Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: a systematic review and meta-analysis

Charlotte Probst; Michael Roerecke; Silke Behrendt; Jürgen Rehm

doi:10.1093/ije/dyu043

Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: a systematic review and meta-analysis

Int J Epidemiol. 2014 Aug;43(4):1314-27. doi: 10.1093/ije/dyu043. Epub 2014 Mar 11.

Authors

Charlotte Probst¹, Michael Roerecke², Silke Behrendt³, Jürgen Rehm⁴

Affiliations

¹ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, Canada c.probst@psychologie.tu-dresden.de.
² Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, Canada.
³ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, Canada.
⁴ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canad

Abstract

Background: Factors underlying socioeconomic inequalities in mortality are not well understood. This study contributes to our understanding of potential pathways to result in socioeconomic inequalities, by examining alcohol consumption as one potential explanation via comparing socioeconomic inequalities in alcohol-attributable mortality and all-cause mortality.

Methods: Web of Science, MEDLINE, PsycINFO and ETOH were searched systematically from their inception to second week of February 2013 for articles reporting alcohol-attributable mortality by socioeconomic status, operationalized by using information on education, occupation, employment status or income. The sex-specific ratios of relative risks (RRRs) of alcohol-attributable mortality to all-cause mortality were pooled for different operationalizations of socioeconomic status using inverse-variance weighted random effects models. These RRRs were then combined to a single estimate.

Results: We identified 15 unique papers suitable for a meta-analysis; capturing about 133 million people, 3 741 334 deaths from all causes and 167 652 alcohol-attributable deaths. The overall RRRs amounted to RRR = 1.78 (95% confidence interval (CI) 1.43 to 2.22) and RRR = 1.66 (95% CI 1.20 to 2.31), for women and men, respectively. In other words: lower socioeconomic status leads to 1.5-2-fold higher mortality for alcohol-attributable causes compared with all causes.

Conclusions: Alcohol was identified as a factor underlying higher mortality risks in more disadvantaged populations. All alcohol-attributable mortality is in principle avoidable, and future alcohol policies must take into consideration any differential effect on socioeconomic groups.

Keywords: Alcohol-attributable mortality; SES; alcohol; all-cause mortality; education; income; meta-analysis; occupation; socioeconomic differences; socioeconomic inequality; socioeconomic status.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Alcohol-Related Disorders / mortality*
Educational Status
Humans
Income / statistics & numerical data
Mortality
Social Class*
Socioeconomic Factors