THE GLOBAL EPIDEMIOLOGY OF ANABOLIC STEROID USE

INTRODUCTION: The worldwide prevalence of anabolic-androgenic steroid (AAS) use is poorly documented, and geographical distribution of studies concerning AAS use is mostly limited to the USA, Canada, Brazil and some European countries. In addition, no quantitative meta-analysis has been conducted on the global prevalence rate of AAS use.

METHODS: We performed the first ever meta-analysis and meta-regression analysis of AAS use using studies gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar among others. Included were 187 studies that provided original data on 271 lifetime prevalence rates. Studies were coded for publication year, region, sample type, age range, sample size, assessment method, and sampling method. Heterogeneity was assessed by the I² index and the Q–statistic. Random effect-size modeling was used. Subgroup comparisons were conducted using Bonferroni correction.

RESULTS: The global lifetime prevalence rate obtained was 3.3% (95 CI, 2.8-3.8, I² = 99.7, P < 0.001]. The prevalence rate for males, 6.4% (95% CI, 5.3-7.7, I² = 99.2, P < 0.001), was significantly higher (Q_bet = 100.1, P < 0.001) than the rate for females, 1.6% (95% CI, 1.3-1.9, I² = 96.8, P < 0.001). Sample type (athletes), assessment method (interviews only and interviews and questionnaires), sampling method, and male sample percentage were significant predictors of AAS use prevalence. There was no indication of publication bias.

CONCLUSION: Non-medical AAS use is a serious widespread public health problem.