Social Gradients in Alcohol Use Disorders with and without Depression: Immigrants vs Norwegians

Abstract

Abstract Background The social gradient in health runs from top to bottom of the socioeconomic spectrum. Poverty is associated with poor health and problematic unhealthy behaviors. Depression is strongly associated with social inequalities, while alcohol use disorders are not necessarily associated with a low socio economic status. Immigrants often have a lower social economic status than the host population. Research regarding alcohol use disorders, depression and a social gradient among immigrants is scare. The present study explores social gradients in persons with alcohol use disorders with and without depression and examines potential discrepancies between immigrant and native Norwegian patients receiving public specialist health care. Methods Data of 2.4 million native Norwegians and 468.496 immigrants, registered in the national mandatory Norwegian Patient Register and population data from Statistics Norway were analyzed. ICD 10 main diagnoses were used to identify patient groups - at least diagnosed once during 2008 - 2016. Immigrants had been pooled into 5 world regions. Logistic regression models have been applied to show associations between socio demographics/regions and alcohol use disorders and/or depression. Results African (OR = 0.35; 95%CI:0.27-0.44) and Asian (OR = 0.23; 95%CI:0.16-0.32) immigrants had a lower risk of developing alcohol use disorders with depression than Western Europeans (OR = 0.76; 95% CI:0.60-0.98), using native Norwegians as a reference. In general, persons with a lower socioeconomic status are more often affected of alcohol use disorder only (OR = 3.77; 95%CI:3.64-3.91) than with alcohol use disorder and concurrent depression (OR = 3.52; 95%CI:3.25-3.83). Conclusions To detect possible deficits in patient care, knowledge of social gradients in a marginalized group such as persons with alcohol use disorders and/or depression is essential. This may contribute to targeted and individualized health care- regardless of immigrant status. Key messages The risk of developing alcohol use disorders with depression varies between immigrants according to their origin. Persons with a lower socioeconomic status are more often affected of alcohol use disorder only than with alcohol use disorder and concurrent depression.