title: Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: a systematic review and meta-analysis.
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.
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, Canada c.probst@psychologie.tu-dresden.de.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Probst
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Roerecke
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Silke
authors.initials: S
authors.lastname: Behrendt
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute of Medical Science, University of Toronto, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canad
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
mesh_terms: D019973:Alcohol-Related Disorders / Q000401:mortality*; D004522:Educational Status; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D009026:Mortality; D012923:Social Class; D012959:Socioeconomic Factors
keywords: Alcohol-attributable mortality; SES; alcohol; all-cause mortality; education; income; meta-analysis; occupation; socioeconomic differences; socioeconomic inequality; socioeconomic status