Epidemiology for public health
Istituto Superiore di Sanità
Epidemiology for public health - ISS

Alcohol and COVID: what is changing due to the pandemic?

The 2021 Alcohol Prevention Day (14 May 2021) provides an opportunity to review the data on alcohol consumption collected by the PASSI (18-64 year-olds) and PASSI d’Argento (over-65s) population-based surveillance systems between March and December 2020.


Adult population

During the pandemic, 57% of all adults aged 18 to 64 years reported consuming alcohol in the past 30 days. Overall, 17% of respondents reported levels and patterns of alcohol consumption that pose an increased health risk: 3% regularly drank large quantities of alcohol, exceeding the limits for average daily consumption recommended by international guidelines, 8% were binge drinkers and 9% consumed alcohol mainly between meals. Risky drinking continued to be more prevalent among more socially advantaged groups (with higher levels of income and education) from the north, especially men. A slow but steady increase in high-risk drinking was recorded between 2008 and 2018, mainly due to binge drinking and predominant/exclusive consumption between meals. The trend reversal that started to take shape in 2018 continued during the pandemic: the percentage of binge drinkers declined from 9.5% in 2019 to 8.2% in 2020, while predominant consumption between meals dropped from 9.4% to 8.6%. These were small yet significant changes, even after adjusting for associated socio-demographic variables.


Elderly population

The data collected during the pandemic by the PASSI d’Argento surveillance show that 45% of people aged over 65 consumed alcohol regularly: 24% of them drank moderately, and their levels of consumption remained below the limits recommended by the guidelines, while 21% engaged in risky drinking (2 or more units of alcohol daily; see below for a definition of “unit of alcohol”). The remaining 55% reported not drinking alcohol regularly. Once again, alcohol consumption was more common among more socially advantaged groups, with higher levels of income and education, and those living in the north, especially men. 


The percentage of over-65s who reported consuming alcohol rose by 6% between March and December 2020, compared to the same period in 2019 (up from 39% to 45%). This increase was fully attributable to a rise in the percentage of women drinking moderately, which grew from 17% in 2019 to 25% in 2020 (from 20% to 30% among highly-educated women; from 15% to 21% among those with a low level of education). There were no changes in either risky drinking among women or general alcohol consumption among men. 


Data collection methods

The PASSI surveillance used a questionnaire to ask adults about their alcohol consumption in the past 30 days and estimate:

  • average daily consumption, with questions about frequency of alcohol use (days per month) and average units of alcohol (UA) consumed
  • levels of consumption when recommended limits were exceeded in a single drinking session
  • timing of consumption in relation to meals.

One UA corresponds to 12 grams of ethanol, which is the approximate amount contained in a can of beer (330 ml), a glass of wine (125 ml) or a small glass of spirit (40 ml) of standard strength. The composite indicator “high-risk drinking” included one or more of these three patterns of drinking: regular high consumption, occasional excessive consumption, consumption between meals. The indicator made it possible to calculate the cumulative share of population whose levels or patterns of alcohol consumption posed a health risk, i.e. the share of people who reported (in the past 30 days) regular high consumption (on average, >2 UA/day for men; >1 UA/day for women), or at least one binge drinking session (>4 UA for men; >3 UA for women), or drinking (predominantly or exclusively) between meals. 


According to the guidelines issued by the National Research Institute of Food and Nutrition (Istituto Nazionale per la Ricerca sugli Alimenti e la Nutrizione - INRAN), in line with WHO recommendations, people aged over 65 years should not exceed the limit of 12 g/day of alcohol, irrespective of sex. People in this age group are particularly vulnerable, as physiological and metabolic changes in the ageing body make them more susceptible to the effects of alcohol. From the age of 50, the amount of water in our bodies starts to decrease, which means that alcohol is diluted in a smaller volume of water. Therefore, in older people, a given amount of alcohol leads to higher blood alcohol concentrations and its effects are stronger. For this reason, men and women aged over 65 are identified as risky drinkers if they consume more than 1 UA a day.


Publication date: 24 May 2021