Age, period and cohort effects of heavy episodic drinking by sex/gender and socioeconomic position in Canada, 2000-2021.

Background and Aims: Heavy episodic drinking (HED) trends have not been comprehensively examined in Canada. We measured age, period and birth cohort trends in HED in Canada by sex/gender and socioeconomic position.
Design and Setting: We analyzed repeat cross-sectional data from the 10 provinces in the Canadian Community Health Surveys from 2000 to 2021 using hierarchical cross-classified random effects logistic regression.
Participants: 1 167 831 respondents aged 12+ .
Measurements: HED was defined as 4+ standard drinks for women or 5+ for men at least monthly in the past 12 months. Socioeconomic position was measured using household income and education.
Findings: We observed steeper HED decreases in young adult men (aged 18-29) than women (by 14.4% and 8.7%, respectively, from 2015 to 2021) and HED increases in middle adult women (ages 50-64) (by 8.0% from 2000 to 2014). Sex/gender-specific age-period-cohort models revealed strong age and birth cohort effects. In women and men, respectively, HED peaked in young adulthood (18.2% and 33.8%) and decreased with age, and HED was greatest in the 1980-1989 cohort (20.7% and 35.8%) and decreased in the most recent cohort born in 1990-2009 (15.6% and 19.8%), particularly in men. Higher household incomes had greater HED across age, periods and cohorts, while trends varied by education. Compared with lower education groups, people with a bachelor's degree or above had the lowest HED in middle adulthood. People with a bachelor's degree or above had low HED in earlier cohorts, which converged with other education groups in recent cohorts due to a pronounced HED increase, particularly in women.
Conclusion: The sex/gender gap in heavy episodic drinking (HED) appears to be converging in Canada: current young adult men are reducing HED, while high-risk cohorts of women are aging into middle adulthood with greater HED. Recent birth cohorts with a bachelor's degree or above experienced pronounced HED increases, which among women suggests greater educational attainment contributes to the converging gender gap in HED.
(© 2024 His Majesty the King in Right of Canada and The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction. Reproduced with the permission of the Minister of Health.)