Assessing the contribution of alcohol-specific causes to socio-economic inequalities in mortality in England and Wales 2001-16

Colin Angus*, Rob Pryce, John Holmes, Frank de Vocht, Matthew Hickman, Petra Meier, Alan Brennan, Duncan Gillespie

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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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.
Original languageEnglish
Pages (from-to)2268-2279
Number of pages12
JournalAddiction
Volume115
Issue number12
Early online date31 Mar 2020
DOIs
Publication statusPublished - 10 Nov 2020

Structured keywords

  • NIHR SPHR

Keywords

  • alcohol
  • demography
  • inequalities
  • life expectancy
  • life-span variation
  • mortality

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