Alcohol‐related mortality as a function of socio‐economic status

AIMS: To describe the differences in acute, chronic and total alcohol-related mortality by several measures of socio-economic status (SES) and to unravel the influences of different dimensions of SES. DESIGN: A register-based follow-up study of alcohol-related mortality. SETTING: Finland. PARTICIPANTS: The dataset was formed by linking census records with death records for 1987-95 and included 21,922 alcohol-related deaths. MEASUREMENTS: SES indicators include education, occupational class, personal income, net household income per consumption unit (spending power) and housing tenure. The judgement of whether death was alcohol-related was based on death certificates. FINDINGS: Acute and chronic alcohol-related mortality were much higher in low SES groups for all SES indicators, including spending power, even when controlling for the remaining SES variables. Among men, personal income was a better predictor of alcohol-related death than spending power, while among women the situation was reversed. The effect of one SES measure was often stronger in low levels of another SES measure. Social selection and drift are likely to contribute to the large differentials in respect to personal income, while their effect on other differentials is likely to be smaller. CONCLUSIONS: SES is an important predictor of acute and chronic alcohol-related mortality. The total impact of SES cannot fully be captured using only one or two measures of SES.