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Modifiable Risk Factors - Alcohol Consumption Exceeding Cancer Prevention Recommendations

Key findings

Approximately 9% of Ontario adults age 19 years and older in 2017 (nearly 1 million people) drank more alcohol than the maximum amount recommended for cancer prevention. That is more than 2 drinks per day for men and more than 1 drink per day for women. These rates were significantly higher in rural residents than urban residents, Canadian-born residents than immigrants, and those with higher household income compared with lower household income. The rates did not differ by education level.

Why is this important to Ontarians?

  • Modifiable risk factors are behaviours and exposures that can lower or raise a person’s risk of cancer and that can be changed. Evidence confirms strong associations between drinking excess alcohol and the risk of certain cancers. A comprehensive World Cancer Research Fund/American Institute for Cancer Research review found convincing evidence that excess alcohol consumption increases the risk of developing colorectal and post-menopausal breast cancers, and probable evidence that it increases risk for pre-menopausal breast cancer.[1]
  • In Ontario, 15.1% of colorectal cancer cases and 7.0% of female breast cancer cases can be attributed to drinking alcohol in excess of the cancer prevention recommendations made in 2010.[2]
  • Reporting on risk factor prevalence in Ontario is important for effectively monitoring trends over time, supporting the development of health promotion strategies and evaluating outcomes of provincial interventions.

 

See Modifiable Risk Factors Methodology for technical information.

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:
1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
2. Alcohol consumption (adults ages 19 and older): Exceeding the cancer prevention recommendations defined as: more than 2 drinks per day for men and more than 1 drink per day for women.

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:
1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
2. Alcohol consumption (adults ages 25 and older): Exceeding the cancer prevention recommendations defined as: more than 2 drinks per day for men and more than 1 drink per day for women.
3. Secondary graduate category includes those with some post-secondary education.

Data Table 1. Percentage of Ontario adults (ages 19 and older) exceeding cancer prevention recommendations for alcohol consumption, by sex, 2015 to 2017
  2015 Estimate (%) 2015
Lower 95% Confidence Interval (%)
2015
Upper 95% Confidence Interval (%)
2016 Estimate (%) 2016
Lower 95% Confidence Interval (%)
2016 
Upper 95% Confidence Interval (%)
2017 
Estimate (%)

2017
Lower 95% Confidence Interval (%)

2017 
Upper 95% Confidence Interval (%)
Both sexes 7.4 6.8 8.1 8.3 7.5 9.0 9.4 8.6 10.3
Male 7.9 6.8 9.0 8.7 7.6 9.7 8.8 7.8 9.8
Female 7.0 6.2 7.9 7.9 6.9 8.9 10.1 8.8 11.4

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:
1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
2. Alcohol consumption (adults ages 19 and older): Exceeding the cancer prevention recommendations defined as: more than 2 drinks per day for men and more than 1 drink per day for women.

 

Data Table 2. Percentage of Ontario adults (ages 25 and older) exceeding cancer prevention recommendations for alcohol consumption, by selected socio-demographic factors, 2015 to 2017 combined
  Excess Alcohol consumption
Estimate (%)

Excess Alcohol consumption
Lower 90% Confidence Interval (%)

Excess Alcohol consumption
Upper 95% Confidence INterval (%)
Residence – Rural 12.2 10.9 13.5
Resident – Urban  8.2 7.7 8.7
Household income quintile- Q1 (lowest) 4.4 3.7 5.1
Household income quintile- Q2 5.7 4.9 6.6
Household income quintile- Q3 8.3 7.1 9.5
Household income quintile- Q4 9.6 8.6 10.6
Household income quintile- Q5 (highest) 14.4 13.1 15.8
Education status - less than secondary 8.1 6.3 10.0
Education status - secondary graduate 8.6 7.6 9.6
Education status - post-secondary graduate 8.8 8.2 9.3
Immigration status – <=10yrs in Canada* 1.5 0.5 2.4
Immigration status – >10yrs in Canada 4.4 3.5 5.2
Immigration status – Canadian born 11.5 10.9 12.2

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:

  1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
  2. Alcohol consumption (adults ages 25 and older): Exceeding the cancer prevention recommendations defined as: more than 2 drinks per day for men and more than 1 drink per day for women.
  3. Secondary graduate category includes those with some post-secondary education.
  4. Bolded estimates are significantly different from the rates in: urban areas for analyses by urban/rural residence; income quintile 5 (Q5) for analyses by income quintile; post-secondary graduate for analyses by education status; and Canadian born for analyses by immigration status.
  5. *Interpret "immigration status <=10 years" with caution due to a large amount of sampling variability in this estimate.
Table 1: National Comparisons: Percentage of adults (ages 18 and older) who were exceeding cancer prevention recommendations for alcohol consumption, 2015 to 2016
Province/Territories Estimate, both sexes (percentage)[3]
British Columbia 8.5
Alberta 8.4
Saskatchewan 7.5
Manitoba 7.7
Ontario 7.8
Quebec 9.7
New Brunswick 7.2
Nova Scotia 8.0
Prince Edward Island 7.6
Newfoundland 8.7
Nunavut 8.0
Northwest Territories 16.2
Yukon 11.7

Note:

  1. Exceeding the cancer prevention recommendations defined as: more than 2 drinks per day for men and more than 1 drink per day for women in last 12 months.

 

Results

  • Between 2015 and 2017, the proportion of Ontario adults ages 19 and older who exceeded the cancer prevention recommendations for alcohol consumption increased each year, from 7.4% in 2015 to 9.4% in 2017. There were no significant differences between males and females over this time.
  • From 2015 to 2017, the rate of Ontario adults ages 25 and older exceeding the cancer prevention recommendations for alcohol was higher in rural residents (12.2%) compared with urban residents (8.2%); higher in those with the highest household income (14.4% in Q5) than the lowest household income (4.4% in Q1); and higher in Canadian-born residents (11.5%) compared with immigrants. Rates did not differ significantly by education level.

Comparisons

Getting comparable data and measures from other jurisdictions is a challenge. Be aware of the different data definitions, methodologies and years used in indicators measured outside of Ontario. Jurisdictional comparison is still useful to provide a rough indication of how well Ontario is doing relative to other provinces and countries.

  • The proportion of adults ages 18 and older who reported exceeding cancer prevention guidelines was higher in Northwest Territories (16.2%), Yukon (11.7%), Quebec (9.7%), Newfoundland (8.7%), British Columbia (8.5%), Nova Scotia (8.0%), and Nunavut (8.0%) compared with Ontario (7.8%) in 2015–2016.[3] It was lower than Ontario in other regions of Canada including New Brunswick (7.2%), Saskatchewan (7.5%), Prince Edward Island (7.6%), and Manitoba (7.7%) in 2015–2016.[3]

Opportunities

  • This indicator needs improvement because the rates of drinking alcohol in excess of the cancer prevention recommendations have been increasing and show differences by socio-demographic factors. Exposure to some risk factors is higher in particular social, economic or geographic populations. Populations facing health inequities experience higher incidence and mortality rates for certain cancers.
  • Evidence shows that healthy public policy and community-wide programs work better to reduce the prevalence of modifiable risk factors at a population level than those that focus on changing individuals’ behaviours.
  • Policies regulating alcohol pricing and taxation, alcohol control and distribution systems, and the physical availability of alcohol are among those supported by evidence that may reduce alcohol consumption at the population level.[4]
  • The Prevention System Quality Index is a series of reports that monitor population-level policies and programs that can reduce cancer risk factors and exposures in the Ontario population. The reports include evidence-based recommendations to strengthen cancer prevention in Ontario.[4]

References

  1. World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report [Internet]. 2018 [cited 2019 May 17]. Available from: https://www.wcrf.org/dietandcancer
  2. Cancer Care Ontario. Cancer Risk Factors in Ontario: Alcohol. Toronto: Queen’s Printer for Ontario; 2014.
  3. Canadian Partnership Against Cancer. The 2018 Cancer System Performance Report [Internet]. Toronto (ON): Canadian Partnership Against Cancer; 2018 Nov [cited 2019 May 17]. 63 p. Available at: https://www.systemperformance.ca/report/2018-cancer-system-performance-report/
  4. Cancer Care Ontario. Prevention System Quality Index: health equity. Toronto: Queen's Printer for Ontario; 2018.