RTI International, Oakland, California.
RTI International, Research Triangle Park, North Carolina.
Alcohol Res. 2024 Oct 31;44(1):06. doi: 10.35946/arcr.v44.1.06. eCollection 2024.
Rates of alcohol-related mortality (including deaths attributed to chronic alcohol use as well as acute causes involving alcohol) have been increasing in the United States, particularly for certain population subgroups, such as women. This review summarizes associations of area-level social determinants of health with alcohol-related mortality. These determinants, measured at the community, county, or state level, include alcohol control policies, health care availability, and a community's socioeconomic environment. Examining multiple geographic levels illuminates how macro-level social determinants and local contexts contribute to alcohol-related mortality to inform intervention. Attention to the broad variety of social determinants of alcohol-related mortality could ultimately improve community health.
A literature search of three databases-PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)-conducted between March 13 and May 16, 2023, identified peer-reviewed studies published from 1990 to May 2023 that modeled at least one area-level social determinant of health as a predictor or correlate of area-level rates of alcohol-related mortality in the United States. Unpublished dissertations, commentaries, editorials, review papers, and articles published in languages other than English were excluded. Two team members reviewed each abstract to verify that the article addressed alcohol-related mortality and included at least one area-level social determinant of health.
The authors screened 313 abstracts and excluded 210 that did not meet inclusion criteria. The full texts of 103 articles were retrieved. Upon further screening, 30 articles were excluded (two were not obtained), leaving 71 studies for detailed review.
Many studies analyzed fatal alcohol-related motor vehicle crashes or cirrhosis/liver disease mortality. Fewer analyzed other mortality causes related to chronic alcohol consumption. No studies focused on racism and discrimination, community-level prevention activities, or community social services in relation to alcohol-related mortality. Few studies examined major health policy changes or addressed health care system factors. Although the variation across studies complicates systematic comparison of the results, some key themes did emerge from the reviewed studies, such as the beneficial effects of stronger alcohol policies and the importance of socioeconomic conditions as determinants of alcohol-related mortality. Research using a more diverse set of theoretically informed social determinants may help examine whether, how, and for whom racism and discrimination as well as health policies and social services impact alcohol-related mortality. Finally, there is a gap in research linking local community contexts with alcohol-related mortality. Better understanding of subgroup differences, interactions between different contextual factors, and specific mechanisms of action may help identify promising new strategies to improve population health and reduce alcohol-related mortality.
在美国，与酒精相关的死亡率（包括因慢性酒精使用和涉及酒精的急性原因导致的死亡）一直在上升，尤其是在某些特定人群中，例如女性。本综述总结了与酒精相关的死亡率与地区社会决定因素之间的关联。这些决定因素在社区、县或州一级进行衡量，包括酒精控制政策、医疗保健的可及性以及社区的社会经济环境。检查多个地理水平可以说明宏观社会决定因素和地方环境如何共同导致与酒精相关的死亡率，从而为干预措施提供信息。关注与酒精相关的死亡率的广泛社会决定因素最终可能会改善社区健康。
2023 年 3 月 13 日至 5 月 16 日，在三个数据库——PubMed、Web of Science 和 Cumulative Index to Nursing and Allied Health Literature（CINAHL）中进行了文献检索，确定了 1990 年至 2023 年 5 月期间发表的同行评议研究，这些研究至少将一个地区社会健康决定因素建模为美国与酒精相关的死亡率的地区水平率的预测因子或相关因素。未发表的论文、评论、社论、综述文章和以英语以外的语言发表的文章被排除在外。两名团队成员审查了每篇摘要，以确认文章涉及与酒精相关的死亡率，并包含至少一个地区社会健康决定因素。
作者筛选了 313 篇摘要，排除了 210 篇不符合纳入标准的摘要。检索到 103 篇文章的全文。进一步筛选后，排除了 30 篇文章（有两篇未获得），留下 71 篇文章进行详细审查。
许多研究分析了致命的与酒精相关的机动车事故或肝硬化/肝脏疾病死亡率。较少的研究分析了与慢性酒精摄入有关的其他死亡原因。没有研究关注与酒精相关的死亡率与种族主义和歧视、社区一级的预防活动或社区社会服务之间的关系。很少有研究探讨主要的卫生政策变化或解决卫生保健系统因素。尽管研究之间的差异使系统比较结果变得复杂，但从审查的研究中出现了一些关键主题，例如更强有力的酒精政策的有益效果以及社会经济条件作为酒精相关死亡率决定因素的重要性。使用更具理论意义的社会决定因素的多样化研究可能有助于研究种族主义和歧视以及卫生政策和社会服务如何以及为何会影响与酒精相关的死亡率，以及影响哪些人群。最后，在将当地社区环境与与酒精相关的死亡率联系起来的研究方面存在差距。更好地了解亚群差异、不同环境因素之间的相互作用以及具体的作用机制，可能有助于确定改善人口健康和降低与酒精相关的死亡率的有希望的新策略。
