Probst Charlotte, Lange Shannon, Kilian Carolin, Saul Celine, Rehm Jürgen
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, M5S 2S1, Canada.
Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, 69120, Heidelberg, Germany.
BMC Med. 2021 Nov 5;19(1):268. doi: 10.1186/s12916-021-02132-z.
Individuals with low socioeconomic status (SES) experience a higher risk of mortality, in general, and alcohol-attributable mortality in particular. However, a knowledge gap exists concerning the dose-response relationships between the level of socioeconomic deprivation and the alcohol-attributable mortality risk.
We conducted a systematic literature search in August of 2020 to update a previous systematic review that included studies published up until February of 2013. Quantitative studies reporting on socioeconomic inequality in alcohol-attributable mortality among the general adult population were included. We used random-effects dose-response meta-analyses to investigate the relationship between the level of socioeconomic deprivation and the relative alcohol-attributable risk (RR), by sex and indicator of SES (education, income, and occupation).
We identified 25 eligible studies, comprising about 241 million women and 230 million men, among whom there were about 75,200 and 308,400 alcohol-attributable deaths, respectively. A dose-response relationship between the level of socioeconomic deprivation and the RR was found for all indicators of SES. The sharpest and non-linear increase in the RR of dying from an alcohol-attributable cause of death with increasing levels of socioeconomic deprivation was observed for education, where, compared to the most educated individuals, individuals at percentiles with decreasing education had the following RR of dying: women: 25th: 2.09 [95% CI 1.70-2.59], 50th: 3.43 [2.67-4.49], 75th: 4.43 [3.62-5.50], 100th: 4.50 [3.26-6.40]; men: 25th: 2.34 [1.98-2.76], 50th: 4.22 [3.38-5.24], 75th: 5.87 [4.75-7.10], 100th: 6.28 [4.89-8.07].
The findings of this study show that individuals along the entire continuum of SES are exposed to increased alcohol-attributable mortality risk. Differences in the dose-response relationship can guide priorities in targeting public health initiatives.
一般而言，社会经济地位（SES）较低的个体死亡率较高，尤其是酒精所致死亡率。然而，关于社会经济剥夺程度与酒精所致死亡风险之间的剂量反应关系，仍存在知识空白。
我们于2020年8月进行了一项系统的文献检索，以更新之前的系统评价，该评价纳入了截至2013年2月发表的研究。纳入了报告普通成年人群中酒精所致死亡的社会经济不平等情况的定量研究。我们使用随机效应剂量反应荟萃分析，按性别和社会经济地位指标（教育程度、收入和职业）研究社会经济剥夺程度与相对酒精所致风险（RR）之间的关系。
我们确定了25项符合条件的研究，涉及约2.41亿女性和2.3亿男性，其中分别有大约75200例和308400例酒精所致死亡。在社会经济地位的所有指标中，均发现社会经济剥夺程度与RR之间存在剂量反应关系。对于教育程度，随着社会经济剥夺程度的增加，死于酒精所致死因的RR呈现最急剧且非线性的增加，与受教育程度最高的个体相比，教育程度递减百分位数的个体的死亡RR如下：女性：第25百分位数：2.09[95%CI 1.70 - 2.59]，第50百分位数：3.43[2.67 - 4.49]，第75百分位数：4.43[3.62 - 5.50]，第100百分位数：4.50[3.26 - 6.40]；男性：第25百分位数：2.34[1.98 - 2.76]，第50百分位数：4.22[3.38 - 5.24]，第75百分位数：5.87[4.75 - 7.10]，第100百分位数：6.28[4.89 - 8.07]。
本研究结果表明，社会经济地位连续谱上的个体面临的酒精所致死亡风险均有所增加。剂量反应关系的差异可为确定公共卫生举措的重点提供指导。
