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Peer-reviewedCC BY-NC 4.0BMJ Open

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

  • Namuna Subedi1
  • Krishna Prasad Sapkota1
  • Basant Kumar Dhami2
  • Dhirendra Nath3
  1. 1School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal
  2. 2Kathmandu Institute of Child Health, Kathmandu, Nepal
  3. 3Health Directorate, Ministry of Social Development, Doti, Sudurpaschim Province, Nepal
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{subedi2026syndemic,
  title = {{Syndemic drivers of Alcohol Use Disorder (AUD) in the urban slum of Nepal: Findings from a cross-sectional study}},
  author = {Namuna Subedi and Krishna Prasad Sapkota and Basant Kumar Dhami and Dhirendra Nath},
  journal = {BMJ Open},
  year = {2026},
  month = nov,
  doi = {10.1136/bmjopen-2026-116282},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-116282},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Syndemic drivers of Alcohol Use Disorder (AUD) in the urban slum of Nepal: Findings from a cross-sectional study
AU  - Namuna Subedi
AU  - Krishna Prasad Sapkota
AU  - Basant Kumar Dhami
AU  - Dhirendra Nath
PY  - 2026
DA  - 2026/11/02
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-116282
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-116282
AB  - 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.
SN  - 2044-6055
SN  - 2044-6055
ER  -