The contribution of alcohol use and other lifestyle factors to socioeconomic differences in all-cause mortality in a Swedish cohort.

Abstract

A relationship between socioeconomic position (SEP) and mortality has been found in high-income countries. One possible explanation is socioeconomic differentials in health behaviours. The aim was to investigate to what degree the association between SEP and all-cause mortality is explained by differences in alcohol use and other lifestyle factors. The study was based on data from a large public health survey from Stockholm County in 2002, with 5 year follow-up for all-cause mortality. Proportional hazard models estimated the effect of education, occupational class and income on all-cause mortality, before and after adjusting for alcohol use (both separate and combined effects of levels and patterns of drinking), smoking, physical activity and body mass index. The prevalence of lifestyle factors showed a marked social gradient. All three SEP indicators showed higher mortality for the most disadvantaged SEP group than in the least disadvantaged group. Adjusting for a combined measure of alcohol use attenuated the SEP differences in mortality by a fifth, whereas adjusting for volume of consumption resulted in considerably smaller attenuations. Adjusting for smoking resulted in attenuations of 6-18%. In the fully adjusted model, physical activity and body mass index did not account for the socioeconomic differences in mortality beyond that of alcohol and smoking.‬ DISCUSSION AND CONCLUSIONS: Irrespective of whether SEP is defined by education, occupational class or income, the unequal distribution of hazardous alcohol use and smoking contributes to a notable proportion of the socioeconomic differences in mortality in Sweden. [Sydén L, Landberg J. The contribution of alcohol use and other lifestyle factors to socioeconomic differences in all-cause mortality in a Swedish cohort. Drug Alcohol Rev 2016;00:000-000].