Associations between interrelated dimensions of socio-economic status, higher risk drinking and mental health in South East London: A cross-sectional study.

Sadie Boniface,Stephani L Hatch,Laura Goodwin,Dan Lewer

doi:10.1371/journal.pone.0229093

Sadie Boniface, Stephani L Hatch + Show 2 more

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https://doi.org/10.1371/journal.pone.0229093

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Abstract

AimTo examine patterns of hazardous, harmful and dependent drinking across different socio-economic groups, and how this relationship may be explained by common mental disorder.Methods and findingsBetween 2011–2013, 1,052 participants (age range 17–91, 53% female) were interviewed for Phase 2 of the South East London Community Health study. Latent class analysis was used to define six groups based on multiple indicators of socio-economic status in three domains. Alcohol use (low risk, hazardous, harmful/dependent) was measured using the Alcohol Use Disorders Identification Test and the presence of common mental disorder was measured using the revised Clinical Interview Schedule. Multinomial regression was used to explore associations with hazardous, harmful and dependent alcohol use, including after adjustment for common mental disorder.Harmful and dependent drinking was more common among people in Class 2 ‘economically inactive renters’ (relative risk ratio (RRR) 3.05, 95% confidence interval (CI) 1.07–8.71), Class 3 ‘economically inactive homeowners’ (RRR 4.11, 95% CI 1.19–14.20) and Class 6 ‘professional renters’ (RRR 3.51, 95% CI 1.14–10.78) than in Class 1 ‘professional homeowners’. Prevalent common mental disorder explained some of the increased risk of harmful or dependent drinking in Class 2, but not Class 3 or 6.ConclusionsAcross distinct socio-economic groups in a large inner-city sample, we found important differences in harmful and dependent drinking, only some of which were explained by common mental disorder. The increased risk of harmful or dependent drinking across classes which are very distinct from each other suggests differing underlying drivers of drinking across these groups. A nuanced understanding of alcohol use and problems is necessary to understand the inequalities in alcohol harms.

Highlights

There are close to 2 billion people who drink alcohol [1]
Across distinct socio-economic groups in a large inner-city sample, we found important differences in harmful and dependent drinking, only some of which were explained by common mental disorder
Interrelated dimensions of socio-economic status and higher risk drinking in South East London author(s) and not necessarily those of the National Institute for Health Research (NIHR) or the Department of Health and Social Care

Summary

Introduction

There are close to 2 billion people who drink alcohol [1]. Alcohol is the seventh leading risk factor in terms of deaths and disability-adjusted life years lost [2], with alcohol use disorders leading to 11 million healthy years of life lost annually worldwide [3]. In England, alcohol contributes to 8,000 deaths and a million hospital admissions annually, and consumption patterns appear stable, hospital admissions are rising [4]. Alcohol harm disproportionately affects the most disadvantaged socio-economic groups despite surveys consistently identifying that people belonging to higher socio-economic groups report drinking the same or more on average. This has been observed repeatedly in the UK [5,6,7,8] as well as a number of other European countries [9,10] and Australia [11,12]. Many explanations exist for this ‘alcohol harm paradox’, one of which is very heavy or problematic drinking being clustered in lower socio-economic groups, which is supported by recent research in the UK [5,6]

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