Do patients who die from an alcohol-related condition ‘drift’ into areas of greater deprivation? Alcohol-related mortality and health selection theory in Scotland

Pulford, A., Gordon, R., Graham, L., Lewsey, J. , McCartney, G. and Robinson, M. (2018) Do patients who die from an alcohol-related condition ‘drift’ into areas of greater deprivation? Alcohol-related mortality and health selection theory in Scotland. Journal of Epidemiology and Community Health, 72, pp. 109-112. (doi: 10.1136/jech-2017-209790) (PMID:29217645) (PMCID:PMC5800349)

Abstract

Background: Health selection has been proposed to explain the patterning of alcohol-related mortality by area deprivation. This study investigated whether persons who die from alcohol-related conditions are more likely to experience social drift than those who die from other causes. Methods: Deaths recorded in Scotland (2013, >21 years) were coded as ‘alcohol-related’ or ‘other’ and by deprivation decile of residence at death. Acute hospital admissions data from 1996 to 2012 were used to provide premortality deprivation data. χ² tests estimated the difference between observed and expected alcohol-related deaths by first Scottish Index of Multiple Deprivation (SIMD) decile and type of death. Logistic regression models were fitted using type of death as the outcome of interest and change in SIMD decile as the exposure of interest. Results: Of 47 012 deaths, 1458 were alcohol-related. Upward and downward mobility was observed for both types of death. An estimated 31 more deaths than expected were classified ‘alcohol-related’ among cases whose deprivation score decreased, while 204 more deaths than expected were classified ‘alcohol-related’ among cases whose initial deprivation ranking was in the four most deprived deciles. Becoming more deprived and first deprivation category were both associated with increased odds of type of death being alcohol-related after adjusting for confounders. Conclusion: This study suggests that health selection appears to contribute less to the deprivation gradient in alcohol-related mortality in Scotland than an individual’s initial area deprivation category.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Pulford, Andrew and Robinson, Dr Mark and Graham, Dr Lesley and Lewsey, Professor Jim and McCartney, Professor Gerard
• Authors: Pulford, A., Gordon, R., Graham, L., Lewsey, J., McCartney, G., and Robinson, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; 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 > Public Health; College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
• Journal Name: Journal of Epidemiology and Community Health
• Publisher: BMJ Publishing Group
• ISSN: 0143-005X
• ISSN (Online): 1470-2738
• Published Online: 07 December 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Journal of Epidemiology and Community Health 72:109-112
• Publisher Policy: Reproduced under a Creative Commons License