title: Drinking patterns and alcohol use disorders in São Paulo, Brazil: the role of neighborhood social deprivation and socioeconomic status.
abstract: BACKGROUND
  Research conducted in high-income countries has investigated influences of socioeconomic inequalities on drinking outcomes such as alcohol use disorders (AUD), however, associations between area-level neighborhood social deprivation (NSD) and individual socioeconomic status with these outcomes have not been explored in Brazil. Thus, we investigated the role of these factors on drink-related outcomes in a Brazilian population, attending to male-female variations.
  
  
  METHODS
  A multi-stage area probability sample of adult household residents in the São Paulo Metropolitan Area was assessed using the WHO Composite International Diagnostic Interview (WMH-CIDI) (n = 5,037). Estimation focused on prevalence and correlates of past-year alcohol disturbances [heavy drinking of lower frequency (HDLF), heavy drinking of higher frequency (HDHF), abuse, dependence, and DMS-5 AUD] among regular users (RU); odds ratio (OR) were obtained.
  
  
  RESULTS
  Higher NSD, measured as an area-level variable with individual level variables held constant, showed an excess odds for most alcohol disturbances analyzed. Prevalence estimates for HDLF and HDHF among RU were 9% and 20%, respectively, with excess odds in higher NSD areas; schooling (inverse association) and low income were associated with male HDLF. The only individual-level association with female HDLF involved employment status. Prevalence estimates for abuse, dependence, and DSM-5 AUD among RU were 8%, 4%, and 8%, respectively, with excess odds of: dependence in higher NSD areas for males; abuse and AUD for females. Among RU, AUD was associated with unemployment, and low education with dependence and AUD.
  
  
  CONCLUSIONS
  Regular alcohol users with alcohol-related disturbances are more likely to be found where area-level neighborhood characteristics reflect social disadvantage. Although we cannot draw inferences about causal influence, the associations are strong enough to warrant future longitudinal alcohol studies to explore causal mechanisms related to the heterogeneous patterns of association and male-female variations observed herein. Hopefully, these findings may help guide future directions for public health.
authors.affiliation: Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil; Program of the Interdisciplinary Group of Studies on Alcohol and Drugs (GREA), Department and Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Camila Magalhães
authors.initials: CM
authors.lastname: Silveira
authors.affiliation: Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Erica Rosanna
authors.initials: ER
authors.lastname: Siu
authors.affiliation: Department of Epidemiology and Statistics, Michigan State University, East Lansing, Michigan, United States of America.
authors.forename: James C
authors.initials: JC
authors.lastname: Anthony
authors.affiliation: Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Luis Paulo
authors.initials: LP
authors.lastname: Saito
authors.affiliation: Program of the Interdisciplinary Group of Studies on Alcohol and Drugs (GREA), Department and Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Arthur Guerra
authors.initials: AG
authors.lastname: de Andrade
authors.affiliation: Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Andressa
authors.initials: A
authors.lastname: Kutschenko
authors.affiliation: Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Viana
authors.affiliation: Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Yuan-Pang
authors.initials: YP
authors.lastname: Wang
authors.affiliation: Department of Epidemiology, Mailman School Of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Martins
authors.affiliation: Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Laura Helena
authors.initials: LH
authors.lastname: Andrade
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D001938:Brazil / Q000453:epidemiology; D004327:Drinking Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D062486:Public Health Surveillance; D012111:Residence Characteristics; D012307:Risk Factors; D012923:Social Class; D055815:Young Adult