Syndemic drivers of Alcohol Use Disorder (AUD) in the urban slum of Nepal: Findings from a cross-sectional study

Objective To examine the cumulative and synergistic association of vulnerable conditions: depression, tobacco use, unrecorded alcohol consumption and peer influence on alcohol use disorder (AUD) among adults of urban squatter settlements in Nepal. Design Cross-sectional. Setting Urban squatter settlements of Pokhara Metropolitan City, Gandaki Province, Nepal. Participants 309 adults aged 18–69 years who used to consume alcohol. Main outcome measure The Alcohol Use Disorders Identification Test (AUDIT) tool was used to assess the AUD and was defined as an AUDIT Score of ≥8. Cumulative and synergistic association of vulnerable conditions on AUD were explored in the multivariable logistic regression models using the interaction (product) term. Results The prevalence of AUD among adults who used to drink alcohol in the urban slum was 54.0% (95% CI 48.4% to 59.6%). The majority (81.9%) reported at least two vulnerable conditions, while 10.0% had all four conditions. The odds of AUD were higher for participants with one or more vulnerable conditions. More specifically, compared with adults with no or one syndemic factor, those who had at least three syndemic conditions had 16-fold higher odds of AUD (aOR: 16.068, 95% CI 6.002 to 43.020). These four vulnerable conditions can increase the risk of AUD by interacting synergistically with one another. Conclusion The synergistic effect of vulnerable conditions on AUD suggests that addressing vulnerable conditions simultaneously is required for the prevention and control of AUD.