Department of Psychiatry, Thammasat University, Faculty of Medicine, Paholyothin Road, Klong Luang, Pathumthani 12120, Thailand; Section of Epidemiology, Institute of Psychiatry, King's College London, DeCrespigny Park, London SE5 8AF, UK.
Section of Epidemiology, Institute of Psychiatry, King's College London, DeCrespigny Park, London SE5 8AF, UK.
Soc Sci Med. 2014 Jan;100(100):107-14. doi: 10.1016/j.socscimed.2013.09.025. Epub 2013 Oct 9.
Evidence on the link between income inequality and alcohol-related problems is scarce, inconclusive and dominated by studies from the developed world. The use of income as a proxy measure for wealth is also questionable, particularly in developing countries. The goal of the present study is to explore the contextual influence of asset-based wealth inequality on problem drinking among Thai older adults. A population-based cohort study with a one-year follow-up was nested in a Demographic Surveillance System (DSS) of 100 villages in western Thailand. Data were drawn from a random sample of 1104 older residents, aged 60 or over (one per household) drawn from all 100 villages, of whom 982 (89%) provided problem drinking data at follow-up. The primary outcome measure was a validated Thai version of the Alcohol-Used Disorder Identification Test for problem drinking. Living in areas of high wealth inequality was prospectively associated with a greater risk for problem drinking among older people (adjusted odds ratio 2.30, 95% confidence intervals 1.02-5.22), after adjusting for individual-level and village-level factors. A rise in wealth inequality over the year was also independently associated with an increased risk of problem drinking (adjusted odds ratio 2.89, 95% confidence intervals 1.24-6.65). The associations were not explained by the social capital, status anxiety or psychosocial stress variables. The data suggest that wealth inequality and an increase in inequality across time lead to a greater risk of problem drinking. Efforts should be directed towards reducing gaps and preventing large jumps in inequality in the communities. Further research should investigate the effect of asset-based inequality on various health risk behaviors and its specific mediating pathways.
关于收入不平等与酒精相关问题之间联系的证据很少，而且没有定论，主要来自发达国家的研究。将收入用作财富的替代衡量标准也是有问题的，尤其是在发展中国家。本研究的目的是探讨基于资产的财富不平等对泰国老年人酗酒问题的背景影响。一项基于人群的队列研究，随访时间为一年，嵌套在泰国西部一个 100 个村庄的人口监测系统（DSS）中。数据来自泰国西部一个人口监测系统（DSS）中 100 个村庄的所有家庭中抽取的 1104 名年龄在 60 岁及以上的老年人随机样本，其中 982 人（89%）在随访时提供了酗酒问题的数据。主要结局指标是经过验证的泰国版酒精使用障碍识别测试（AUDIT），用于衡量酗酒问题。在调整了个体和村庄层面的因素后，高财富不平等地区的老年人在未来一年发生酗酒问题的风险更高（调整后的优势比为 2.30，95%置信区间为 1.02-5.22）。在一年内财富不平等程度上升也与酗酒问题的风险增加独立相关（调整后的优势比为 2.89，95%置信区间为 1.24-6.65）。这些关联不能用社会资本、地位焦虑或心理社会压力变量来解释。数据表明，财富不平等和不平等程度的增加会导致酗酒问题的风险增加。应该努力缩小差距，防止社区内不平等程度的大幅跃升。进一步的研究应该调查基于资产的不平等对各种健康风险行为的影响及其具体的中介途径。
