survey plus abstainers.

Disaggregation: Sex, Age, Country, Year

Method of measurement: A representative sample of the adult population (15 years and older) of the country is asked to answer questions in a survey. The first priority in the decision tree is given to internationally comparative, nationally representative surveys (in this order of preference: WHS, STEPS, GENACIS, and ECAS); and the second is national surveys.

Method of estimation: Weighted percentages of survey respondents, where abstainers were coded as having 0 occasions.

Method of estimation of global and regional aggregates: Survey estimates weighted by population size of countries. 

Preferred data sources: nationally representative population-based surveys

Data sources for alcohol drinking status and heavy episodic drinking

Data on alcohol drinking status and heavy episodic drinking (HED) were obtained from various surveys (published survey reports, multi-country reports and nationally representative surveys) in the general population including but not limited to the STEPwise approach to surveillance and Gender, Alcohol and Culture: an international study. The main sources of data on young persons (15-19 years of age) were the Global School-based Student Health Survey (GSHS)

  • Pan American Health Organization. Regional Status Report on Alcohol and Health 2020. Washington, D.C.: Pan American Health Organization; 2020. License: CC BY-NC-SA 3.0 IGO. Available online: https://iris.paho.org/handle/10665.2/52705  (accessed Sept 28, 2021)
  • World Health Organization. Global status report on alcohol and health 2018. World Health Organization; 2018. https://apps.who.int/iris/handle/10665/274603. License: CC BY-NC-SA 3.0 IGO (accessed Sept 28, 2021)

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