Lewer Dan, Meier Petra, Beard Emma, Boniface Sadie, Kaner Eileen
Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK.
ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
BMC Public Health. 2016 Jul 19;16:599. doi: 10.1186/s12889-016-3265-9.
There is consistent evidence that individuals in higher socioeconomic status groups are more likely to report exceeding recommended drinking limits, but those in lower socioeconomic status groups experience more alcohol-related harm. This has been called the 'alcohol harm paradox'. Such studies typically use standard cut-offs to define heavy drinking, which are exceeded by a large proportion of adults. Our study pools data from six years (2008-2013) of the population-based Health Survey for England to test whether the socioeconomic distribution of more extreme levels of drinking could help explain the paradox.
The study included 51,498 adults from a representative sample of the adult population of England for a cross-sectional analysis of associations between socioeconomic status and self-reported drinking. Heavy weekly drinking was measured at four thresholds, ranging from 112 g+/168 g + (alcohol for women/men, or 14/21 UK standard units) to 680 g+/880 g + (or 85/110 UK standard units) per week. Heavy episodic drinking was also measured at four thresholds, from 48 g+/64 g + (or 6/8 UK standard units) to 192 g+/256 g + (or 24/32 UK standard units) in one day. Socioeconomic status indicators were equivalised household income, education, occupation and neighbourhood deprivation.
Lower socioeconomic status was associated with lower likelihoods of exceeding recommended limits for weekly and episodic drinking, and higher likelihoods of exceeding more extreme thresholds. For example, participants in routine or manual occupations had 0.65 (95 % CI 0.57-0.74) times the odds of exceeding the recommended weekly limit compared to those in 'higher managerial' occupations, and 2.15 (95 % CI 1.06-4.36) times the odds of exceeding the highest threshold. Similarly, participants in the lowest income quintile had 0.60 (95 % CI 0.52-0.69) times the odds of exceeding the recommended weekly limit when compared to the highest quintile, and 2.30 (95 % CI 1.28-4.13) times the odds of exceeding the highest threshold.
Low socioeconomic status groups are more likely to drink at extreme levels, which may partially explain the alcohol harm paradox. Policies that address alcohol-related health inequalities need to consider extreme drinking levels in some sub-groups that may be associated with multiple markers of deprivation. This will require a more disaggregated understanding of drinking practices.
有一致的证据表明，社会经济地位较高群体中的个体更有可能报告饮酒量超过建议限度，但社会经济地位较低群体中的个体遭受的与酒精相关的危害更多。这被称为“酒精危害悖论”。此类研究通常使用标准临界值来定义重度饮酒，而很大比例的成年人饮酒量超过了这些临界值。我们的研究汇总了英格兰基于人群的健康调查六年（2008 - 2013年）的数据，以测试更极端饮酒水平的社会经济分布是否有助于解释这一悖论。
该研究纳入了来自英格兰成年人口代表性样本的51498名成年人，用于对社会经济地位与自我报告饮酒之间的关联进行横断面分析。每周重度饮酒量在四个阈值下进行测量，范围从每周112克+/168克+（女性/男性酒精量，或14/21英国标准单位）到680克+/880克+（或85/110英国标准单位）。一次性重度饮酒量也在四个阈值下进行测量，从一天内48克+/64克+（或6/8英国标准单位）到192克+/256克+（或24/32英国标准单位）。社会经济地位指标包括等效家庭收入、教育程度、职业和邻里贫困程度。
社会经济地位较低与每周和一次性饮酒量超过建议限度的可能性较低以及超过更极端阈值的可能性较高相关。例如，从事常规或体力职业的参与者超过建议每周饮酒限度的几率是“高级管理”职业参与者的0.65（95%置信区间0.57 - 0.74）倍，超过最高阈值的几率是其2.15（95%置信区间1.06 - 4.36）倍。同样，收入最低五分位数的参与者与最高五分位数相比，超过建议每周饮酒限度的几率是0.60（95%置信区间0.52 - 0.69）倍，超过最高阈值的几率是其2.30（95%置信区间1.28 - 4.13）倍。
社会经济地位低的群体更有可能大量饮酒，这可能部分解释了酒精危害悖论。解决与酒精相关的健康不平等问题的政策需要考虑某些可能与多种贫困指标相关的亚群体中的极端饮酒水平。这将需要对饮酒行为有更细致的了解。
