Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
Doctoral Programme in Population Health, University of Helsinki, Helsinki, Finland.
Addiction. 2021 Aug;116(8):2220-2230. doi: 10.1111/add.15395. Epub 2021 Jan 28.
Lower socio-economic status (SES) is associated with higher alcohol-related harm despite lower levels of alcohol use. Differential vulnerability due to joint effects of behavioural risk factors is one potential explanation for this 'alcohol harm paradox'. We analysed to what extent socio-economic inequalities in alcohol-mortality are mediated by alcohol, smoking and body mass index (BMI), and their joint effects with each other and with SES.
Cohort study of eight health examination surveys (1978-2007) linked to mortality data.
Finland.
A total of 53 632 Finnish residents aged 25+ years.
The primary outcome was alcohol-attributable mortality. We used income as an indicator of SES. We assessed the joint effects between income and mediators (alcohol use, smoking and BMI) and between the mediators, adjusting for socio-demographic indicators. We used causal mediation analysis to calculate the total, direct, indirect and mediated interactive effects using Aalen's additive hazards models.
During 1 085 839 person-years of follow-up, we identified 865 alcohol-attributable deaths. We found joint effects for income and alcohol use and income and smoking, resulting in 46.8 and 11.4 extra deaths due to the interaction per 10 000 person-years. No interactions were observed for income and BMI or between alcohol and other mediators. The lowest compared with the highest income quintile was associated with 5.5 additional alcohol deaths per 10 000 person-years (95% confidence interval = 3.7, 7.3) after adjusting for confounders. The proportion mediated by alcohol use was negative (-69.3%), consistent with the alcohol harm paradox. The proportion mediated by smoking and BMI and their additive interactions with income explained 18.1% of the total effect of income on alcohol-attributable mortality.
People of lower socio-economic status appear to be more vulnerable to the effects of alcohol use and smoking on alcohol-attributable mortality. Behavioural risk factors and their joint effects with income may explain part of the alcohol harm paradox.
尽管饮酒水平较低，但社会经济地位（SES）较低与更高的酒精相关伤害相关。由于行为危险因素的共同影响导致的差异化脆弱性是这种“酒精危害悖论”的一个潜在解释。我们分析了 SES 与酒精相关死亡率之间的社会经济不平等在多大程度上是由酒精、吸烟和体重指数（BMI）介导的，以及它们彼此之间以及与 SES 之间的共同作用。
对 8 项健康检查调查（1978-2007 年）进行队列研究，并与死亡率数据相关联。
芬兰。
共 53632 名年龄在 25 岁及以上的芬兰居民。
主要结局是酒精相关死亡率。我们使用收入作为 SES 的指标。我们评估了收入与中介因素（酒精使用、吸烟和 BMI）之间的共同作用，以及中介因素之间的共同作用，同时调整了社会人口统计学指标。我们使用因果中介分析，使用 Aalen 的加法风险模型计算总、直接、间接和介导的交互作用。
在 1085839 人年的随访期间，我们确定了 865 例酒精相关死亡。我们发现 SES 与酒精使用和 SES 与吸烟之间存在共同作用，导致每 10000 人年因交互作用而增加 46.8 和 11.4 例额外死亡。BMI 或酒精与其他中介因素之间没有观察到相互作用。与收入最高的五分位数相比，最低五分位数与每 10000 人年增加 5.5 例酒精相关死亡相关（95%置信区间 3.7-7.3），调整混杂因素后。酒精使用介导的比例为负（-69.3%），与酒精危害悖论一致。吸烟和 BMI 介导的比例及其与收入的相加交互作用解释了收入对酒精相关死亡率的总效应的 18.1%。
社会经济地位较低的人似乎更容易受到酒精使用和吸烟对酒精相关死亡率的影响。行为危险因素及其与收入的共同作用可能部分解释了酒精危害悖论。
