4.2 Article

Alcohol and educational inequalities: Hazardous drinking prevalence and all-cause mortality by hazardous drinking group in people aged 50 and older in Europe

Journal

SUBSTANCE ABUSE
Volume 43, Issue 1, Pages 152-160

Publisher

SAGE PUBLICATIONS INC
DOI: 10.1080/08897077.2020.1773597

Keywords

Alcohol; middle-aged; SEP differences; hazardous drinking; Europe

Funding

  1. European Commission through FP5 [QLK6-CT-2001-00360]
  2. DG Employment, Social Affairs Inclusion
  3. German Ministry of Education and Research
  4. Max Planck Society for the Advancement of Science
  5. U.S. National Institute on Aging [U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C]
  6. European Commission through FP6 [SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812]
  7. European Commission through FP7 [SHARE-PREP] [211909]
  8. European Commission through FP7 [SHARE-LEAP] [227822]
  9. European Commission through FP7 [SHARE M4] [261982]
  10. European Commission through Horizon 2020 [SHAREDEV-3] [676536]
  11. European Commission through Horizon 2020 [SERISS] [654221]

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Among people aged 50 or above in European countries, there is a positive association between higher education and hazardous drinking prevalence among women, but not among men. Clear educational inequalities in mortality among hazardous drinkers were only observed in Eastern Europe. Further research on the associations between alcohol use and all-cause mortality in different regions is needed.
Background:We examined educational inequalities in hazardous drinking prevalence among individuals aged 50 or more in 14 European countries, and explored educational inequalities in mortality in hazardous drinkers in European regions.Methods:We analyzed data from waves 4, 5 and 6 of the Survey of Health Ageing and Retirement in Europe (SHARE). We estimated age-standardized hazardous drinking prevalence, and prevalence ratios (PR) of hazardous drinking by country and educational level using Poisson regression models with robust variance. We estimated the relative index of inequality (RII) for all-cause mortality among hazardous drinkers and non-hazardous drinkers using Cox proportional hazards regression models and for each region (North, South, East and West).Results:In men, educational inequalities in hazardous drinking were not observed (PRmedium= 1.09 [95%CI: 0.98-1.21] and PRhigh= 0.99 [95%CI: 0.88-1.10], ref. low), while in they were observed in women, having the highest hazardous drinking prevalence in the highest educational levels (PRmedium= 1.28 [95%CI: 1.15-1.42] and PRhigh= 1.53 [95%CI: 1.36-1.72]). Overall, the Relative Index of Inequality (RII) in all-cause mortality among hazardous drinkers was 1.12 [95%CI: 1.03-1.22] among men and 1.10 [95%CI: 0.97-1.25] among women. Educational inequalities among hazardous drinkers were observed in Eastern Europe for both men (RIIhazardous= 1.21 [95%CI: 1.01-1.45]) and women (RIIhazardous= 1.46 [95%CI: 1.13-1.87]). Educational inequalities in mortality among non-hazardous drinkers were observed in Southern, Western and Eastern Europe among men, and in Eastern Europe among women.Conclusions:Higher educational attainment is positively associated with hazardous drinking prevalence among women, but not among men in most of the analyzed European countries. Clear educational inequalities in mortality among hazardous drinkers were only observed in Eastern Europe. Further research on the associations between alcohol use and inequalities in all-cause mortality in different regions is needed.

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