Smith Brendan T, Benny Claire, Andreacchi Alessandra T, Schwartz Naomi, Warren Christine M, Forbes Samantha, Hobin Erin
Public Health Ontario, Toronto, Ontario, Canada
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
J Epidemiol Community Health. 2025 May 9;79(6):416-423. doi: 10.1136/jech-2024-222476.
Differential vulnerability to alcohol contributes to socioeconomic inequities in alcohol-attributable harm. This study aimed to estimate the sex-/gender-specific joint effects of socioeconomic position (SEP) and heavy episodic drinking or volume of alcohol use on 100% alcohol-attributable emergency department (ED) visits.
We conducted a cohort study among 36 900 men and 39 700 women current and former alcohol consumers aged 15-64 from population-representative Canadian Community Health Surveys (2003-2008) linked to administrative ED visit data through 2017 in Ontario and Alberta. We estimated sex-/gender-specific associations between SEP (both education and income) and heavy episodic drinking (≥5 standard drinks on one occasion, at least monthly) or volume of alcohol use (standard drinks per week) on incident alcohol-attributable ED visits and assessed additive interactions using the Synergy Index (S).
Lower levels of education (eg, less than high school vs Bachelor's degree or above: men: adjusted HR (aHR)=3.71, 95% CI 2.47 to 5.58; women: aHR=1.75, 95% CI 1.15 to 2.68) and income (eg, quintile (Q)1 vs Q5, men: aHR=2.07, 95% CI 1.35 to 3.17; women: aHR=1.84, 95% CI 0.91 to 3.71) were associated with increased rates of alcohol-attributable ED visits. Among men and women, superadditive joint effects (ie, greater than the sum of both exposures experienced independently) were observed between low SEP (education and income) and heavy episodic drinking and higher volume of alcohol use on alcohol-attributable ED visits.
Our results indicate that individuals with lower SEP experience increased vulnerability to alcohol use and related harms. These findings highlight the urgent need for population-level interventions that reduce both the high burden and socioeconomic inequities in alcohol-attributable harm.
对酒精的易感性差异导致了酒精所致伤害方面的社会经济不平等。本研究旨在估计社会经济地位（SEP）与大量饮酒或饮酒量对100%酒精所致急诊科（ED）就诊的性别特异性联合效应。
我们对来自具有人群代表性的加拿大社区健康调查（2003 - 2008年）的36900名男性和39700名15 - 64岁的当前和既往饮酒者进行了队列研究，这些数据与安大略省和艾伯塔省截至2017年的行政ED就诊数据相关联。我们估计了SEP（教育程度和收入）与大量饮酒（一次≥5个标准饮酒单位，至少每月一次）或饮酒量（每周标准饮酒单位）之间的性别特异性关联，这些关联与酒精所致ED就诊事件有关，并使用协同指数（S）评估相加交互作用。
较低的教育水平（例如，高中以下学历与本科学历或以上学历相比：男性：调整后风险比（aHR）=3.71，95%置信区间2.47至5.58；女性：aHR =1.75，95%置信区间1.15至2.68）和收入（例如，第一五分位数（Q）1与第五五分位数（Q）5相比，男性：aHR =2.07，95%置信区间1.35至3.17；女性：aHR =1.84，95%置信区间0.91至3.71）与酒精所致ED就诊率增加相关。在男性和女性中，低SEP（教育程度和收入）与大量饮酒以及较高饮酒量之间在酒精所致ED就诊方面存在超相加联合效应（即大于独立经历的两种暴露之和）。
我们的结果表明，SEP较低的个体对酒精使用及相关伤害的易感性增加。这些发现凸显了迫切需要采取人群层面的干预措施，以减少酒精所致伤害的高负担以及社会经济不平等。
