title: Inequalities in Alcohol-Related Mortality in 17 European Countries: A Retrospective Analysis of Mortality Registers.
abstract: BACKGROUND
  Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time.
  
  
  RESULTS
  We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated. Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3.6 (95% CI 3.3-4.0) and the slope index of inequality is 112.5 (95% CI 106.2-118.8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality. Because our study relies on routinely collected underlying causes of death, it is likely that our results underestimate the true extent of the problem.
  
  
  CONCLUSIONS
  Alcohol-related conditions play an important role in generating inequalities in total mortality in many European countries. Countering increases in alcohol-related mortality in lower socioeconomic groups is essential for reducing inequalities in mortality. Studies of why such increases have not occurred in countries like France, Switzerland, Spain, and Italy can help in developing evidence-based policies in other European countries.
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kulhánová
authors.affiliation: Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bopp
authors.affiliation: Agència de Salut Pública de Barcelona, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Borrell
authors.affiliation: Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Deboosere
authors.affiliation: Demographic Research Institute, Hungarian Central Statistical Office, Budapest, Hungary.
authors.forename: Katalin
authors.initials: K
authors.lastname: Kovács
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Caspar W N
authors.initials: CW
authors.lastname: Looman
authors.affiliation: Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden.|Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
authors.forename: Mall
authors.initials: M
authors.lastname: Leinsalu
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Mäkelä
authors.affiliation: Department of Sociology, University of Helsinki, Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie (Paris 6), INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France.
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
authors.affiliation: Agència de Salut Pública de Barcelona, Barcelona, Spain.
authors.forename: Maica
authors.initials: M
authors.lastname: Rodríguez-Sanz
authors.affiliation: Department of Demography, Charles University, Prague, Czech Republic.
authors.forename: Jitka
authors.initials: J
authors.lastname: Rychtaříková
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Rianne
authors.initials: R
authors.lastname: de Gelder
mesh_terms: D000328:Adult; D000368:Aged; D000431:Ethanol / Q000633:toxicity*; D005060:Europe / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009790:Occupations; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D012959:Socioeconomic Factors
chemical_list: D000431:Ethanol