Trends in alcohol use disorder symptoms among U.S. adults disaggregated by sex, race, and age

Population-based studies of alcohol-related trends typically collapse across sex while examining race and/or age, limiting understanding of shifts in alcohol involvement at the intersection of sex, race, and age. Therefore, this study evaluated population-level trends in alcohol use and alcohol use disorder (AUD) symptoms as disaggregated within Hispanic, Black, and White female and male U.S. early and middle adults. Data were from years 2002 to 2019 of the National Survey on Drug Use and Health, Participants were 18 to 64, Hispanic, Black, or White, and consumed any alcohol. Annualized linear change estimates were computed to assess trends in past-month drinking days and AUD symptoms. Between groups analyses were also conducted to examine (a) sex differences within ethnoracial identity and (b) ethnoracial differences within sex. All analyses were further stratified across early (age 18 to 29) and middle adults (age 30 to 64). Number of drinking days increased only among Black early adult females and Black middle adult females and decreased for all males except for Black middle adults, with the strongest decrease for Black early adult males. AUD symptoms decreased for all early adult males, and most strongly among Black males. Among middle adults, AUD symptoms decreased only among Hispanic males and increased among White males and females. National trends in alcohol use and AUD symptoms are distinct across subpopulations at the intersection of sex, race, and age. Continued disaggregated analyses across heterogeneous U.S. subpopulations are needed to better inform clinical care.