Charlotte Probst1, Carolin Kilian2, Sherald Sanchez3, Shannon Lange4, Jürgen Rehm5. 1. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Heidelberg Institute of Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany. Electronic address: mariecharlotte.probst@gmail.com. 2. Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany. 3. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 4. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada. 5. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Abstract
BACKGROUND: Individuals with low socioeconomic status (SES) experience disproportionately greater alcohol-attributable health harm than individuals with high SES from similar or lower amounts of alcohol consumption. Our aim was to provide an update of the current evidence for the role of alcohol use and drinking patterns in socioeconomic inequalities in mortality, as well as the effect modification or interaction effects between SES and alcohol use, as two potential explanations of this so-called alcohol-harm paradox. METHODS: We did a systematic review, searching Embase, Medline, PsycINFO, and Web of Science (published between Jan 1, 2013, and June 30, 2019) for studies reporting alcohol consumption, SES, and mortality. Observational, quantitative studies of the general adult population (aged ≥15 years) with a longitudinal study design were included. Two outcome measures were extracted: first, the proportion of socioeconomic inequalities in mortality explained by alcohol use; and second, the effect modification or interaction between SES and alcohol use regarding mortality risks. This study is registered with PROSPERO (CRD42019140279). FINDINGS: Of 1941 records identified, ten met the inclusion criteria. The included studies contained more than 400 000 adults, more than 30 000 deaths from all causes, and more than 3000 100% alcohol-attributable events. Alcohol use explained up to 27% of the socioeconomic inequalities in mortality. The proportion of socioeconomic inequalities explained systematically differed by drinking pattern, with heavy episodic drinking having a potentially significant explanatory value. Although scarce, there was some evidence of effect modification or interaction between SES and alcohol use. INTERPRETATION: To reduce socioeconomic inequalities in mortality, addressing heavy episodic drinking in particular, rather than alcohol use in general, is worth exploring as a public health strategy. FUNDING: Canadian Institutes of Health Research.
BACKGROUND: Individuals with low socioeconomic status (SES) experience disproportionately greater alcohol-attributable health harm than individuals with high SES from similar or lower amounts of alcohol consumption. Our aim was to provide an update of the current evidence for the role of alcohol use and drinking patterns in socioeconomic inequalities in mortality, as well as the effect modification or interaction effects between SES and alcohol use, as two potential explanations of this so-called alcohol-harm paradox. METHODS: We did a systematic review, searching Embase, Medline, PsycINFO, and Web of Science (published between Jan 1, 2013, and June 30, 2019) for studies reporting alcohol consumption, SES, and mortality. Observational, quantitative studies of the general adult population (aged ≥15 years) with a longitudinal study design were included. Two outcome measures were extracted: first, the proportion of socioeconomic inequalities in mortality explained by alcohol use; and second, the effect modification or interaction between SES and alcohol use regarding mortality risks. This study is registered with PROSPERO (CRD42019140279). FINDINGS: Of 1941 records identified, ten met the inclusion criteria. The included studies contained more than 400 000 adults, more than 30 000 deaths from all causes, and more than 3000 100% alcohol-attributable events. Alcohol use explained up to 27% of the socioeconomic inequalities in mortality. The proportion of socioeconomic inequalities explained systematically differed by drinking pattern, with heavy episodic drinking having a potentially significant explanatory value. Although scarce, there was some evidence of effect modification or interaction between SES and alcohol use. INTERPRETATION: To reduce socioeconomic inequalities in mortality, addressing heavy episodic drinking in particular, rather than alcohol use in general, is worth exploring as a public health strategy. FUNDING: Canadian Institutes of Health Research.
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