title: What underlies the high alcohol related mortality of the disadvantaged: high morbidity or poor survival?
abstract: OBJECTIVE
  To investigate whether the large socioeconomic differences in alcohol related mortality can be explained by differences in morbidity or differences in survival.
  
  
  METHODS
  Register linkage study. A nationwide hospital discharge register was linked to population censuses for socioeconomic data and to the cause of death register for mortality follow up.
  
  
  METHODS
  Finland.
  
  
  METHODS
  Men and women aged 15 years and older discharged from hospitals with an alcohol related diagnosis in 1991-1996.
  
  
  METHODS
  Mortality hazard up to the end of 1997 by socioeconomic category was estimated with Cox's regression model.
  
  
  RESULTS
  Socioeconomic differences in alcohol related hospitalisation rates were almost as large as those that have been observed for alcohol related mortality. For example, the rate ratio among male unspecialized workers for any alcohol related hospitalisations was 3.6 as compared with upper white collar workers; among women the rate ratio was 2.7. Depending on gender, age, hospitalisation diagnosis, and cause of death, survival after discharge either showed no socioeconomic differences or it was worse among better off groups.
  
  
  CONCLUSIONS
  The study suggests that differences in survival after hospitalisation do not cause the high socioeconomic differences in alcohol related mortality.
authors.affiliation: STAKES, National Research and Development Centre for Welfare and Health, Finland. pia.makela@stakes.fi
authors.forename: P
authors.initials: P
authors.lastname: Mäkelä
authors.forename: I
authors.initials: I
authors.lastname: Keskimäki
authors.forename: S
authors.initials: S
authors.lastname: Koskinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000401:mortality*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors