title: Gender differences in socioeconomic inequality of alcohol-attributable mortality: A systematic review and meta-analysis.
abstract: OBJECTIVE
  The present analysis contributes to understanding the societal distribution of alcohol-attributable harm by investigating socioeconomic inequality and related gender differences in alcohol-attributable mortality.
  
  
  METHODS
  A systematic literature search was performed on Web of Science, MEDLINE, PsycINFO and ETOH from their inception until February 2013. Articles were included when they reported data on alcohol-attributable mortality by socioeconomic status (SES), operationalised as education, occupation, employment status or income. Gender-specific relative risks (RR) comparing low with high SES were pooled using random effects meta-analyses. Gender differences were additionally investigated in random effects meta-regressions.
  
  
  RESULTS
  Nineteen articles from 14 countries were included. For women, significant RRs across all measures of SES, except employment status, were found, ranging between 1.75 [95% confidence interval (CI) 1.21-2.54; occupation] and 4.78 (95% CI 2.57-8.87; income). For men, all measures of SES showed significant RRs ranging between 2.88 (95% CI 2.45-3.40; income) and 12.25 (95% CI 11.45-13.10; employment status). While RRs for men were in general slightly higher, only for occupation this gender difference was above chance (P = 0.01). Results refer to deaths 100% attributable to alcohol.
  
  
  CONCLUSIONS
  The results are predominantly based on data from high-income countries, limiting generalisability. Alcohol-attributable mortality is strongly distributed to the disadvantage of persons with a low SES. Marked gender differences in this inequality were found for occupation. Possibly male-dominated occupations of low SES were more strongly related to risky drinking cultures compared with female-dominated occupations of the same SES.
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Probst
authors.forename: Michael
authors.initials: M
authors.lastname: Roerecke
authors.forename: Silke
authors.initials: S
authors.lastname: Behrendt
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
mesh_terms: D019973:Alcohol-Related Disorders / Q000401:mortality*; D002423:Cause of Death; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: alcohol-related disorder; gender; mortality; risk; socioeconomic status