Alcohol consumption, wealth, and health
Authors: Martin Frisher
Journal: The Lancet Public Health (2017)

In their Article, Srinivasa Vittal Katikireddi and colleagues1Katikireddi SV Whitley E Lewsey J Gray L Leyland AH Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data.Lancet Public Health. 2017; 2: e267-e276Summary Full Text Full Text PDF PubMed Scopus (170) Google Scholar report an analysis of the Scottish Health Surveys and suggest that “alcohol-attributable harms are far higher in disadvantaged social groups” but that “adjustment for alcohol consumption and binge drinking had little effect on the magnitude of the associations seen”. It is interesting to view these findings alongside those from the ELSA study, which found that, among people aged 50 years or older, the “level of alcohol consumption is not associated with self-rated health” and “rates of poor self-rated health among non-drinkers were significantly higher than the rates…for any of the groups who reported alcohol consumption”.2Frisher M Mendonça M Shelton N Pikhart H de Oliveira C Holdsworth C Is alcohol consumption in older adults associated with poor self-rated health? Cross-sectional and longitudinal analyses from the English longitudinal study of ageing.BMC Public Health. 2015; 15: 703Crossref PubMed Scopus (30) Google Scholar The results of both studies might seem surprising when set against evidence that high levels of alcohol consumption directly contribute to ill health.3NICEAlcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. Clinical guideline.https://www.nice.org.uk/guidance/cg115/resources/alcoholuse-disorders-diagnosis-assessment-and-management-of-harmful-drinking-and-alcohol-dependence-pdf-35109391116229Google Scholar Katikireddi and colleagues state that “the poorest in society are at greater risk of alcohol's harmful impacts on health, but this is not because they are drinking more or [are] more often binge drinking. Experiencing poverty may impact on health, not only through leading an unhealthy lifestyle but also as a direct consequence of poor material circumstances and psychosocial stresses.”4The Herald (Glasgow). May 11, 2017; Google Scholar A link clearly exists between alcohol use or non-use and health.5Rehm J Room R Graham K Monteiro M Gmel G Sempos CT The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease—an overview.Addiction. 2003; 98: 1209-1228Crossref PubMed Scopus (736) Google Scholar However, the link is not straightforward6Rao R Schofield P Ashworth M Alcohol use, socioeconomic deprivation and ethnicity in older people.BMJ Open. 2015; 5: e007525Google Scholar and the evidence from these two studies indicates that the extent of alcohol use does not necessarily correspond to adverse health outcomes.7Frisher M Does alcohol consumption predict future health among older adults? BMC Series Blog.http://blogs.biomedcentral.com/bmcseriesblog/2015/09/17/alcohol-consumption-predict-future-health-among-older-adultsDate: 2015Google Scholar These studies raise questions about how evidence-based research in this area should be translated into public health messages. I declare no competing interests. Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort dataDisadvantaged social groups have greater alcohol-attributable harms compared with individuals from advantaged areas for given levels of alcohol consumption, even after accounting for different drinking patterns, obesity, and smoking status at the individual level. Full-Text PDF Open AccessAlcohol consumption, wealth, and health – Authors' replyWe thank Martin Frisher for his Correspondence about our Article,1 in which we used linked data to investigate the alcohol harms paradox. We found that increased alcohol consumption was associated with greater harms attributable to alcohol, but that populations of low socioeconomic status (measured by area-based deprivation, income, educational attainment, and social class) were disproportionately affected by alcohol-attributable harm. We found this disparity to be the case even when adjusting for differences in binge drinking, smoking, and body-mass index. Full-Text PDF Open Access