Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Heidelberg Institute of Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany.
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Lancet Public Health. 2020 Jun;5(6):e324-e332. doi: 10.1016/S2468-2667(20)30052-9.
Individuals with low socioeconomic status (SES) experience disproportionately greater alcohol-attributable health harm than individuals with high SES from similar or lower amounts of alcohol consumption. Our aim was to provide an update of the current evidence for the role of alcohol use and drinking patterns in socioeconomic inequalities in mortality, as well as the effect modification or interaction effects between SES and alcohol use, as two potential explanations of this so-called alcohol-harm paradox.
We did a systematic review, searching Embase, Medline, PsycINFO, and Web of Science (published between Jan 1, 2013, and June 30, 2019) for studies reporting alcohol consumption, SES, and mortality. Observational, quantitative studies of the general adult population (aged ≥15 years) with a longitudinal study design were included. Two outcome measures were extracted: first, the proportion of socioeconomic inequalities in mortality explained by alcohol use; and second, the effect modification or interaction between SES and alcohol use regarding mortality risks. This study is registered with PROSPERO (CRD42019140279).
Of 1941 records identified, ten met the inclusion criteria. The included studies contained more than 400 000 adults, more than 30 000 deaths from all causes, and more than 3000 100% alcohol-attributable events. Alcohol use explained up to 27% of the socioeconomic inequalities in mortality. The proportion of socioeconomic inequalities explained systematically differed by drinking pattern, with heavy episodic drinking having a potentially significant explanatory value. Although scarce, there was some evidence of effect modification or interaction between SES and alcohol use.
To reduce socioeconomic inequalities in mortality, addressing heavy episodic drinking in particular, rather than alcohol use in general, is worth exploring as a public health strategy.
Canadian Institutes of Health Research.
与高社会经济地位（SES）的个体相比，SES 较低的个体即使饮酒量相似或更少，也会遭受不成比例的更大的与酒精相关的健康危害。我们的目的是提供当前关于酒精使用和饮酒模式在与酒精相关的死亡率方面的社会经济不平等中的作用的最新证据，以及 SES 和酒精使用之间的作用修饰或相互作用（这是所谓的酒精危害悖论的两种潜在解释）。
我们进行了系统综述，在 Embase、Medline、PsycINFO 和 Web of Science（发表于 2013 年 1 月 1 日至 2019 年 6 月 30 日）中搜索了报告酒精消费、SES 和死亡率的研究。纳入了具有纵向研究设计的一般成年人群（年龄≥15 岁）的观察性、定量研究。提取了两个结局指标：第一，酒精使用对死亡率的社会经济不平等的解释比例；第二，SES 和酒精使用对死亡率风险的作用修饰或相互作用。本研究已在 PROSPERO（CRD42019140279）中注册。
在 1941 条记录中，有 10 项符合纳入标准。纳入的研究包含超过 40 万成年人，超过 30000 例所有原因导致的死亡，超过 3000 例 100%归因于酒精的事件。酒精使用最多可解释死亡率的社会经济不平等的 27%。按饮酒模式划分，社会经济不平等的解释比例系统地存在差异，其中重度间歇性饮酒具有潜在的显著解释价值。尽管证据很少，但 SES 和酒精使用之间存在一些作用修饰或相互作用的证据。
为了减少死亡率的社会经济不平等，特别是解决重度间歇性饮酒问题，值得探索作为一项公共卫生策略。
加拿大卫生研究院。
