Andreacchi Alessandra T, Hobin Erin, Siddiqi Arjumand, Smith Brendan T
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Public Health Ontario, Toronto, Ontario, Canada.
Am J Epidemiol. 2024 Oct 8. doi: 10.1093/aje/kwae385.
Individuals with low socioeconomic position (SEP) experience greater rates of alcohol-attributable mortality, contributing to health inequities in mortality and life expectancy. We examined the association between SEP and alcohol-attributable mortality by sex/gender and age in Canada. Census records from the 2006 Canadian Census Health and Environment Cohort (ages 12+; n=5,038,790) were linked to mortality data from 2006-2019. SEP was measured by educational attainment and household income. Poisson and Fine and Gray sub-distribution hazard models estimated rate differences (RD) per 100,000 person-years and hazard ratios (HR). Both educational attainment and household income were inversely associated with alcohol-attributable mortality. Absolute SEP inequities were greater among men than women, with a RD of 30.81 (95% CI: 28.04, 33.57) for men and 9.86 (95% CI: 8.49, 11.22) for women when comparing the lowest to the highest income quintile. Age-stratified analyses showed absolute SEP inequities were most pronounced in middle and older adulthood, above age 30 for women and age 50 for men, with smaller RDs in ages 12-29. Relative SEP inequities were similar in women and men, with greater HRs at younger ages. Public health policies addressing social determinants and population-level alcohol policies should consider patterning of SEP inequities by sex/gender and age group.
社会经济地位较低的个体酒精所致死亡率更高，这导致了死亡率和预期寿命方面的健康不平等。我们研究了加拿大社会经济地位与按性别和年龄划分的酒精所致死亡率之间的关联。2006年加拿大人口普查健康与环境队列（年龄12岁及以上；n = 5,038,790）的普查记录与2006 - 2019年的死亡率数据相链接。社会经济地位通过教育程度和家庭收入来衡量。泊松模型以及费恩和格雷子分布风险模型估计了每10万人年的率差（RD）和风险比（HR）。教育程度和家庭收入均与酒精所致死亡率呈负相关。男性的绝对社会经济地位不平等比女性更大，比较最低收入五分位数和最高收入五分位数时，男性的率差为30.81（95%置信区间：28.04，33.57），女性为9.86（95%置信区间：8.49，11.22）。年龄分层分析表明，绝对社会经济地位不平等在中年及老年期最为明显，女性高于30岁，男性高于50岁，12 - 29岁的率差较小。女性和男性的相对社会经济地位不平等相似，在较年轻年龄时风险比更高。解决社会决定因素的公共卫生政策和人群层面的酒精政策应考虑按性别和年龄组划分的社会经济地位不平等模式。
