The prevalence of hazardous and harmful alcohol use across trauma-exposed occupations: A meta-analysis and meta-regression.

ABSTRACT

BACKGROUND: Trauma exposure is associated with hazardous and/or harmful alcohol use. Occupational groups frequently exposed to trauma may be at risk of alcohol harm. This meta-analysis determined the prevalence of hazardous and harmful alcohol use across trauma-exposed occupations and meta-regressions explored the impact of pre-defined covariates on the variance in prevalence estimates. METHOD: Literature was searched from 2000 to March 2020, using Scopus, Web of Science and PsycINFO. Studies were included in the meta-analysis if they used a standardized measure of alcohol use (e.g., Alcohol Use Disorder Identification Test (AUDIT)). Studies were excluded if they measured alcohol use following an isolated sentinel event (e.g., 9/11). The following occupations were included first responders, health care workers, Armed Forces, war journalists and train drivers. RESULTS: 1882 studies were identified; 55 studies were eligible. The pooled prevalence of hazardous use was 22% (95% Confidence Intervals [CI] 17%-27%) and 11% (95% CI 8%-14%) for harmful use. Hazardous alcohol use was significantly lower in health care workers (13%; 95% CI 10%-16%) than first responders (26%; 95% CI 20%-32%) and Armed Forces (34%; 95% CI 18%-52%). There was marked heterogeneity across studies and higher prevalence rates in low-quality studies. The meta-regression identified higher proportion of males and younger mean age as predictors of variance. CONCLUSIONS: Male-dominated occupations, such as police officers and military personnel, showed higher levels of hazardous and harmful alcohol use, indicating that interventions tailored specifically for these occupational groups may be needed.