Socioeconomic status as an effect modifier of alcohol consumption and harm: an analysis of linked cohort data

Katikireddi, S. V. , Whitley, E. , Lewsey, J. , Gray, L. and Leyland, A. H. (2017) Socioeconomic status as an effect modifier of alcohol consumption and harm: an analysis of linked cohort data. Lancet Public Health, 2(6), e267-e276. (doi: 10.1016/S2468-2667(17)30078-6) (PMID:28626829) (PMCID:PMC5463030)

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Background: Alcohol-related mortality and morbidity are higher in socioeconomically disadvantaged populations. It is unclear if elevated harm reflects differences in consumption, reverse causation or greater risk of harm following similar consumption. We investigated whether the harmful effects differed by socioeconomic status accounting for alcohol consumption and other health-related factors. Methods: Alcohol consumption (weekly units and binge drinking) data (n=50,236; 429,986 person-years of follow-up) were linked to deaths, hospitalisations and prescriptions. The primary outcome was alcohol-attributable hospitalisation/death. The relationship between alcohol attributable harm and socioeconomic status was investigated for four measures (education level, social class, household income and area-based deprivation) using Cox proportional hazards models. The potential for alcohol consumption and other risk factors mediating the social patterning was explored. Downward social selection for high-risk drinkers (reverse causation) was tested by comparing change in area deprivation over time. Findings: Low socioeconomic status was consistently associated with markedly elevated alcohol-attributable harms, including after adjustment for weekly consumption, binge drinking, body mass index and smoking. There was evidence of effect modification: for example, relative to light drinkers living in advantaged areas, the hazard ratio for excessive drinkers was 6.75 (95% CI 5.09-8.93) in advantaged and 11.06 (95% CI 8.53-14.35) in deprived areas. We found little support for downward social selection. Interpretation: Disadvantaged social groups experience greater alcohol-attributable harms compared to the advantaged for given levels of alcohol consumption, even after accounting for different drinking patterns, obesity and smoking status at the individual level.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Whitley, Dr Elise and Gray, Dr Linsay and Lewsey, Professor Jim and Leyland, Professor Alastair
Authors: Katikireddi, S. V., Whitley, E., Lewsey, J., Gray, L., and Leyland, A. H.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Lancet Public Health
Published Online:10 May 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Lancet Public Health 2(6): e267-e276
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
727671SPHSU Core Renewal: Informing Healthy Public Policy Research ProgrammePeter CraigMedical Research Council (MRC)MC_UU_12017/15IHW - MRC/CSO SPHU
699162Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientist (CSO)SCAF/15/02IHW - MRC/CSO SPHU