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Angus C, Henney M, Pryce R. Modelling the longer-term health and health inequality impacts of changes in alcohol consumption during the COVID-19 pandemic in England. J Public Health (Oxf) 2024; 46:286-293. [PMID: 38304989 DOI: 10.1093/pubmed/fdae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/12/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Alcohol consumption changed substantially during the COVID-19 pandemic for many people. This study quantified how these changes in drinking varied across the population and their potential longer-term impact on health and health inequalities. METHODS We analyzed data from the Alcohol Toolkit Study to estimate how alcohol consumption changed during the pandemic (April 2020-November 2021) and how these changes varied with age, sex, drinking level and socioeconomic position. We combined these estimates with a range of alternative scenarios of future alcohol consumption and used the Sheffield Alcohol Policy Model to assess the long-term health and health inequality impacts of these changes. RESULTS Alcohol consumption in 2020-21 increased in heavier drinkers but fell in moderate drinkers. If alcohol consumption returns to pre-pandemic levels in 2022, we estimate a total of 42 677 additional hospital admissions and 1830 deaths over 20 years because of these changes. If consumption remains at 2021 levels in the long-term these figures rise to 355 832 and 12 849, respectively. In all scenarios, the biggest increase in harm occurs in the most deprived 20% of the population. CONCLUSIONS Pandemic-era changes in alcohol consumption are likely to have a significant negative impact on public health and health inequalities, even under optimistic assumptions about future drinking.
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Affiliation(s)
- Colin Angus
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Madeleine Henney
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Robert Pryce
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
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2
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Jensen HAR, Møller SR, Christensen AI, Davidsen M, Juel K, Petersen CB. Trends in social inequality in mortality in Denmark 1995-2019: the contribution of smoking- and alcohol-related deaths. J Epidemiol Community Health 2023; 78:18-24. [PMID: 37451846 PMCID: PMC10715496 DOI: 10.1136/jech-2023-220599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND During the past decades, social inequality in mortality has increased in several countries, including Denmark. Modifiable risk factors, such as smoking and harmful alcohol consumption, have been suggested to moderate the association between socioeconomic position and health-related outcomes. The present study aims to investigate the contribution of smoking- and alcohol-related deaths to the trends in educational inequality in mortality in Denmark 1995-2019 among individuals aged 30-74 years. METHODS Nationwide data on mortality and highest attained educational level divided into quartiles were derived from administrative registers. Alcohol-related mortality was directly estimated using information on alcohol-related deaths from death certificates. Smoking-related mortality was indirectly estimated using the Peto-Lopez method. The contribution of smoking- and alcohol-related deaths to the social inequality gap in mortality 1995-2019 was calculated. RESULTS Alongside a decrease in all-cause mortality in Denmark 1995-2019, absolute differences in the mortality rate (per 100 000 person-year) between the lowest and the highest educational quartile increased from 494 to 607 among men and from 268 to 376 among women. Among both men and women, smoking- and alcohol-related deaths explained around 60% of the social inequality in mortality and around 50% of the increase in mortality inequality. CONCLUSION Smoking and harmful alcohol consumption continue to be important risk factors and causes of social inequality in mortality, with around half of the increase in Denmark 1995-2019 being attributable to smoking- and alcohol-related deaths. Future healthcare planning and policy development should aim at reducing social inequality in modifiable health risk behaviours and their negative consequences.
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Affiliation(s)
| | - Sofie Rossen Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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3
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Boyd J, Hayes K, Green D, Angus C, Holmes J. The contribution of health behaviour to socioeconomic inequalities in alcohol harm: Analysis of the UK biobank, a large cohort study with linked health outcomes. SSM Popul Health 2023; 23:101443. [PMID: 37334333 PMCID: PMC10275713 DOI: 10.1016/j.ssmph.2023.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023] Open
Abstract
This is the first study to use the UK Biobank database to: 1) test whether participants of a low socioeconomic position (SEP) are less likely to drink, but more likely to suffer alcohol-related harm, and 2) test the contribution of behavioural factors. The database contains health-related information from 500,000 UK residents that were recruited aged 40-69 between 2006 and 2010. Our analysis focuses on participants resident in England (86% of the total sample). We obtained baseline demographics, survey data regarding alcohol consumption and other behaviours, and linked death and hospital-admission records. The primary outcome was time from study entry to experiencing an alcohol-attributable event (hospital admission or death). The relationship between alcohol-attributable harm and five measures of SEP (area-level deprivation, housing tenure, employment status, household income and qualifications) was investigated using time-to-event analysis. Average weekly alcohol consumption, other drinking behaviours (drinking history and beverage preference), and lifestyle factors (BMI and smoking status) were added incrementally as covariates in nested regression models to investigate whether they could explain the relationship between harm and SEP. 432,722 participants (197,449 men and 235,273 women) were included in the analysis with 3,496,431 person-years of follow-up. Those of a low SEP were most likely to be never/former drinkers or high-risk drinkers. However, alcohol consumption could not explain experiences of alcohol-attributable harm between SEP groups (Hazard Ratio (HR) 1.48; 95% Confidence Interval 1.45-1.51, after adjusting for alcohol consumption). Drinking history, drinking mostly spirits, an unhealthy Body Mass Index and smoking all increased the risk of alcohol-attributable harm. However, these factors only partially explain SEP differences in alcohol harm as the HR for the most deprived vs the least deprived was still 1.28 after adjustment. This suggests that improving wider health behaviour of the most deprived could reduce alcohol-related inequalities. However, a substantial proportion of the variance in alcohol harm remains unexplained.
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Affiliation(s)
- Jennifer Boyd
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kate Hayes
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Dan Green
- College of Health and Life Sciences, Aston University, B4 7ET, Birmingham, UK
| | - Colin Angus
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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4
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Probst C, Könen M, Rehm J, Sudharsanan N. Alcohol-Attributable Deaths Help Drive Growing Socioeconomic Inequalities In US Life Expectancy, 2000-18. HEALTH AFFAIRS (PROJECT HOPE) 2022; 41:1160-1168. [PMID: 35914205 DOI: 10.1377/hlthaff.2021.01905] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Socioeconomic gaps in life expectancy have widened substantially in the United States since 2000. Yet the contribution of specific causes to these growing disparities remains unknown. We used death records from the National Vital Statistics System and population data from Current Population Surveys to quantify the contribution of alcohol-attributable causes of death to changes in US life expectancy between 2000 and 2018 by sex and socioeconomic status (as measured by educational attainment). During the study period, the gap in life expectancy between people with low (high school diploma or less) compared with high (college degree) levels of education increased by three years among men and five years among women. Between 2000 and 2010 declines in cardiovascular disease mortality among people with high education made major contributions to growing inequalities. In contrast, between 2010 and 2018 deaths from a cause with an alcohol-attributable fraction of 20 percent or more were a dominant driver of socioeconomic divergence. Increased efforts to implement cost-effective alcohol control policies will be essential for reducing health disparities.
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Affiliation(s)
- Charlotte Probst
- Charlotte Probst , Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Miriam Könen
- Miriam Könen, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Jürgen Rehm
- Jürgen Rehm, Centre for Addiction and Mental Health
| | - Nikkil Sudharsanan
- Nikkil Sudharsanan, Technical University of Munich, Munich, Bavaria, Germany
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Trias-Llimós S, Spijker JJA. Educational differences in alcohol-related mortality and their impact on life expectancy and lifespan variation in Spain (2016-2018): a cross-sectional analysis using multiple causes of death. BMJ Open 2022; 12:e053205. [PMID: 35074816 PMCID: PMC8788229 DOI: 10.1136/bmjopen-2021-053205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in alcohol-related mortality in Spain exists, and are postulated to contribute to inequalities in all-cause mortality. We aim to assess absolute and relative educational inequalities in alcohol-related mortality, and to estimate the role of alcohol in educational inequalities in both life expectancy and lifespan variation in Spain. METHODS We used multiple cause-of-death (MCOD) mortality data for individuals aged 30 and over for Spain (2016-2018) by educational attainment. We estimated by sex and educational attainment age-standardised alcohol-attributable mortality rates, relative and absolute indices of educational inequalities; and total life expectancy and lifespan variation at age 30 for all-cause mortality and after eliminating alcohol-attributable mortality. RESULTS The use of MCOD resulted in an additional 2543 annual alcohol-related deaths (+75% among men and +50% among women) compared with estimates derived from underlying causes of death. In absolute terms, educational inequalities were the highest among men aged 45-84 and among women aged 45-64. In relative terms, higher inequalities raised in working ages, whereas at older ages inequalities tended to be lower, although still important among men. Alcohol contributed to educational inequalities in life expectancy (men: 0.13 years (3.2%); women 0.02 years (0.7%)) and lifespan variation (2.1% and 1.4% for men and women, respectively). CONCLUSION Alcohol consumption remains an important lifestyle habit to be tackled in order to reduce socioeconomic inequalities in mortality in Spain, particularly among men.
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Affiliation(s)
- Sergi Trias-Llimós
- Centre d'Estudis Demografics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jeroen J A Spijker
- Centre d'Estudis Demografics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra, Spain
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Boyd J, Sexton O, Angus C, Meier P, Purshouse RC, Holmes J. Causal mechanisms proposed for the alcohol harm paradox-a systematic review. Addiction 2022; 117:33-56. [PMID: 33999487 PMCID: PMC8595457 DOI: 10.1111/add.15567] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/17/2020] [Accepted: 04/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The alcohol harm paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another. METHODS This was a systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974-January 2021) and PsycINFO (1967-January 2021), supplemented with manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm and socio-economic position. Papers were set in Organization for Economic Cooperation and Development high-income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations. RESULTS Seventy-nine papers met the inclusion criteria and initial coding revealed that these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: individual, life-style, contextual, disadvantage, upstream and artefactual. Explanations related to risk behaviours, which fitted within the life-style domain, were the most frequently proposed (n = 51) and analysed (n = 21). CONCLUSIONS While there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing.
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Affiliation(s)
- Jennifer Boyd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Olivia Sexton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Robin C. Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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7
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Probst C, Lange S, Kilian C, Saul C, Rehm J. The dose-response relationship between socioeconomic deprivation and alcohol-attributable mortality risk-a systematic review and meta-analysis. BMC Med 2021; 19:268. [PMID: 34736475 PMCID: PMC8569998 DOI: 10.1186/s12916-021-02132-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Individuals with low socioeconomic status (SES) experience a higher risk of mortality, in general, and alcohol-attributable mortality in particular. However, a knowledge gap exists concerning the dose-response relationships between the level of socioeconomic deprivation and the alcohol-attributable mortality risk. METHODS We conducted a systematic literature search in August of 2020 to update a previous systematic review that included studies published up until February of 2013. Quantitative studies reporting on socioeconomic inequality in alcohol-attributable mortality among the general adult population were included. We used random-effects dose-response meta-analyses to investigate the relationship between the level of socioeconomic deprivation and the relative alcohol-attributable risk (RR), by sex and indicator of SES (education, income, and occupation). RESULTS We identified 25 eligible studies, comprising about 241 million women and 230 million men, among whom there were about 75,200 and 308,400 alcohol-attributable deaths, respectively. A dose-response relationship between the level of socioeconomic deprivation and the RR was found for all indicators of SES. The sharpest and non-linear increase in the RR of dying from an alcohol-attributable cause of death with increasing levels of socioeconomic deprivation was observed for education, where, compared to the most educated individuals, individuals at percentiles with decreasing education had the following RR of dying: women: 25th: 2.09 [95% CI 1.70-2.59], 50th: 3.43 [2.67-4.49], 75th: 4.43 [3.62-5.50], 100th: 4.50 [3.26-6.40]; men: 25th: 2.34 [1.98-2.76], 50th: 4.22 [3.38-5.24], 75th: 5.87 [4.75-7.10], 100th: 6.28 [4.89-8.07]. CONCLUSIONS The findings of this study show that individuals along the entire continuum of SES are exposed to increased alcohol-attributable mortality risk. Differences in the dose-response relationship can guide priorities in targeting public health initiatives.
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Affiliation(s)
- Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, M5S 2S1, Canada.
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, 69120, Heidelberg, Germany.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, 01187, Dresden, Germany
| | - Celine Saul
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, 01187, Dresden, Germany
- Dalla Lana School of Public Health, University of Toronto, M5T 3 M7, Toronto, ON, Canada
- Centre for Interdisciplinary Addiction Research, University of Hamburg, 20246, Hamburg, Germany
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation, 125009
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8
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Finlay IG, Severi K. Commentary on Robinson et al.: England needs minimum pricing to tackle alcohol's hidden harms-Scotland's experience shows minimum unit pricing (MUP) on off-trade alcohol sales is effective. Addiction 2021; 116:2708-2709. [PMID: 34085346 DOI: 10.1111/add.15578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Ilora G Finlay
- Commission on Alcohol Harms (supported by the Alcohol Health Alliance UK) and House of Lords, London, UK
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9
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Bergeron-Boucher MP, Aburto JM, van Raalte A. Diversification in causes of death in low-mortality countries: emerging patterns and implications. BMJ Glob Health 2021; 5:bmjgh-2020-002414. [PMID: 32694219 PMCID: PMC7375425 DOI: 10.1136/bmjgh-2020-002414] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION An important role of public health organisations is to monitor indicators of variation, so as to disclose underlying inequality in health improvement. In industrialised societies, more individuals than ever are reaching older ages and have become more homogeneous in their age at death. This has led to a decrease in lifespan variation, with substantial implications for the reduction of health inequalities. We focus on a new form of variation to shed further light on our understanding of population health and ageing: variation in causes of death. METHODS Data from the WHO Mortality Database and the Human Mortality Database are used to estimate cause-of-death distributions and life tables in 15 low-mortality countries. Cause-of-death variation, using 19 groups of causes, is quantified using entropy measures and analysed from 1994 to 2017. RESULTS The last two decades have seen increasing diversity in causes of death in low-mortality countries. There have been important reductions in the share of deaths from diseases of the circulatory system, while the share of a range of other causes, such as diseases of the genitourinary system, mental and behavioural disorders, and diseases of the nervous system, has been increasing, leading to a more complex cause-of-death distribution. CONCLUSIONS The diversification in causes of death witnessed in recent decades is most likely a result of the increase in life expectancy, together with better diagnoses and awareness of certain diseases. Such emerging patterns bring additional challenges to healthcare systems, such as the need to research, monitor and treat a wider range of diseases. It also raises new questions concerning the distribution of health resources.
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Affiliation(s)
| | - José Manuel Aburto
- Interdisciplinary Centre on Population Dynamics, Syddansk Universitet, Odense, Denmark.,Department of Sociology and Leverhulme Centre for Demographic Science, University of Oxford, Oxford, Oxfordshire, UK.,Max-Planck-Institute for Demographic Research, Rostock, Mecklenburg-Vorpommern, Germany
| | - Alyson van Raalte
- Max-Planck-Institute for Demographic Research, Rostock, Mecklenburg-Vorpommern, Germany
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Boyd J, Bambra C, Purshouse RC, Holmes J. Beyond Behaviour: How Health Inequality Theory Can Enhance Our Understanding of the 'Alcohol-Harm Paradox'. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6025. [PMID: 34205125 PMCID: PMC8199939 DOI: 10.3390/ijerph18116025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
There are large socioeconomic inequalities in alcohol-related harm. The alcohol harm paradox (AHP) is the consistent finding that lower socioeconomic groups consume the same or less as higher socioeconomic groups yet experience greater rates of harm. To date, alcohol researchers have predominantly taken an individualised behavioural approach to understand the AHP. This paper calls for a new approach which draws on theories of health inequality, specifically the social determinants of health, fundamental cause theory, political economy of health and eco-social models. These theories consist of several interwoven causal mechanisms, including genetic inheritance, the role of social networks, the unequal availability of wealth and other resources, the psychosocial experience of lower socioeconomic position, and the accumulation of these experiences over time. To date, research exploring the causes of the AHP has often lacked clear theoretical underpinning. Drawing on these theoretical approaches in alcohol research would not only address this gap but would also result in a structured effort to identify the causes of the AHP. Given the present lack of clear evidence in favour of any specific theory, it is difficult to conclude whether one theory should take primacy in future research efforts. However, drawing on any of these theories would shift how we think about the causes of the paradox, from health behaviour in isolation to the wider context of complex interacting mechanisms between individuals and their environment. Meanwhile, computer simulations have the potential to test the competing theoretical perspectives, both in the abstract and empirically via synthesis of the disparate existing evidence base. Overall, making greater use of existing theoretical frameworks in alcohol epidemiology would offer novel insights into the AHP and generate knowledge of how to intervene to mitigate inequalities in alcohol-related harm.
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Affiliation(s)
- Jennifer Boyd
- School of Health and Related Research, The University of Sheffield, S1 4DA Sheffield, UK;
| | - Clare Bambra
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, NE2 4HH Newcastle upon Tyne, UK;
| | - Robin C. Purshouse
- Department of Automatic Control and Systems Engineering, The University of Sheffield, S1 3JD Sheffield, UK;
| | - John Holmes
- School of Health and Related Research, The University of Sheffield, S1 4DA Sheffield, UK;
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11
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Currie J, Boyce T, Evans L, Luker M, Senior S, Hartt M, Cottrell S, Lester N, Huws D, Humphreys C, Little K, Adekanmbi V, Paranjothy S. Life expectancy inequalities in Wales before COVID-19: an exploration of current contributions by age and cause of death and changes between 2002 and 2018. Public Health 2021; 193:48-56. [PMID: 33735693 DOI: 10.1016/j.puhe.2021.01.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/26/2020] [Accepted: 01/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The COVID-19 pandemic in Wales and the UK has highlighted significant and historic inequalities in health between social groups. To better understand the composition of these inequalities and inform planning after the pandemic, we undertook a decomposition of life expectancy inequalities between the most and least deprived quintiles for men and women by age and cause of death and explored trends between 2002 and 2018. STUDY DESIGN Statistical decomposition of life expectancy inequalities by age and cause of death using routine population mortality datasets. METHODS We used routine statistics from the Office for National Statistics for the period 2002-2018 on population and deaths in Wales stratified by age, gender, Welsh Index of Multiple Deprivation (WIMD) 2019 quintile and cause of death, categorised by International Classification of Disease, version 10, code into 15 categories of public health relevance. We aggregated data to 3-year rolling figures to account for low numbers of events in some groups annually. Next, we estimated life expectancy at birth by quintile, gender and period using life table methods. Lastly, we performed a decomposition analysis using the Arriaga method to identify the specific disease categories and ages at which excess deaths occur in more disadvantaged areas to highlight potential areas for action. RESULTS Life expectancy inequalities between the most and least WIMD quintiles rose for both genders between 2002 and 2018: from 4.69 to 6.02 years for women (an increase of 1.33 years) and from 6.34 to 7.42 years for men (an increase of 1.08 years). Exploratory analysis of these trends suggested that the following were most influential for women: respiratory disease (1.50 years), cancers (1.36 years), circulatory disease (1.35 years) and digestive disease (0.51 years). For men, the gap was driven by circulatory disease (2.01 years), cancers (1.39 years), respiratory disease (1.25 years), digestive disease (0.79 years), drug- and alcohol-related conditions (0.54 years) and external causes (0.54 years). Contributions for women from respiratory disease, cancers, dementia and drug- and alcohol-related conditions appeared to be increasing, while among men, there were rising contributions from respiratory, digestive and circulatory disease. CONCLUSIONS Life expectancy inequalities in Wales remain wide and have been increasing, particularly among women, with indications of worsening trends since 2010 following the introduction of fiscal austerity. As agencies recover from the pandemic, these findings should be considered alongside any resumption of services in Wales or future health and public policy.
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Affiliation(s)
- J Currie
- Division of Population Medicine, School of Medicine, Cardiff University, Division of Population Medicine, School of Medicine, Cardiff University, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK.
| | - T Boyce
- Institute of Health Equity, Department for Epidemiology & Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - L Evans
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - M Luker
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - S Senior
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - M Hartt
- Department of Geography and Planning, Queen's University, Mackintosh-Corry Hall, Room E208, Kingston, Ontario, Canada
| | - S Cottrell
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - N Lester
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - D Huws
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - C Humphreys
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - K Little
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - V Adekanmbi
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Great Maze Pond, Addison House, Guy's Campus, London SE1 9RT, UK
| | - S Paranjothy
- Division of Population Medicine, School of Medicine, Cardiff University, Division of Population Medicine, School of Medicine, Cardiff University, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK
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12
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Angus C, Pryce R, Holmes J, de Vocht F, Hickman M, Meier P, Brennan A, Gillespie D. Assessing the contribution of alcohol-specific causes to socio-economic inequalities in mortality in England and Wales 2001-16. Addiction 2020; 115:2268-2279. [PMID: 32237009 PMCID: PMC7687183 DOI: 10.1111/add.15037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/02/2020] [Accepted: 02/28/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS When measuring inequalities in health, public health and addiction research has tended to focus on differences in average life-span between socio-economic groups. This does not account for the extent to which age of death varies between individuals within socio-economic groups or whether this variation differs between groups. This study assesses (1) socio-economic inequalities in both average life-span and variation in age at death, (2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and (3) how this contribution has changed over time. DESIGN Cause-deleted life table analysis of national mortality records. SETTING England and Wales, 2001-16. CASES All-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the index of multiple deprivation (IMD). MEASUREMENTS Life expectancy at age 18 yearss and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality 'gaps'. FINDINGS In 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years, respectively, and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years, respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of life-span uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men. CONCLUSIONS Deaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socio-economic groups. Using both measures can provide a fuller picture of overall inequalities in health.
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Affiliation(s)
- Colin Angus
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Rob Pryce
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - John Holmes
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Frank de Vocht
- NIHR School for Public Health Research,School of Social and Community MedicineBristolUK
| | - Matthew Hickman
- NIHR School for Public Health Research,School of Social and Community MedicineBristolUK
| | - Petra Meier
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Alan Brennan
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Duncan Gillespie
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
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Pechholdová M, Jasilionis D. Contrasts in alcohol-related mortality in Czechia and Lithuania: Analysis of time trends and educational differences. Drug Alcohol Rev 2020; 39:846-856. [PMID: 32909686 PMCID: PMC7756221 DOI: 10.1111/dar.13157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/18/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Globally, Czechia and Lithuania are among the top-ranking countries in terms of high alcohol consumption. This study highlights notable contrasts in temporal trends in alcohol-related mortality and identifies country-specific patterns in educational differences. DESIGN AND METHODS The study uses harmonised cause-of-death series from the Human Cause of Death Database. Mortality disparities by education were assessed using census-linked mortality data. Directly standardised death rates were used to estimate levels of national and group-specific mortality. Relative and absolute mortality differences by education were assessed by range-type measures (Poisson regression mortality ratios and rate differences) and Gini-type measures. RESULTS Between 1994-1995 and 2016, the absolute difference between Czechia and Lithuania in terms of alcohol-related age-standardised death rates (per 1 000 000) decreased from 450 for males and 130 for females to 76 in males and 11 in females. In both countries, alcohol-related mortality was markedly higher among persons of lower education levels. Lithuanian males experienced the highest absolute inequalities measured by rate difference between the low and high educated (740 per million), while Lithuanian females showed the most pronounced relative inequalities (6.70-fold difference between low and high educated). The corresponding figures were less than half for Czechia. DISCUSSION AND CONCLUSIONS Reducing educational disparities in alcohol-related mortality within both countries would have a substantial impact on overall levels. Policies aimed at targeting the lowest priced and illegal alcohols and reducing levels of harmful drinking should be a priority, especially in Lithuania.
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Affiliation(s)
- Markéta Pechholdová
- Department of Demography, Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic
| | - Domantas Jasilionis
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany.,Demographic Research Centre, Faculty of Social Sciences, Vytautas Magnus University, Kaunas, Lithuania
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14
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Trias-Llimós S, Bosque-Prous M, Obradors-Rial N, Teixidó-Compañó E, Belza MJ, Janssen F, Espelt A. Alcohol and educational inequalities: Hazardous drinking prevalence and all-cause mortality by hazardous drinking group in people aged 50 and older in Europe. Subst Abus 2020; 43:152-160. [PMID: 32543303 DOI: 10.1080/08897077.2020.1773597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: We examined educational inequalities in hazardous drinking prevalence among individuals aged 50 or more in 14 European countries, and explored educational inequalities in mortality in hazardous drinkers in European regions. Methods: We analyzed data from waves 4, 5 and 6 of the Survey of Health Ageing and Retirement in Europe (SHARE). We estimated age-standardized hazardous drinking prevalence, and prevalence ratios (PR) of hazardous drinking by country and educational level using Poisson regression models with robust variance. We estimated the relative index of inequality (RII) for all-cause mortality among hazardous drinkers and non-hazardous drinkers using Cox proportional hazards regression models and for each region (North, South, East and West). Results: In men, educational inequalities in hazardous drinking were not observed (PRmedium = 1.09 [95%CI: 0.98-1.21] and PRhigh = 0.99 [95%CI: 0.88-1.10], ref. low), while in they were observed in women, having the highest hazardous drinking prevalence in the highest educational levels (PRmedium = 1.28 [95%CI: 1.15-1.42] and PRhigh = 1.53 [95%CI: 1.36-1.72]). Overall, the Relative Index of Inequality (RII) in all-cause mortality among hazardous drinkers was 1.12 [95%CI: 1.03-1.22] among men and 1.10 [95%CI: 0.97-1.25] among women. Educational inequalities among hazardous drinkers were observed in Eastern Europe for both men (RIIhazardous = 1.21 [95%CI: 1.01-1.45]) and women (RIIhazardous = 1.46 [95%CI: 1.13-1.87]). Educational inequalities in mortality among non-hazardous drinkers were observed in Southern, Western and Eastern Europe among men, and in Eastern Europe among women. Conclusions: Higher educational attainment is positively associated with hazardous drinking prevalence among women, but not among men in most of the analyzed European countries. Clear educational inequalities in mortality among hazardous drinkers were only observed in Eastern Europe. Further research on the associations between alcohol use and inequalities in all-cause mortality in different regions is needed.
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Affiliation(s)
- Sergi Trias-Llimós
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marina Bosque-Prous
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Nuria Obradors-Rial
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Ester Teixidó-Compañó
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Maria José Belza
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute - KNAW/University of Groningen, The Hague, The Netherlands.,Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands
| | - Albert Espelt
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
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