Page last updated: March 27, 2017
Understanding the alcohol harm paradox

In many countries conflicting gradients in alcohol consumption and alcohol-associated mortality have been observed. To understand this ‘alcohol harm paradox’ researchers analysed the socioeconomic gradient in alcohol-associated hospital admissions to test whether it was greater in conditions which were: (1) chronic (associated with long-term drinking) and partially alcohol-attributable, (2) chronic and wholly alcohol-attributable, (3) acute (associated with intoxication) and partially alcohol-attributable, (4) acute and wholly-alcohol attributable.

The researchers aimed to clarify how (1) drinking patterns (e.g. intoxication linked to acute admissions or dependence linked to chronic conditions) and (2) non-alcohol causes (e.g. smoking and poor diet which are risks for partially alcohol-attributable conditions) contribute to the paradox.

The study included 9.2 million English hospital admissions where a primary or secondary cause was one of 36 alcohol-associated conditions. Admissions by condition and deciles of Index of Multiple Deprivation (IMD). Socioeconomic gradient measured as the relative index of inequality (RII, the slope of a linear regression of IMD on admissions adjusted for overall admission rate). Conditions were categorised by ICD-10 code. A socioeconomic gradient in hospitalisations was seen for all conditions except partially attributable chronic conditions. The gradient was significantly steeper for conditions which were wholly attributable to alcohol and for acute conditions than for conditions partially alcohol-attributable and for chronic conditions. Gradients were steeper for men than for women in cases of wholly alcohol attributable conditions.

The authors conclude that there is a socioeconomic gradient in English hospital admissions for most alcohol-associated conditions. The greatest inequalities are in conditions associated with alcohol dependence, such as liver disease and mental and behavioural conditions, and in acute conditions, like alcohol poisoning and assault. Socioeconomic differences in harmful drinking patterns (dependence and intoxication) may contribute to the ‘alcohol harm paradox’.

Source: Understanding the alcohol harm paradox: an analysis of sex- and condition-specific hospital admissions by socioeconomic group for alcohol-associated conditions in England. S Sadler, C Angus, L Gavens, D Gillespie, J Holmes, J Hamilton, A Brennan, P Meier. Addiction Accepted online: 15 December 2016.

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