Educational inequalities in hospitalization attributable to alcohol: a population-based longitudinal study of changes during the period 2000-07.

Abstract

To estimate the relative risk of hospitalization from alcohol-related causes among men and women in Finland across different educational categories, and to determine whether these differentials changed following a large reduction in alcohol prices in 2004. A register-based longitudinal study of hospitalizations. We used repeated-measures analysis to estimate alcohol-attributable hospitalization rates and assessed effects of the reduction in alcohol prices by comparing two 4-year periods (2000-03 and 2004-07). Finland. A representative sample of the residents of Finland aged 30-79 years in the period 2000-07 (n = 470,627). There was a clear gradient across educational levels in alcohol-attributable hospitalizations: the incidence rate ratios among men and women with basic education were 1.70 [95% confidence interval (CI) = 1.32, 2.20] and 1.96 (95% CI = 1.36, 2.84), respectively, compared with those with upper-tertiary education. After allowing for the long-term trend, there were no significant changes between the two follow-up periods either among men with an upper tertiary education or among women in any educational level, whereas the rate increased by 21% (95% CI = 5, 41), 16% (95% CI = 6, 27) and 10% (95% CI = 2, 18), respectively, among men with a lower tertiary, secondary and basic education. However, these differences in changes were not statistically significant. Lower-level education is associated with a substantially increased risk of alcohol-related hospitalization among men and women in Finland, even when adjusted for age, economic activity and income. The results do not provide strong evidence that the 2004 price reduction had differential effects by education.