Age, period and cohort effects of heavy episodic drinking by sex/gender and socioeconomic position in Canada, 2000–2021

Background and Aims Heavy episodic drinking (HED) trends have not been comprehensively examined in Canada. We measured age, period and birth cohort trends in HED in Canada by sex/gender and socioeconomic position. Design and setting. We analyzed repeat cross‐sectional data from the 10 provinces in the Canadian Community Health Surveys from 2000 to 2021 using hierarchical cross‐classified random effects logistic regression. Participants 1 167 831 respondents aged 12+ . Measurements HED was defined as 4+ standard drinks for women or 5+ for men at least monthly in the past 12 months. Socioeconomic position was measured using household income and education. Findings We observed steeper HED decreases in young adult men (aged 18–29) than women (by 14.4% and 8.7%, respectively, from 2015 to 2021) and HED increases in middle adult women (ages 50–64) (by 8.0% from 2000 to 2014). Sex/gender‐specific age‐period‐cohort models revealed strong age and birth cohort effects. In women and men, respectively, HED peaked in young adulthood (18.2% and 33.8%) and decreased with age, and HED was greatest in the 1980–1989 cohort (20.7% and 35.8%) and decreased in the most recent cohort born in 1990–2009 (15.6% and 19.8%), particularly in men. Higher household incomes had greater HED across age, periods and cohorts, while trends varied by education. Compared with lower education groups, people with a bachelor's degree or above had the lowest HED in middle adulthood. People with a bachelor's degree or above had low HED in earlier cohorts, which converged with other education groups in recent cohorts due to a pronounced HED increase, particularly in women. Conclusion The sex/gender gap in heavy episodic drinking (HED) appears to be converging in Canada: current young adult men are reducing HED, while high‐risk cohorts of women are aging into middle adulthood with greater HED. Recent birth cohorts with a bachelor's degree or above experienced pronounced HED increases, which among women suggests greater educational attainment contributes to the converging gender gap in HED.