Alcohol use

1. Key messages

European countries have the highest level of alcohol consumption in the world. The average consumption of pure alcohol in Belgium is 12 liters per capita per year, which is above the mean European consumption. This makes Belgium one of the countries with a high disease burden related to alcohol.

In 2018, 7.4% of men and 4.3% of women (15 years and over) had a hazardous consumption of alcohol (defined as more than 21 or more than 14 drinks per week for men and women, respectively). This prevalence has decreased over time.

Around one in ten young people in the age group 15-24 years reported a weekly episode of "risky single occasion drinking" (consumption of at least 6 glasses of alcohol at a single occasion), and also one in ten young people met the criteria for "problematic alcohol consumption" (as defined by the CAGE instrument) in the past 12 months.

2. Background

Excessive alcohol consumption leads to a considerable health burden: it is associated with mental disorders, liver cirrhosis, cancer, cardiovascular disease, as well as trauma, and is a leading cause of premature death. Alcohol consumption in European countries is largely above the world average. Reducing excessive alcohol consumption through appropriate strategies is a priority for public health.

At the international level, estimations of alcohol consumption are often based on sales data. While those average estimates are useful to assess long-term population trends, they do not allow identifying harmful drinking patterns. Survey-based data are more appropriate to describe problematic alcohol consumption, although self-reported consumption is subject to under-reporting and social desirability bias.

In this report, we describe three survey-based indicators of excessive alcohol consumption and one indicator based on sales:

  1. Hazardous alcohol consumption: weekly consumption exceeding 21 drinks containing the equivalent of 10 g of pure alcohol in men and 14 drinks in women;
  2. Weekly Risky Single Occasion Drinking (WRSOD): consumption of 6 drinks or more in a single occasion, at least once a week;
  3. Past year problematic alcohol consumption: people experiencing problematic drinking in the last 12 months defined by the CAGE instrument;
  4. Average alcohol consumption per capita: estimations by the World Health Organization, used here for international comparisons.

3. Hazardous drinking

Situation in 2018

Belgium

In 2018, in the whole population aged 15 years and over, the proportion of hazardous drinkers (more than 21 and 14 drinks per week respectively in men and women) was 5.9%. Twice as many men than women are considered to be hazardous drinkers. As the threshold for defining hazardous alcohol consumption in women is lower than in men, those results indicate a much lower consumption in women.

The highest prevalence is observed in the age group 55-64 and the lowest in the age group 75+.

Prevalence of hazardous alcohol consumption in the population aged 15 and over by age group and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [1]
Regional differences

In 2018, the highest rate was observed in Brussels both for men and women, while the prevalence was lower in Flanders.

Trends

At Belgian level, the prevalence of hazardous alcohol consumption continues to decline. A decrease of 12% in men and 8% in women was observed between 2013 and 2018.

Regional specificities

In men, the prevalence was the highest in Wallonia between 2004 and 2013, and the lowest in Brussels between 2004 and 2013. Since 2004 a continuous decrease of the prevalence in men was observed in Flanders and Wallonia, while in Brussels the decrease stopped in 2008 then markedly increased between 2013 and 2018, resulting in the highest prevalence of the three regions in 2018.

In women, the prevalence has been highest in Brussels in all HIS waves. A slight decrease was observed in Flanders, starting in 2001, with no clear trends in the other regions.

  • Men
  • Women

Prevalence of hazardous alcohol consumption in men aged 15 and over by region, Belgium, 1997-2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

Prevalence of hazardous alcohol consumption in women aged 15 and over by region, Belgium, 1997-2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

Socio-economic disparities

There is no clear socio-economic gradient in the prevalence of hazardous drinking.

Prevalence of hazardous alcohol consumption in the population aged 15 and over by educational level, Belgium, 2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

4. Weekly risky single occasion drinking

Situation in 2018

Belgium

The prevalence of weekly risky single occasion drinking (WRSOD) was 7.6% in Belgium in 2018. It was much more frequent in men (11.5%) than in women (3.9%). The age group 15-24 had the highest prevalence of WRSOD (10.4%) followed by the 55-64 (9.2%) and the 25-34 (9%).

Prevalence of weekly risky single occasion drinking in the population aged 15 or over by age group and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [1]
Regional differences

In 2018, a slightly higher percentage of risky single occasion drinkers was observed in Flanders for men, in Brussels for women, but those differences were not statistically significant.

Trends

At Belgian level, after age-adjustment, the prevalence of WRSOD decreased in men (-18%) and remained stable in women between 2013 and 2018.

Regional differences

In men, while the prevalence was significantly higher in Flanders in 2008, the difference between regions has narrowed and is no more significant. Between 2013 and 2018, a declining trend is observed in all three regions.

In women, in Flanders and Wallonia, the percentages remain stable around 4%; while Brussels witnesses a decrease but had still a higher prevalence than the other regions.

  • Men
  • Women

Prevalence of weekly risky single occasion drinking in men aged 15 and over by region, Belgium, 2008-2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

Prevalence of weekly risky single occasion drinking in women aged 15 and over by region, Belgium, 2008-2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

Socio-economic disparities

There is no clear socio-economic gradient in the prevalence of weekly risky single occasion drinking.

Prevalence of weekly risky single occasion drinking in the population aged 15 years and over by educational level, Belgium, 2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

International comparison

The prevalence of weekly risky single occasion drinking is higher in Belgium than the EU-15 average (for the 13 countries with available data), for both men (13 vs 10%) and women (3.8 vs 3.1%).

  • Men
  • Women

Prevalence of weekly risky single occasion drinking in men aged 15 or older by country of residence, Europe, 2014
Source: Eurostat [2]

Prevalence of weekly Risky Single Occasion Drinking in women aged 15 or older by country of residence, Europe, 2014
Source: Eurostat [2]

5. Problematic alcohol consumption

Belgium

Problematic alcohol use is defined based on answers to a specific 4-item questionnaire (CAGE) and is predictive of alcohol dependence. The prevalence of problematic alcohol consumption in the last 12 months was 7% in Belgium in 2018. It was higher in men (9.5%) than in women (4.7%). The prevalence of problematic alcohol consumption was the highest in the younger age group (9.8%) followed by the age group 25-44 and 45-54 (8.8%). The prevalence was similar in men and women in the age group 55-64.

Prevalence of problematic alcohol consumption in the last 12 months in the population aged 15 years and over by age group and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [1]

Regional differences

The prevalence of problematic alcohol consumption in the past 12 months was the highest in Wallonia for men and in Brussels for women.

Prevalence of problematic alcohol consumption in the last 12 months in the population aged 15 years and over by region and sex, Belgium, 2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

6. Total alcohol consumption per capita

According to the WHO estimations for 2016, the total consumption in Belgium was 12.1 liters of pure alcohol per capita (15+), which was higher than the EU-15 average (11.1 liters). The World Health Organization (WHO) European Region has the highest level (9.7 l) of alcohol consumption in the world (6.2 l).

Total alcohol (recorded + unrecorded) per capita consumption (in liters of pure alcohol) among the population aged 15 or over by country of residence, Europe, 2016
Source: GISAH [3]
Total alcohol (recorded + unrecorded) per capita consumption (in liters of pure alcohol) among the population aged 15 or over by region of the world, 2016
Source: GISAH [3]

7. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, and the United Kingdom. We compare the Belgian health status to that of the EU-15 rather than the one of EU-28 because this historical construction has more socio-economic similarity than EU28.
Hazardous alcohol consumption
Hazardous alcohol consumption, or alcohol overconsumption is defined as a consumption of pure alcohol exceeding 30 g for men and 20 g for women daily; it is equivalent to 21 and 14 standard drinks (of 10 g pure alcohol content) per week respectively.
Weekly risky single occasion drinking (WRSOD)
Weekly risky single occasion drinking is defined as consumption of at least 6 standard drinks (of 10 g pure alcohol content) on the same occasion, at least once a week.
Problematic alcohol consumption
Problematic alcohol consumption is defined as 2 positive answers out of the 4 questions of the CAGE instrument and is predictive of alcohol dependence.
CAGE instrument
The CAGE instrument is a widely used screening test for problem drinking and potential alcohol problems. The questionnaire contains four ‘yes-no’ questions and two positive answers are considered as a warning signal for potential problematic use of alcohol:
1. Have you ever felt the need to cut down on your drinking?
2. Have you ever been criticized concerning your drinking?
3. Have you ever felt guilty about drinking?
4. Have you ever felt the need to take a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?
Total alcohol consumption per capita
The total alcohol per capita consumption is the recorded 3-years average and the unrecorded alcohol consumption per capita in the population aged 15 and over, expressed in liters of pure alcohol a year. Recorded alcohol consumption refers to official statistics (production, import, export, and sales or taxation data. Unrecorded consumption refers to alcohol which is not taxed and is outside the usual system of governmental control. This can be estimated thanks to specific survey questions. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/465

References

  1. Health Interview Survey, Sciensano, 1997-2018. https://hisia.wiv-isp.be/SitePages/Home.aspx
  2. Eurostat. http://ec.europa.eu/eurostat/fr/data/database
  3. World Health Organization, GISAH, 2016. http://apps.who.int/gho/data/node.gisah.A1036?lang=en&showonly=GISAH