The alcohol harm paradox: using a national survey to explore how alcohol may disproportionately impact health in deprived individuals

BMC Public Health

Research Article

James Nicholls¹  Karen Hughes²  Lisa Jones²  Mark A. Bellis³  Nick Sheron⁴  Ian Gilmore⁵ 

[1] Centre for History in Public Health, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK;Alcohol Research UK, 83 Victoria Street, SW1H 0HW, London, UK;Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, L3 2ET, Liverpool, UK;College of Health and Behavioural Sciences, Bangor University, LL57 2PZ, Bangor, UK;Public Health Wales, Hadyn Ellis Building, Cardiff University, Maindy Road, CF24 4HQ, Cardiff, UK;Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, L3 2ET, Liverpool, UK;Faculty of Medicine, University of Southampton, Mailpoint 811, University Hospital Southampton, SO16 6YD, Southampton, UK;School of Medicine, University of Liverpool, Cedar House, Ashton Street, L69 3GE, Liverpool, UK;

关键词: Alcohol;    Deprivation;    Inequalities;    Disease;    Injury;    Binge;   

DOI  :  10.1186/s12889-016-2766-x

 received in 2015-10-05, accepted in 2016-01-21,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundInternationally, studies show that similar levels of alcohol consumption in deprived communities (vs. more affluent) result in higher levels of alcohol-related ill health. Hypotheses to explain this alcohol harm paradox include deprived drinkers: suffering greater combined health challenges (e.g. smoking, obesity) which exacerbate effects of alcohol harms; exhibiting more harmful consumption patterns (e.g. bingeing); having a history of more harmful consumption; and disproportionately under-reporting consumption. We use a bespoke national survey to assess each of these hypotheses.MethodsA national telephone survey designed to test this alcohol harm paradox was undertaken (May 2013 to April 2014) with English adults (n = 6015). Deprivation was assigned by area of residence. Questions examined factors including: current and historic drinking patterns; combined health challenges (smoking, diet, exercise and body mass); and under-reported consumption (enhanced questioning on atypical/special occasion drinking). For each factor, analyses examined differences between deprived and more affluent individuals controlled for total alcohol consumption.ResultsIndependent of total consumption, deprived drinkers were more likely to smoke, be overweight and report poor diet and exercise. Consequently, deprived increased risk drinkers (male >168–400 g, female >112–280 g alcohol/week) were >10 times more likely than non-deprived counterparts to drink in a behavioural syndrome combining smoking, excess weight and poor diet/exercise. Differences by deprivation were significant but less marked in higher risk drinkers (male >400 g, female >280 g alcohol/week). Current binge drinking was associated with deprivation independently of total consumption and a history of bingeing was also associated with deprivation in lower and increased risk drinkers.ConclusionsDeprived increased/higher drinkers are more likely than affluent counterparts to consume alcohol as part of a suite of health challenging behaviours including smoking, excess weight and poor diet/exercise. Together these can have multiplicative effects on risks of wholly (e.g. alcoholic liver disease) and partly (e.g. cancers) alcohol-related conditions. More binge drinking in deprived individuals will also increase risks of injury and heart disease despite total alcohol consumption not differing from affluent counterparts. Public health messages on how smoking, poor diet/exercise and bingeing escalate health risks associated with alcohol are needed, especially in deprived communities, as their absence will contribute to health inequalities.

【 授权许可】

CC BY   
© Bellis et al. 2016