Improved estimates for individual and population-level alcohol use in the United States, 1984-2020

Aims: 
While nationally representative alcohol surveys are a mainstay of public health monitoring, they underestimate consumption at the population level. This paper demonstrates how to adjust individual-level survey data using aggregated alcohol per capita (APC) data for improved individual- and population-level consumption estimates. 
Design and methods: 
For the period 1984-2020 data on self-reported alcohol consumption in the past 30 days were taken from the Behavioral Risk Factor Surveillance System (BRFSS) involving participants (18+ years) in the US. Monthly abstainers were re-allocated into lifetime abstainers, former drinkers and 12-month drinkers using the 2005 National Alcohol Survey data.  To correct for under-coverage of alcohol use, we triangulated APC and survey data by upshifting quantity (average grams/ day) and frequency (drinking days/week) of alcohol use based on national and state-level alcohol per capita data. 
Findings 
The corrections described above resulted in better correspondence between survey and APC data. Following our procedure, national estimates of alcohol quantity increased from 45% to 77% of APC estimates. Both quantity and frequency of alcohol use were upshifted; by upshifting to 90% of APC, we were able to fit trends and distributions in APC patterns for individual states and the US. 
Conclusions: 
An individual-level dataset which more accurately reflects the alcohol use of US citizens was achieved. This dataset will be invaluable as a research tool and for the planning and evaluation of alcohol control policies for the US. The methodology described can also be used to adjust individual-level alcohol survey data in other geographical settings.