Abstract
Background and Aims
When measuring inequalities in health, public health and addiction research has tended to focus on differences in average lifespan between socioeconomic groups. This does not account for the extent to which age of death varies between individuals within socioeconomic groups or whether this variation differs between groups. This study assesses 1) socioeconomic inequalities in both average lifespan and variation in age at death, 2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and 3) how this contribution has changed over time.
Design
Cause-deleted life table analysis of national mortality records.
Setting
England and Wales, 2001-2016.
Cases
All-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the Index of Multiple Deprivation (IMD).
Measurements
Life expectancy at age 18 and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality ‘gaps’.
Findings
In 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years respectively and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of lifespan uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men.
Conclusions
Deaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socioeconomic groups. Using both measures can provide a fuller picture of overall inequalities in health.
When measuring inequalities in health, public health and addiction research has tended to focus on differences in average lifespan between socioeconomic groups. This does not account for the extent to which age of death varies between individuals within socioeconomic groups or whether this variation differs between groups. This study assesses 1) socioeconomic inequalities in both average lifespan and variation in age at death, 2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and 3) how this contribution has changed over time.
Design
Cause-deleted life table analysis of national mortality records.
Setting
England and Wales, 2001-2016.
Cases
All-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the Index of Multiple Deprivation (IMD).
Measurements
Life expectancy at age 18 and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality ‘gaps’.
Findings
In 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years respectively and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of lifespan uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men.
Conclusions
Deaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socioeconomic groups. Using both measures can provide a fuller picture of overall inequalities in health.
| Original language | English |
|---|---|
| Pages (from-to) | 2268-2279 |
| Number of pages | 12 |
| Journal | Addiction |
| Volume | 115 |
| Issue number | 12 |
| Early online date | 31 Mar 2020 |
| DOIs | |
| Publication status | Published - 10 Nov 2020 |
Research Groups and Themes
- NIHR SPHR
Keywords
- alcohol
- demography
- inequalities
- life expectancy
- life-span variation
- mortality
Access to Document
- Full-text PDF (final published version)
This is the final published version of the article (version of record). It first appeared online via Wiley at https://onlinelibrary.wiley.com/doi/full/10.1111/add.15037 . Please refer to any applicable terms of use of the publisher.
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