The dose-response relationship between socioeconomic deprivation and alcohol-attributable mortality risk-a systematic review and meta-analysis

Charlotte Probst, Shannon Lange, Carolin Kilian, Celine Saul, Jürgen Rehm, Charlotte Probst, Shannon Lange, Carolin Kilian, Celine Saul, Jürgen Rehm

Abstract

Background: Individuals with low socioeconomic status (SES) experience a higher risk of mortality, in general, and alcohol-attributable mortality in particular. However, a knowledge gap exists concerning the dose-response relationships between the level of socioeconomic deprivation and the alcohol-attributable mortality risk.

Methods: We conducted a systematic literature search in August of 2020 to update a previous systematic review that included studies published up until February of 2013. Quantitative studies reporting on socioeconomic inequality in alcohol-attributable mortality among the general adult population were included. We used random-effects dose-response meta-analyses to investigate the relationship between the level of socioeconomic deprivation and the relative alcohol-attributable risk (RR), by sex and indicator of SES (education, income, and occupation).

Results: We identified 25 eligible studies, comprising about 241 million women and 230 million men, among whom there were about 75,200 and 308,400 alcohol-attributable deaths, respectively. A dose-response relationship between the level of socioeconomic deprivation and the RR was found for all indicators of SES. The sharpest and non-linear increase in the RR of dying from an alcohol-attributable cause of death with increasing levels of socioeconomic deprivation was observed for education, where, compared to the most educated individuals, individuals at percentiles with decreasing education had the following RR of dying: women: 25th: 2.09 [95% CI 1.70-2.59], 50th: 3.43 [2.67-4.49], 75th: 4.43 [3.62-5.50], 100th: 4.50 [3.26-6.40]; men: 25th: 2.34 [1.98-2.76], 50th: 4.22 [3.38-5.24], 75th: 5.87 [4.75-7.10], 100th: 6.28 [4.89-8.07].

Conclusions: The findings of this study show that individuals along the entire continuum of SES are exposed to increased alcohol-attributable mortality risk. Differences in the dose-response relationship can guide priorities in targeting public health initiatives.

Keywords: Alcohol use; Dose-response; Inequality; Mortality; Public health; Socioeconomic deprivation; Socioeconomic status.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
PRISMA flow chart of study selection for the search conducted in 2013 and 2020. SES, socioeconomic status
Fig. 2
Fig. 2
Bubble plots with locally weighted scatterplot smoothing for dose-response relationships between the level of socioeconomic deprivation and the relative alcohol-attributable mortality risk (RR, shown on the log scale) by indicator of socioeconomic status and sex (women in light blue, men in dark blue), using inverse variance weights. All pairwise comparisons reported in a study were included (unit of observation). The level of socioeconomic deprivation is coded as the midpoint of the percentile range in the cumulative SES distribution with 0=lowest level of socioeconomic deprivation and 100=highest level of socioeconomic deprivation. Triangles indicate reference groups, and bubbles show the RR point estimates according to their weight. The gray-shaded areas indicate the 95% confidence intervals around the locally weighted scatterplot smoothing lines
Fig. 3
Fig. 3
Dose-response relationship between the level of socioeconomic deprivation and the relative risk of mortality from an alcohol-attributable cause of death (RR, shown on the log scale) by the indicator of socioeconomic status (SES) and sex. The level of socioeconomic deprivation indicates the percentile in the cumulative SES distribution with 0=lowest level of socioeconomic deprivation and 100=highest level of socioeconomic deprivation. Gray-shaded areas show 95% uncertainty bands

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