Effects of Type of Alcohol and Drinking Patterns Among People With Low Socio-economic Status

Studies have indicated that people with lower socio-economic status (SES) experience more adverse effects of alcohol consumption compared with people with higher SES, even when their reported intake is similar. Researchers investigated data from 11,038 respondents to the Welsh Health Survey to determine whether alcohol consumption by beverage type, body mass index (BMI), smoking, and other factors explain inequalities in alcohol-related harm. Lower SES was determined by levels of “deprivation,” an extensive definition that included geographic area of residence as well as details on education, income, and employment.

• Greater deprivation was associated with 75% higher rates of alcohol-related hospital admissions (ARHA), compared with participants with lower levels of deprivation.
• Adjustment for the number of units of alcohol consumed only reduced the risk of ARHA for participants experiencing high levels of deprivation by 4%, compared with those experiencing less deprivation.
• Adjustment for smoking and BMI reduced these inequalities by 36%, with greater reduction when other factors (e.g., self-reported health, mental health problems) were included.
• Increases of units of spirits (much higher in participants with deprivation) were positively associated with increasing risk of ARHA, more than for other drink types.

Comments: The amount of alcohol reportedly consumed by people with lower SES appears to be only a minor contributing factor to the higher rates of alcohol-related harms that they experience, compared with people with higher SES. Other comorbidities—especially smoking, obesity, living in a deprived environment, poor health status, mental health, etc—appeared to have much greater effects. This study suggests that even for alcohol-related hospital admissions, other factors associated with low SES may be important determinants of adverse health outcomes.

R. Curtis Ellison, MD

Reference: Gartner A, Trefan L, Moore S, et al. Drinking beer, wine or spirits – does it matter for inequalities in alcohol-related hospital admission? A record-linked longitudinal study in Wales. BMC Public Health 2019;19:1651.