Women are catching up to men in rates of alcohol consumption and this has important implications for how we think about our community response to harmful alcohol use.
Historically, men have been more likely to drink alcohol than women and to drink in quantities that damage their health. However, evidence points to a significant shift in the drinking landscape with rates of alcohol use appearing to converge among men and women born more recently. In a bid to quantify this trend, we pooled data from 68 studies in 36 countries with a total sample size of over four million men and women.
All of the studies we looked at reported data on both men's and women's drinking across at least two time periods. Some data were available from men and women born in the early 1900s, other data from men and women born in the late 1900s, but each data point represented the ratio of men's to women's alcohol use for those born within a specific five-year time window. Taken together we were able to map ratios across the entire period from as early as 1891 right up to the year 2000 and everything in between.
We grouped data according to three broad definitions: any alcohol use (in other words being a drinker or not), problematic alcohol use (binge or heavy episodic drinking) and alcohol-related harms (negative consequences as a result of drinking such as accidents or injuries or a diagnosis of an alcohol use disorder).
What we found was that the gap between the sexes has narrowed over time. Among cohorts born in the early 1900s men were just over two times more likely than women to drink, three times more likely to drink in ways suggesting problematic alcohol use and three-and-a-half times more likely to experience alcohol-related harms.
Among those born in the late 1900s these ratios had decreased to almost one. This means that by the end of the last century men's and women's drinking had almost reached parity.
We did not seek to quantify by how much alcohol use is falling among men and/or increasing among women. However, of the 42 studies that showed converging alcohol use, most reported this was driven by increases in the rates of female drinking.
A small proportion (5%) of the individual sex ratios was less than one, the majority of which came from cohorts born after 1981. This suggests women born after this time may, in fact, be drinking at higher rates and in more harmful ways than their male counterparts.
What's changed in the last 100 years?
We don't have a definitive answer to what has driven the rise in alcohol consumption among women but in many countries around the world we have seen substantial developments in broader social, cultural and economic factors for women and increasingly accepting societal norms around female drinking.
It is likely sex differences in alcohol use are linked, probably in complex ways, to these societal changes. Most people would argue these changes have been positive. However, increased exposure to alcohol for women also means increased exposure to the physical and mental health risks associated with drinking too much.
Regardless of the reasons behind these changes, it's clear alcohol use and associated problems are not problems that only affect men.
This matters because often the focus in the media and public debate is on young men and alcohol. It matters because universal prevention can be an effective strategy to reduce harmful alcohol use among women. It matters because, while women seek treatment for almost every other physical and mental health problem at higher rates than men, women who experience problems related to alcohol generally don't seek treatment.
The sooner we structure our education campaigns as well as our prevention, early intervention and treatment programmes around this notion, the better our community response to harmful alcohol use will be.
We need to ensure education campaigns addressing the harms of alcohol use are designed to appeal to both men and women. We need to target adolescents before drinking patterns are entrenched and deliver high quality, evidence-based universal prevention and early intervention programs. We need to reduce the structural barriers (such as cost and location) as well as negative attitudes that get in the way of women seeking treatment for alcohol problems.
Many of the men and women who are contributing to these changing drinking patterns are only now in their 20s or 30s. We need to keep tracking population trends in drinking as these cohorts age into their 40s, 50s and beyond. We need to keep asking the question: how can we do better to prevent alcohol related harms?