COVID-19 and alcohol in Mexico: A serious health crisis, strong actions on alcohol in response-Commentary on Stockwell et al

Differential Experiences of Intimate Partner Violence during COVID-19: A Cross-Regional Study in Mexico

The COVID-19 pandemic brought on a marked increase in intimate partner violence (IPV) worldwide, Mexico being no exception. Factors that exacerbated gender-based violence (GBV) in the household during the pandemic include gendered loss of income, regression in access to social and legal justice resources, reversal to more traditional gender norms and roles, and increased alcoholism. While there are studies about the prevalence and determinants of IPV in rural and urban Mexico, there appears to be a lack of information regarding how these realities differed as they interacted with the compounding pressures of the COVID-19 pandemic. Stemming from 10 ethnographic interviews with women across rural and urban localities of Oaxaca, Mexico City, and Mexico State, who were recruited from NGOs providing psychological and legal services against GBV, we analyze some factors associated with the prevalence of IPV during confinement. We conclude that all women in our study experienced IPV both before and during the pandemic, with variations in IPV patterns influenced by their rural or urban residence, socio-economic status, ethnic-racial identity, and proximity to the abuser's network. We also found that not all impacts were negative, rather COVID-19 measures had a paradoxical effect for some women where restrictions on geographical mobility and decrease in access to alcohol became pivotal protective factors. We recommend that public policymakers and civil society organizations alike pay attention to these differential challenges and benefits in their crisis responses.

Survival Patterns and Predictors of Mortality among COVID-19 Patients Admitted to Treatment Centers in Oromia Region, Ethiopia

Purpose

To assess survival patterns and predictors of mortality among patients admitted with COVID-19 to treatment centers in the Oromia region of Ethiopia from April 1 to August 31, 2021.

Methods

A prospective cohort study design was employed, taking a sample of 854 patients selected from eight treatment centers in the region. The follow-up duration was the time interval from admission to the treatment center until the final disposition of patients at discharge (death, recovery, or failed to recover). Data were collected by computer tablet with an interviewer-administered questionnaire and checklist designed using CSPro 7.5 and exported to Stata 13 for analysis. Descriptive analysis was used to explore the characteristics of patients. The mortality rate was estimated by number of deaths per 1,000 person-days of observation. The survival duration was estimated by medians with IQR. The Kaplan-Meier method was used to compare the survival experiences of patients. To identify the predictors of time to death after hospitalization, a Cox proportional-hazard model was used. The magnitude of association was estimated using HRs with 95% CIs, and statistical significance was set at P<0.05.

Results

The mortality rate among hospitalized patients was 9.9 per 1,000 person-days of observation and the median survival time after admission was 9 (IQR 9-10) days. Higher hazard of death was observed among patients who drank alcohol (AHR 2.0, 95% CI 1.2-3.3), required anticoagulants (AHR 10, 95% CI 1.2-91.5), glucocorticoids (AHR 1.7, 95% CI 1.1-2.8), and oxygen (AHR 4.7, 95% CI 1.1-22.0), those with acute respiratory distress syndrome (AHR 2.9, 95% CI 1.7-5.1), and critical patients admitted to intensive care units (AHR 3.4, 95% CI 2.0-5.9).

Conclusion

The hazard of death is significantly predicted by alcohol use, requiring anticoagulants, glucocorticoids, or oxygen medication, acute respiratory distress syndrome complication, and being critical when admitted to intensive care units.

Alcohol sales in Canadian liquor outlets as a predictor of subsequent COVID-19 infection rates: a time-series analysis

AIMS

Government alcohol sales data were used to examine whether age 15+ per-capita alcohol consumption (PCAC) (i) changed during COVID-19 and (ii) predicted COVID-19 infections 2-5 weeks later.

DESIGN

Interrupted time-series analyses were applied to panels of data before and after COVID-19 restrictions were introduced in Canada.

SETTING AND PARTICIPANTS

The populations, aged 15+, of the provinces of Ontario (ON), British Columbia (BC) and Nova Scotia (NS), Canada.

INTERVENTION

Expansion of home delivery options and hours of trading for liquor stores while restrictions on travel, social and economic activities were imposed by governments during COVID-19 from 17 March 2020 until 29 March 2021.

MEASUREMENTS

Weekly estimates of (i) age 15+ PCAC using sales data supplied by provincial government alcohol distributors for liquor stores, bars and restaurants, (ii) stringency of public health measures assessed by the Public Health Agency of Canada (PHAC) and (iii) new COVID-19 infections reported by PHAC.

FINDINGS

PCAC increased by 7.10% (P = 0.013) during the pandemic versus previous years, with increased private liquor store sales partly offset by reduced bar/restaurant sales. Consumption was positively associated with stringency of public health measures. Weekly PCAC was positively associated with new COVID-19 infections 2 weeks later (+6.34% for a one drink/week increase, P < 0.001). Lagged associations with COVID-19 infections 2 or 3 weeks later were observed for PCAC from all sales channels, with larger effect sizes per standard drink/person/week increase for on-premise outlets (+77.27% week 2, P = 0.009) than government liquor stores (+6.49%, week 2, P < 0.001) or private liquor stores (+7.13%, week 4, P < 0.001).

CONCLUSIONS

Alcohol consumption increased in three Canadian provinces during COVID-19 to degrees corresponding to the extent of the strictness of measures imposed to prevent viral spread. Increased consumption of alcohol was associated with increased COVID-19 infection rates 2 weeks later.

Changes in alcohol use during the COVID-19 pandemic and previous pandemics: A systematic review

The objective of this study is to summarize the research on the relationships between exposure to the COVID-19 pandemic or previous pandemics and changes in alcohol use. A systematic search of Medline and Embase was performed to identify cohort and cross-sectional population studies that examined changes in alcohol use during or following a pandemic compared to before a pandemic occurred. Outcomes examined included differences in the volume and frequency of alcohol consumption and the frequencies of heavy episodic drinking (HED) and alcohol-related problems during a pandemic compared to before a pandemic. Quality assessment was performed using the Cochrane Risk of Bias Tool for Nonrandomized Studies. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search yielded 672 articles; 27 were included in the narrative review, of which 6 were cohort studies (all from high-income countries). A total of 259,188 participants were included. All cohort studies examined the impact of COVID-19 and associated pandemic-related policies, including social distancing and alcohol-specific policies, on alcohol use. Cohort studies demonstrated a consistent significant decrease in total alcohol consumption (Australia) and a significant increase in the frequency of alcohol use (United States). A significant decrease in the frequency of HED was observed in Australia and Spain but not in the United States. A significant increase in the proportion of people with problematic alcohol use was observed in the United Kingdom. Initial insights into changes in alcohol use indicate substantial heterogeneity. Alcohol use may have decreased in some countries, while HED and the proportion of people with problematic alcohol use may have increased. The lack of high-quality studies from low- and middle-income countries reflects a dearth of information from countries inhabited by most of the world's population.

Reduced alcohol consumption during the COVID-19 pandemic: Analyses of 17 000 patients seeking primary health care in Colombia and Mexico

Background

During the COVID-19 pandemic, an increase of heavy alcohol use has been reported in several high-income countries. We examined changes in alcohol use during the pandemic among primary health care (PHC) patients in two middle income countries, Colombia and Mexico.

Methods

Data were collected during routine consultations in 34 PHC centres as part of a large-scale implementation study. Providers measured patients’ alcohol consumption with the three item ‘Alcohol Use Disorders Identification Test’ (AUDIT-C). Generalized linear mixed models were performed to examine changes in two dependent variables over time (pre-pandemic and during pandemic): 1) the AUDIT-C score and 2) the proportion of heavy drinking patients (8+ on AUDIT-C).

Results

Over a period of more than 600 days, data from N = 17 273 patients were collected. During the pandemic, the number of patients with their alcohol consumption measured decreased in Colombia and Mexico. Each month into the pandemic was associated with a 1.5% and 1.9% reduction in the mean AUDIT-C score in Colombia and Mexico, respectively. The proportion of heavy drinking patients declined during the pandemic in Colombia (pre-pandemic: 5.4%, 95% confidence interval (CI) = 4.8% to 6.0%; during the pandemic: 0.8%, 95% CI = 0.6% to 1.1%) but did not change in Mexico.

Conclusions

Average consumption levels declined and the prevalence of heavy drinking patterns did not increase. In addition to reduced opportunities for social drinking during the pandemic, changes in the population seeking PHC and restrictions in alcohol availability and affordability are likely drivers for lower levels of alcohol use by patients in this study.