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Meta-Analysis
. 2014 Aug;43(4):1314-27.
doi: 10.1093/ije/dyu043. Epub 2014 Mar 11.

Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: a systematic review and meta-analysis

Charlotte Probst  1 , Michael Roerecke  2 , Silke Behrendt  3 , Jürgen Rehm  4
Affiliations
Meta-Analysis

Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: a systematic review and meta-analysis

Charlotte Probst et al. Int J Epidemiol. 2014 Aug.

Abstract

Background: Factors underlying socioeconomic inequalities in mortality are not well understood. This study contributes to our understanding of potential pathways to result in socioeconomic inequalities, by examining alcohol consumption as one potential explanation via comparing socioeconomic inequalities in alcohol-attributable mortality and all-cause mortality.

Methods: Web of Science, MEDLINE, PsycINFO and ETOH were searched systematically from their inception to second week of February 2013 for articles reporting alcohol-attributable mortality by socioeconomic status, operationalized by using information on education, occupation, employment status or income. The sex-specific ratios of relative risks (RRRs) of alcohol-attributable mortality to all-cause mortality were pooled for different operationalizations of socioeconomic status using inverse-variance weighted random effects models. These RRRs were then combined to a single estimate.

Results: We identified 15 unique papers suitable for a meta-analysis; capturing about 133 million people, 3 741 334 deaths from all causes and 167 652 alcohol-attributable deaths. The overall RRRs amounted to RRR = 1.78 (95% confidence interval (CI) 1.43 to 2.22) and RRR = 1.66 (95% CI 1.20 to 2.31), for women and men, respectively. In other words: lower socioeconomic status leads to 1.5-2-fold higher mortality for alcohol-attributable causes compared with all causes.

Conclusions: Alcohol was identified as a factor underlying higher mortality risks in more disadvantaged populations. All alcohol-attributable mortality is in principle avoidable, and future alcohol policies must take into consideration any differential effect on socioeconomic groups.

Keywords: Alcohol-attributable mortality; SES; alcohol; all-cause mortality; education; income; meta-analysis; occupation; socioeconomic differences; socioeconomic inequality; socioeconomic status.

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Figures

Figure 1.
Figure 1.
Flow diagram for study selection and exclusion. SES, socioeconomic status.
Figure 2.
Figure 2.
Random effects meta-analyses for women. Forest plot of pooled RRR for women, stratified by measure of SES. Size of squares corresponds to the weight of each study in the meta-analysis. Ref, reference number in references; RRR, ratio of relative risk; SES, socioeconomic status; CI, confidence interval.
Figure 3.
Figure 3.
Random effects meta-analyses for men. Forest plot of pooled RRR for men, stratified by measure of SES. Size of squares corresponds to the weight of each study in the meta-analysis. Ref, reference number in references; RRR, ratio of relative risk; SES, socioeconomic status; CI, confidence interval.
Figure 4.
Figure 4.
Overall random effects meta-analyses. Forest plot of pooled RRR across measures of SES, stratified by sex. Size of squares corresponds to the weight of each study in the meta-analysis. RRR, ratio of relative risk; SES, socioeconomic status; CI, confidence interval.
See this image and copyright information in PMC

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