Boyd Jennifer, Hayes Kate, Green Dan, Angus Colin, Holmes John
School of Health and Related Research, The University of Sheffield, Sheffield, UK.
MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
SSM Popul Health. 2023 Jun 10;23:101443. doi: 10.1016/j.ssmph.2023.101443. eCollection 2023 Sep.
This is the first study to use the UK Biobank database to: 1) test whether participants of a low socioeconomic position (SEP) are less likely to drink, but more likely to suffer alcohol-related harm, and 2) test the contribution of behavioural factors. The database contains health-related information from 500,000 UK residents that were recruited aged 40-69 between 2006 and 2010. Our analysis focuses on participants resident in England (86% of the total sample). We obtained baseline demographics, survey data regarding alcohol consumption and other behaviours, and linked death and hospital-admission records. The primary outcome was time from study entry to experiencing an alcohol-attributable event (hospital admission or death). The relationship between alcohol-attributable harm and five measures of SEP (area-level deprivation, housing tenure, employment status, household income and qualifications) was investigated using time-to-event analysis. Average weekly alcohol consumption, other drinking behaviours (drinking history and beverage preference), and lifestyle factors (BMI and smoking status) were added incrementally as covariates in nested regression models to investigate whether they could explain the relationship between harm and SEP. 432,722 participants (197,449 men and 235,273 women) were included in the analysis with 3,496,431 person-years of follow-up. Those of a low SEP were most likely to be never/former drinkers or high-risk drinkers. However, alcohol consumption could not explain experiences of alcohol-attributable harm between SEP groups (Hazard Ratio (HR) 1.48; 95% Confidence Interval 1.45-1.51, after adjusting for alcohol consumption). Drinking history, drinking mostly spirits, an unhealthy Body Mass Index and smoking all increased the risk of alcohol-attributable harm. However, these factors only partially explain SEP differences in alcohol harm as the HR for the most deprived vs the least deprived was still 1.28 after adjustment. This suggests that improving wider health behaviour of the most deprived could reduce alcohol-related inequalities. However, a substantial proportion of the variance in alcohol harm remains unexplained.
1）测试社会经济地位（SEP）较低的参与者饮酒可能性是否较低，但遭受酒精相关伤害的可能性是否较高，以及2）测试行为因素的作用的研究。该数据库包含了2006年至2010年间招募的年龄在40至69岁之间的50万英国居民的健康相关信息。我们的分析重点是居住在英格兰的参与者（占总样本的86%）。我们获取了基线人口统计学数据、关于饮酒及其他行为的调查数据，并关联了死亡和住院记录。主要结局是从研究入组到经历酒精所致事件（住院或死亡）的时间。使用事件发生时间分析研究了酒精所致伤害与SEP的五项指标（地区层面的贫困程度、住房保有形式、就业状况、家庭收入和学历）之间的关系。在嵌套回归模型中逐步加入平均每周饮酒量、其他饮酒行为（饮酒史和饮料偏好）以及生活方式因素（体重指数和吸烟状况）作为协变量，以研究它们是否能够解释伤害与SEP之间的关系。432,722名参与者（197,449名男性和235,273名女性）被纳入分析，随访人年数为3,496,431人年。SEP较低的人最有可能从不饮酒/曾经饮酒或为高风险饮酒者。然而，饮酒量并不能解释SEP组之间酒精所致伤害的情况（调整饮酒量后，风险比（HR）为1.48；95%置信区间为1.45 - 1.51）。饮酒史、主要饮用烈酒、不健康的体重指数和吸烟都会增加酒精所致伤害的风险。然而，这些因素仅部分解释了SEP在酒精伤害方面的差异，因为调整后最贫困组与最不贫困组的HR仍为1.28。这表明改善最贫困人群更广泛的健康行为可能会减少与酒精相关的不平等现象。然而，酒精伤害方面仍有很大一部分差异无法解释。
