Pulido José, Vallejo Fernando, Alonso-López Ignacio, Regidor Enrique, Villar Fernando, de la Fuente Luis, Domingo-Salvany Antonia, Barrio Gregorio
National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Department of Preventive Medicine and Public Health, Madrid Complutense University, Ciudad Universitaria s/n, E-28040 Madrid, Spain.
National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
Drug Alcohol Depend. 2017 Nov 1;180:93-102. doi: 10.1016/j.drugalcdep.2017.07.028. Epub 2017 Aug 18.
To assess disparities in directly alcohol-attributable (DAA) mortality by industry/occupation in Spain during 2002-2011 and the contribution of different socio-demographic factors, including socioeconomic position, to explain such disparity.
Nationwide cohort study covering 16 million economically active people living in Spain in 2001. Deaths at age 25-64 were analyzed. Subjects were classified by employment status, industry and occupation at baseline. Poisson regression models were built, calculating rate ratios (RRs) compared to all employees or those in the education sector.
DAA mortality was much higher in the unemployed than in employees (Crude RR: 2.4; 95% CI: 2.3-2.6) and varied widely across industries/occupations. Crude RRs>3.0 (p<0.05) compared to teachers were found in employees in extractive industries/fishing, agriculture/livestock, construction, catering/accommodation and protective services. Socio-demographic factors, especially age, gender and educational attainment contributed more to explain risk disparities than other factors or potential selection bias. However, after exhaustive sociodemographic adjustment, including education attainment and material wealth, a RR>1.33 (p<0.05) remained in unemployed, catering/accommodation employees and unskilled construction workers. RRs were significantly larger in women than men (p<0.05) among mineworkers/fishworkers/sailors (RR=8.6 vs. 1.2) and drivers (RR=3.7 vs. 1.0).
The results could be extrapolated to all alcohol-attributable mortality since disparities for other strongly alcohol-related deaths, although smaller, were in the same direction. Given the wide occupational disparities in alcohol-attributable mortality, implementation of special measures to reduce this mortality in the highest risk groups is fully justified. Future research should better characterize the explanatory factors of disparities and their role in the causal chain.
评估2002年至2011年期间西班牙按行业/职业划分的直接酒精归因（DAA）死亡率差异，以及包括社会经济地位在内的不同社会人口因素对解释这种差异的贡献。
对2001年居住在西班牙的1600万经济活跃人口进行全国队列研究。分析25至64岁的死亡情况。受试者在基线时按就业状况、行业和职业进行分类。建立泊松回归模型，计算与所有员工或教育部门员工相比的率比（RRs）。
失业者的DAA死亡率远高于员工（粗RR：2.4；95%CI：2.3 - 2.6），且在不同行业/职业中差异很大。与教师相比，采矿业/渔业、农业/畜牧业、建筑业、餐饮/住宿业和保安服务业的员工粗RR>3.0（p<0.05）。社会人口因素，尤其是年龄、性别和教育程度，比其他因素或潜在的选择偏倚更有助于解释风险差异。然而，在进行包括教育程度和物质财富在内的详尽社会人口学调整后，失业者、餐饮/住宿业员工和非技术建筑工人的RR>1.33（p<0.05）。在矿工/渔民/水手（RR = 8.6对1.2）和司机（RR = 3.7对1.0）中，女性的RR显著高于男性（p<0.05）。
由于其他与酒精密切相关的死亡差异虽小但方向相同，因此这些结果可外推至所有酒精归因死亡率。鉴于酒精归因死亡率存在广泛的职业差异，在高风险群体中实施特殊措施以降低这种死亡率是完全合理的。未来的研究应更好地描述差异的解释因素及其在因果链中的作用。
