Relationship between alcohol-attributable disease and socioeconomic status, and the role of alcohol consumption in this relationship: a systematic review and meta-analysis.
BACKGROUND
Studies show that alcohol consumption appears to have a disproportionate impact on people of low socioeconomic status. Further exploration of the relationship between alcohol consumption, socioeconomic status and the development of chronic alcohol-attributable diseases is therefore important to inform the development of effective public health programmes.


METHODS
We used systematic review methodology to identify published studies of the association between socioeconomic factors and mortality and morbidity for alcohol-attributable conditions. To attempt to quantify differences in the impact of alcohol consumption for each condition, stratified by SES, we (i) investigated the relationship between SES and risk of mortality or morbidity for each alcohol-attributable condition, and (ii) where, feasible explored alcohol consumption as a mediating or interacting variable in this relationship.


RESULTS
We identified differing relationships between a range of alcohol-attributable conditions and socioeconomic indicators. Pooled analyses showed that low, relative to high socioeconomic status, was associated with an increased risk of head and neck cancer and stroke, and in individual studies, with hypertension and liver disease. Conversely, risk of female breast cancer tended to be associated with higher socioeconomic status. These findings were attenuated but held when adjusted for a number of known risk factors and other potential confounding factors. A key finding was the lack of studies that have explored the interaction between alcohol-attributable disease, socioeconomic status and alcohol use.


CONCLUSIONS
Despite some limitations to our review, we have described relationships between socioeconomic status and a range of alcohol-attributable conditions, and explored the mediating and interacting effects of alcohol consumption where feasible. However, further research is needed to better characterise the relationship between socioeconomic status alcohol consumption and alcohol-attributable disease risk so as to gain a greater understanding of the mechanisms and pathways that influence the differential risk in harm between people of low and high socioeconomic status.
Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, Henry Cotton Campus, Level 2, 15-21 Webster Street, Liverpool, L3 2ET, UK. l.jones1@ljmu.ac.uk.
Lisa
L
Jones
Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, Henry Cotton Campus, Level 2, 15-21 Webster Street, Liverpool, L3 2ET, UK. g.bates@ljmu.ac.uk.
Geoff
G
Bates
Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, Henry Cotton Campus, Level 2, 15-21 Webster Street, Liverpool, L3 2ET, UK. e.j.mccoy@ljmu.ac.uk.
Ellie
E
McCoy
Policy, Research and Development, Public Health Wales, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK. m.a.bellis@bangor.ac.uk.
Mark A
MA
Bellis
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000401:mortality; D015984:Causality; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D055815:Young Adult