Understanding the prevalence of lifetime abstinence from alcohol: An ecological study

- Lifetime abstinence (LA) from alcohol is associated with gross domestic product (GDP).
- This negative association applies predominantly to countries with a lower GDP.
- The proportion of Muslims is positively associated with the prevalence of LA.
- This applies predominantly to countries with a Muslim majority.

BackgroundThe level of alcohol consumption and related burden in a country are strongly impacted by the prevalence of abstinence from alcohol use. The objective of this study was to characterize the association of lifetime abstinence from alcohol use with economic wealth (as measured in the gross domestic product [GDP]) and Muslim religion on a country level.MethodsAn ecological study was performed using aggregate data of 183 countries for the year 2010. Lifetime abstinence among men and women was predicted using fractional response regression models with the natural logarithm of GDP-PPP (purchasing power parity) and the proportion of Muslim population as predictors. The models were further adjusted by the country's median age and World Health Organization region. Precision of prediction was investigated.ResultsDescriptive analyses showed a strong negative association between GDP-PPP and lifetime abstinence in countries without a Muslim majority and a GDP-PPP up to 20,000 international dollars. Regression models confirmed the negative association with GDP-PPP and showed a strong positive association between lifetime abstinence and the proportion of Muslim population. Stratified sensitivity analyses showed that in countries without a Muslim majority only GDP-PPP showed a statistically significant association whereas in Muslim majority countries only the proportion of Muslims was associated with the prevalence of lifetime abstinence.ConclusionsParticularly in countries with a lower GDP and without Muslim majority the prevalence of lifetime abstinence from alcohol use is strongly negatively associated with GDP-PPP. Future research should analyze the accordance in trends of GDP and lifetime abstinence over time.

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