Why Are the Harmful Effects of Alcohol Consumption Greater Among People with Low Socioeconomic Status?

This systematic review investigated the relationship between socioeconomic status (SES) and risk of mortality or morbidity for a number of alcohol-attributable conditions. It summarized data from 31 case-control or cohort studies (published in English) relating an overall measure of the effects of low SES (variously defined) to the risk of cancers related to alcohol, as well as to liver disease, hypertension, stroke, epilepsy, cardiac arrhythmias, and pancreatitis.

• Participants with low SES had a greater risk than those with high SES of developing head and neck cancer and stroke associated with alcohol consumption.
• There was a tendency for lower risk of breast cancer among women with low SES, but differences were not significant when adjusted for known confounders.
• Data were insufficient to specify the effects of SES on other alcohol-attributable diseases.

Comments:

Theories to explain why people with low SES may experience more adverse effects from alcohol use include: 1) different drinking patterns, with higher rates of heavy episodic drinking among people with low SES; 2) clustering of lifestyle factors associated with poor health; and 3) decreased access to health care. In some studies, even though the reported total alcohol intake of people with low and high SES may be similar, the latter may be more likely to drink “moderate” amounts of alcohol on a regular basis, while people with low SES are more likely to have a few days of heavy consumption per week. There may also be differences according to the type of alcoholic beverage consumed, which was not considered in this study.

R. Curtis Ellison, MD

Reference:

Jones L, Bates G, McCoy E, Bellis MA. Relationship between alcohol-attributable disease and socioeconomic status, and the role of alcohol consumption in this relationship: a systematic review and meta-analysis. BMC Public Health. 2015;15:400.