CHARACTERIZATION OF THE UNRECORDED ALCOHOL USE WORLDWIDE: A SYSTEMATIC REVIEW AND SURVEY-BASED STUDY

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Introduction and Objectives Unrecorded alcohol - products that escape taxation, regulation, and safety checks - represents up to one quarter of world alcohol intake and is strongly linked to hazardous drinking and alcohol-related liver disease. Knowledge gaps regarding unrecorded alcohol worldwide need to be addressed to better inform region-specific harm reduction strategies. To characterize the population, contemporary consumption patterns, and physicians' interest in unrecorded alcohol worldwide. Materials and Methods Cross-sectional survey-based study. Data was collected between August and November 2024, distributing a 19 item electronic questionnaire to hepatology-focused physicians worldwide. Responses were categorized into 15 geographic regions and were analyzed by descriptive statistics. Results We collected 116 survey responses from 44 countries. Homemade alcohol was the predominant form of unrecorded alcohol consumed, representing the largest share in most regions. Consumers were predominantly male and of working age. Rural consumption of homemade alcohol exceeded that of urban areas, whereas smuggled and cross-border alcohol were mainly consumed in urban areas. Among at-risk groups unrecorded alcohol consumption was highest in drug users and lowest in pregnant women and prisioners. Binge drinking was the most pattern for homemade, illegal, and smuggled alcohol; heavy drinking predominated for surrogate alcohol; and moderate drinking was most common for cross-border purchases. Sub-Saharan Africa had the highest prevalence of heavy drinking across all unrecorded alcohol categories, whereas North America had the highest prevalence of heavy drinking in the surrogate alcohol category. Only 21% of physicians reported "always" asking patients about unrecorded alcohol use, whereas 4.6% reported "never" doing so. A combined 52% indicated they "usually" or "Rarely" ask about unrecorded alcohol use. Conclusions Unrecorded alcohol use is widespread, driven by homemade sources, with higher prevalence in rural areas and among people who consume drugs, while physician screening remains limited.

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