Low socioeconomic status is linked to higher rates of alcohol-attributable death and disability.
Alcohol consumption causes or contributes to many deaths and disabilities globally. In disadvantaged socioeconomic groups, the number of alcohol-related and alcohol-attributable deaths is greater than in more privileged populations. In a study published in The Lancet, Srinivasa Katikireddi and colleagues investigated why low socioeconomic status is linked to a higher risk of alcohol-related harm. Does high-risk drinking lead to socioeconomic disadvantage (reverse causation)? Or are people of low socioeconomic status at a greater risk of harm than those of higher status after consuming similar amounts of alcohol?
Investigators analyzed demographic and alcohol consumption data from eight Scottish Health Surveys conducted between 1995 and 2012. The surveys were representative of the adult population of Scotland and included detailed questions about alcohol consumption. They matched the data to records for deaths, hospital admissions, and prescriptions for any medication related to drug dependence. Individuals were categorized into 5 groups based on binge drinking and the number of alcohol units consumed per week (1 unit = 8 grams pure alcohol). The groups were: never drinker or ex-drinker, light drinker (1-10 units for men, 1-7 units for women), moderate drinker (11-20 units for men, 8-13 units for women), heavy drinker (21-50 units for men, 14-35 units for women), and excessive drinker (≥51 units for men, ≥36 units for women).
Binge drinking was defined as exceeding the UK Government recommendations of 6 units per day for women and 8 units per day for men. Four different measures of socioeconomic status were examined including, highest education level achieved, area-based deprivation (based on geographical community data), work classification (e.g. professional, intermediate, skilled non-manual, skilled manual, partly skilled, or unskilled), and household income level. Factors of age, sex, body mass index, and smoking status were also considered in the statistical analyses.
Overall, data from 50,236 participants (43.3% men and 56.7% women) were included in the study. Men were more likely to engage in high-risk drinking patterns than women. During the years of follow-up (429,986 person-years), 1,398 individuals had an alcohol-attributable death, hospital admission, or received a prescription for alcohol dependence. After adjusting for age, sex, and survey year, the results revealed that alcohol-attributable incidents happened more often in socially disadvantaged groups. Compared to those in the highest socioeconomic groups, rates of alcohol-attributable harm were three-fold higher for members of the most disadvantaged groups.
The results of this study highlight the need for further research to understand how health inequalities begin. The investigators suggest that new policies to combat alcohol-attributable harm are needed.
Written By: Cindi A. Hoover, Ph.D.