Socioeconomic Differences in Alcohol Harm in Finland in a Nationwide Cohort Study

May 16, 2023 updated by: Finnish Institute for Health and Welfare

Unveiling the Alcohol Harm Paradox: Analysis of Socioeconomic Differences in Alcohol Harm in Finland in a Nationwide Cohort Study

This is a nationwide cohort study of Finnish adults aged 25 and older, who are followed up for the incidence of an alcohol-attributable hospitalization or death. The primary objective is to examine the relative and absolute socioeconomic differences in cause-specific alcohol-attributable hospital admissions and deaths.

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

Background

Alcohol consumption is a leading risk factor for death and disability, resulting in substantial societal costs and social and community harm. Alcohol-related harm has been consistently shown to be higher among people of lower socioeconomic status, despite the fact they often report similar or lower levels of alcohol use. This apparent contrast has been called the alcohol harm paradox.

Understanding what explains the alcohol harm paradox is crucial for the design and implementation of population health interventions to reduce socioeconomic differences in alcohol harm. Explanations for the paradox can be broadly categorised into three groups: (i) differential exposure to alcohol, drinking patterns and trajectories and to other behavioural risk factors and joint effects among them, (ii) differential vulnerability resulting from individual factors, such as biological characteristics, psychological traits or stress, cumulative disadvantage and broader community and societal upstream factors, and (iii) differential biases in the measurement of alcohol exposure.

A crucial weakness of existing empirical studies comes from the operationalization of alcohol harm. With few exceptions, a vast majority of studies has used a composite endpoint combining several causes of alcohol-attributable deaths or hospitalizations or even merging alcohol-attributable hospital admissions with deaths in a single outcome. While this strategy increases the statistical power to analyse rare events, composite endpoints are prone to misclassification bias by masking divergent underlying patterns and associations.

Cause-specific analyses might shed light on different mechanisms driving the socioeconomic differences in overall alcohol-attributable harm, as well as opening potential avenues for policy interventions to reduce them. The study will take advantage of a recently formed dataset covering the total Finnish population to explore associations between socioeconomic status and cause-specific alcohol-attributable events. An additional contribution to the literature will be reporting both relative and absolute inequalities in alcohol-attributable harm. Absolute differences have been rarely reported even though might be as relevant as relative differences because, from a pragmatic standpoint, they are more feasible to reduce.

The study will aim to (1) examine the relative and absolute socioeconomic differences in cause-specific alcohol-attributable hospital admissions and deaths; (2) describe the geographical differences in cause-specific alcohol-attributable hospital admissions and deaths; and (3) quantify the relative contribution of each specific alcohol-attributable cause to the overall alcohol-attributable harm.

Study Type

Observational

Enrollment (Anticipated)

3950000

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Probability Sample

Study Population

All permanent residents in Finland older than 25 years old and without an alcohol-attributable hospital admission during the past three years

Description

Inclusion Criteria:

  • Permanent residents (defined by Statistics Finland as those Finnish and foreign nationals who have a legal domicile in Finland and intend to stay (or have stayed) for at least one year) alive in Finland by December 31, 2015
  • Age 25 years or older by January 1, 2016
  • Not having an alcohol-attributable hospitalization during the past three years ((January 2013-December 2015

Exclusion Criteria:

  • Temporary residents, including foreign nationals living in Finland for less than a year, asylum seekers who have not been granted a legal domicile, temporary migrant workers and Finnish nationals living temporarily abroad by December 31, 2015

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Lowest income groups
Deciles of equivalized net household income. The method compares the whole socioeconomic distribution.
Other: Not applicable, this is an observational study
Not applicable, this is an observational study

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Alcohol intoxication - Hospitalization
Time Frame: January 1, 2016 to February 28, 2020
Incidence of alcohol intoxication hospitalization (ICD-10 F10.0-1)
January 1, 2016 to February 28, 2020
Alcohol intoxication - Death
Time Frame: January 1, 2016 to February 28, 2020
Death due to alcohol intoxication (ICD-10 F10.0-1)
January 1, 2016 to February 28, 2020
Alcohol dependence - Hospitalization
Time Frame: January 1, 2016 to February 28, 2020
Incidence of hospitalization due to alcohol dependence (F10.2)
January 1, 2016 to February 28, 2020
Alcohol dependence - Death
Time Frame: January 1, 2016 to February 28, 2020
Death due to alcohol dependence (F10.2)
January 1, 2016 to February 28, 2020
Psycho-organic syndrome caused by alcohol - Hospitalization
Time Frame: January 1, 2016 to February 28, 2020
Incidence of hospitalization due to psycho-organic syndrome caused by alcohol (F10.3-9)
January 1, 2016 to February 28, 2020
Psycho-organic syndrome caused by alcohol - Death
Time Frame: January 1, 2016 to February 28, 2020
Death due to psycho-organic syndrome caused by alcohol (F10.3-9)
January 1, 2016 to February 28, 2020
Alcoholic liver disease - Hospitalization
Time Frame: January 1, 2016 to February 28, 2020
Incidence of hospitalization due to alcoholic liver disease(K70)
January 1, 2016 to February 28, 2020
Alcoholic liver disease - Death
Time Frame: January 1, 2016 to February 28, 2020
Death due to alcoholic liver disease(K70)
January 1, 2016 to February 28, 2020
Pancreatic diseases caused by alcohol - Hospitalization
Time Frame: January 1, 2016 to February 28, 2020
Incidence of hospitalization due to pancreatic diseases caused by alcohol (K85.2, K86.0)
January 1, 2016 to February 28, 2020
Pancreatic diseases caused by alcohol - Death
Time Frame: January 1, 2016 to February 28, 2020
Death due to pancreatic diseases caused by alcohol (K85.2, K86.0)
January 1, 2016 to February 28, 2020
Gastritis caused by alcohol - Hospitalization
Time Frame: January 1, 2016 to February 28, 2020
Incidence of hospitalization due to gastritis caused by alcohol (K29.2)
January 1, 2016 to February 28, 2020
Gastritis caused by alcohol - Death
Time Frame: January 1, 2016 to February 28, 2020
Death due to gastritis caused by alcohol (K29.2)
January 1, 2016 to February 28, 2020
Alcoholic cardiomyopathy - Hospitalization
Time Frame: January 1, 2016 to February 28, 2020
Incidence of hospitalization due to alcoholic cardiomyopathy (I42.6)
January 1, 2016 to February 28, 2020
Alcoholic cardiomyopathy - Death
Time Frame: January 1, 2016 to February 28, 2020
Death due to alcoholic cardiomyopathy (I42.6)
January 1, 2016 to February 28, 2020
Nervous system disorders caused by alcohol - Hospitalization
Time Frame: January 1, 2016 to February 28, 2020
Incidence of hospitalization due to degeneration of the nervous system due to alcohol, epileptic seizures related to alcohol, alcoholic polyneuropathy, alcoholic myopathy (G312, G4051, G621, G721)
January 1, 2016 to February 28, 2020
Nervous system disorders caused by alcohol - Death
Time Frame: January 1, 2016 to February 28, 2020
Death due to degeneration of the nervous system due to alcohol, epileptic seizures related to alcohol, alcoholic polyneuropathy, alcoholic myopathy (G312, G4051, G621, G721)
January 1, 2016 to February 28, 2020
Alcohol poisoning - Hospitalization
Time Frame: January 1, 2016 to February 28, 2020
Incidence of hospitalization due to alcohol poisoning (T51, X45)
January 1, 2016 to February 28, 2020
Alcohol poisoning - Death
Time Frame: January 1, 2016 to February 28, 2020
Death due to alcohol poisoning (T51, X45)
January 1, 2016 to February 28, 2020

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Finnish Institute for Health and Welfare

Collaborators

Social Insurance Institution, Finland

Investigators

  • Principal Investigator: Sebastián Peña, MD, PhD, Finnish Institute for Health and Welfare
  • Study Chair: Sonja Lumme, PhD, Finnish Institute for Health and Welfare
  • Study Chair: Päivikki Koponen, PhD, Finnish Institute for Health and Welfare

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2015

Primary Completion (Actual)

February 28, 2020

Study Completion (Anticipated)

September 30, 2023

Study Registration Dates

First Submitted

May 3, 2023

First Submitted That Met QC Criteria

May 16, 2023

First Posted (Actual)

May 19, 2023

Study Record Updates

Last Update Posted (Actual)

May 19, 2023

Last Update Submitted That Met QC Criteria

May 16, 2023

Last Verified

May 1, 2023

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • KKO-Inv 4-Johto-VPT-Terveysind

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The investigators will share the harmonization protocol to define the variables and the statistical code. Individual participant data is available upon request at FinData, following national data protection procedures.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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