Inequalities in Alcohol-Related Mortality in 17 European Countries : A Retrospective Analysis of Mortality Registers
Mackenbach, J.P (Erasmus University Medical Center)
Kulhánová, Ivana (Erasmus University Medical Center)
Bopp, Matthias (University of Zurich)
Borrell i Thió, Carme (Institut d'Investigació Biomèdica Sant Pau)
Deboosere, Patrick (Vrije Universiteit Brussel)
Kovács, Katalin (Hungarian Central Statistical Office)
Looman, Caspar W.N. (Erasmus University Medical Center)
Leinsalu, Mall (National Institute for Health Development (Estònia))
Mäkelä, Pia (National Institute for Health and Welfare)
Martikainen, Pekka (University of Helsinki)
Menvielle, Gwenn (Sorbonne Universités)
Rodríguez-Sanz, Maica (Institut d'Investigació Biomèdica Sant Pau)
Rychtarikova, Jitka (Charles University)
De Gelder, Rianne (Erasmus University Medical Center)
Universitat Autònoma de Barcelona

Data:	2015
Resum:	Background: Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time. Methods and Findings: We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated. Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3. 6 (95% CI 3. 3-4. 0) and the slope index of inequality is 112. 5 (95% CI 106. 2-118. 8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality. Because our study relies on routinely collected underlying causes of death, it is likely that our results underestimate the true extent of the problem. Conclusions: Alcohol-related conditions play an important role in generating inequalities in total mortality in many European countries. Countering increases in alcohol-related mortality in lower socioeconomic groups is essential for reducing inequalities in mortality. Studies of why such increases have not occurred in countries like France, Switzerland, Spain, and Italy can help in developing evidence-based policies in other European countries.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Adult ; Aged ; Ethanol ; Europe ; Female ; Health Status Disparities ; Humans ; Male ; Middle Aged ; Mortality ; Occupations ; Prevalence ; Registries ; Retrospective Studies ; Socioeconomic Factors
Publicat a:	PLoS Medicine, Vol. 12 Núm. 12 (2015) , p. e1001909, ISSN 1549-1676

DOI: 10.1371/journal.pmed.1001909
PMID: 26625134

31 p, 575.9 KB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
Articles > Articles de recerca
Articles > Articles publicats