Mäkelä Pia, Lindell Elsi
Finnish Institute for Health and Welfare, Helsinki, Finland.
Drug Alcohol Rev. 2025 Feb;44(2):424-433. doi: 10.1111/dar.13989. Epub 2024 Dec 12.
Reducing alcohol affordability reduces alcohol-related harm but its impact on socio-economic inequalities requires further study. We examine changes in alcohol-attributable mortality inequalities in Finland during periods of sharply rising (2000-2007) and falling (2008-2017) alcohol affordability.
Linking individual-level register data on causes of death and socio-demographics for the Finnish population aged ≥25 in 2000-2017 (68 million person-years), we analysed age-standardised monthly alcohol-attributable mortality rates by sex and income quintile (n = 32,699 alcohol-attributable deaths). Regression models were used to analyse mortality trends in the two periods, contrasting high- and low-income groups.
Inequalities in alcohol-attributable mortality between low- and high-income groups were large throughout the study period. During the period of rising alcohol affordability, mortality increased among high-income men with an average monthly increase of 0.17% (p = 0.046). This rate was even higher among low-income men, increasing by 0.55% per month, that is, +0.38 percentage points more than the rate for high-income men (p = 0.002). Among women, mortality increased at similar rates in both income groups. During the period of falling alcohol affordability, mortality decreased among high-income men with an average monthly decrease of -0.21% (p < 0.001), and it decreased even more among low-income men (-0.40%, i.e., -0.19 percentage points more, p = 0.030). Among women, the decreases were not statistically significant.
The results indicate that increased alcohol affordability was associated with widening socio-economic inequalities while reduced affordability was linked with narrowing inequalities among men. Reducing alcohol affordability is thus a recommendable policy for reducing socio-economic inequality in alcohol-related harm.
降低酒精的可承受性可减少与酒精相关的危害，但其对社会经济不平等的影响仍需进一步研究。我们研究了在芬兰酒精可承受性急剧上升（2000 - 2007年）和下降（2008 - 2017年）期间，酒精归因死亡率不平等的变化情况。
将2000 - 2017年芬兰25岁及以上人口的个体层面死亡原因登记数据与社会人口统计学数据相链接（6800万人年），我们按性别和收入五分位数分析了年龄标准化的每月酒精归因死亡率（n = 32699例酒精归因死亡）。回归模型用于分析这两个时期的死亡率趋势，对比高收入组和低收入组。
在整个研究期间，低收入和高收入群体之间酒精归因死亡率的不平等程度都很大。在酒精可承受性上升期间，高收入男性的死亡率上升，平均每月上升0.17%（p = 0.046）。低收入男性的这一比率更高，每月上升0.55%，即比高收入男性的比率高0.38个百分点（p = 0.002）。在女性中，两个收入组的死亡率以相似的速率上升。在酒精可承受性下降期间，高收入男性的死亡率下降，平均每月下降 - 0.21%（p < 0.001），低收入男性下降得更多（ - 0.40%，即多下降0.19个百分点，p = 0.030）。在女性中，下降幅度无统计学意义。
结果表明，酒精可承受性增加与社会经济不平等加剧相关，而可承受性降低与男性不平等程度缩小相关。因此，降低酒精可承受性是一项值得推荐的政策，有助于减少与酒精相关危害中的社会经济不平等。
