Does Industrialization Change Drinking Behaviors in China? A Longitudinal Study of Changing Patterns of Alcohol Consumption in Modern China

Purpose: Excessive alcohol consumption is a worldwide social problem that has greatly contributed to the global burden of disease, disability and death.  Since the liberal economic reforms of the 1980s, which launched an era of increasing urbanization, westernization, and changes in social and family structure, China has witnessed an alarmingly increasing rate of alcohol consumption, and increasing prevalence of alcohol-related injuries and morbidity.  We examine longitudinal alcohol consumption trends within China to determine the factors that are associated with alcohol consumption and potential changes in alcohol consumption behavior through this period of dramatic social change, investigating these research questions: (1) How has alcohol drinking behavior changed among Chinese adults, particularly women, from 1993 to 2009?; and (2) What demographic variables predict differences in alcohol use, and how do these predictors change over time?

Methods:Using representative sample panel data from the China Health and Nutrition Survey (N=15,875), we used four-level logistic and linear random-intercept multilevel models to examine the relationship between demographic characteristics and three measures of alcohol drinking behaviors across 1993, 2000, and 2009: current drinking, quantity of alcoholic beverages consumed per week, and frequency of drinking (once per week or more).  To examine changes across time, we used ANOVAs and chi-square tests to test differences for these measures between 1993 and 2009. 

Results: Rural residents were less likely to be current drinkers for all three years (OR=0.56-0.62, p<0.001), but consumed more alcohol in 1993 (B=3.21, p<0.001) and 2000 (B=1.32, p<0.05), compared to urban residents.  There were no significant differences between urban and rural residents found for quantity of alcohol consumed for 2009 and for frequent drinking across all years. Women were less likely to be current (OR=0.02, p<0.001) and frequent drinkers (OR=0.12, p<0.001), and consumed less alcohol than men across all three years (B=-6.50, p<0.001).  Quantity of alcohol consumed significantly increased for women (x²=8.00, p<0.01), but current and frequent drinking did not.  Older categorical age groups demonstrated an increased likelihood of current and frequent drinking, and increased alcohol consumption quantity compared to the youngest categorical age group across all years. 

Implications: Our mixed findings regarding urbanicity suggest the relationship between urbanization/industrialization and drinking behaviors is complex.  While there is evidence of a closing gender gap in alcohol consumption in industrialized countries, our findings indicate that this trend is less apparent in China. Nevertheless, given that quantity of alcohol consumed appears to be increasing for women, especially among urban women, attention to women’s drinking behaviors should be included in screening interventions and education efforts regarding excessive alcohol use.  Our findings also suggest a cohort effect, in which younger cohorts over time tend to consume less and drink less frequently than older cohorts.  Implications are that older Chinese adults may not be aware of the combined effects of alcohol and aging, such as decreased brain function, increased risk for dementia, and increased risk of injury.  Screening for alcohol misuse among Chinese older adults may help identify individuals at risk for alcohol-related problems.