Inequalities in alcohol-related mortality in 17 European countries: register-based study

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, educational 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 inequalities between low and high socioeconomic groups were calculated. Rates of alcohol-related mortality are higher in lower socioeconomic 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. Over time, relative inequalities in alcohol-related mortality have increased in many countries, but the main change is a strong rise of absolute inequalities in several countries in the East (Hungary, Lithuania, Estonia) and North (Finland, Denmark) due to a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries alcohol-related causes now account for 10 percent or more of inequalities 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 increasingly 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 to develop evidence-based policies in other European countries.