Socioeconomic Differences in Alcohol Harm in Finland in a Nationwide Cohort Study
Study Details
Study Description
Brief Summary
This is a nationwide cohort study of Finnish adults aged 25 and older, who are followed up for the incidence of an alcohol-attributable hospitalization or death. The primary objective is to examine the relative and absolute socioeconomic differences in cause-specific alcohol-attributable hospital admissions and deaths.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Background
Alcohol consumption is a leading risk factor for death and disability, resulting in substantial societal costs and social and community harm. Alcohol-related harm has been consistently shown to be higher among people of lower socioeconomic status, despite the fact they often report similar or lower levels of alcohol use. This apparent contrast has been called the alcohol harm paradox.
Understanding what explains the alcohol harm paradox is crucial for the design and implementation of population health interventions to reduce socioeconomic differences in alcohol harm. Explanations for the paradox can be broadly categorised into three groups: (i) differential exposure to alcohol, drinking patterns and trajectories and to other behavioural risk factors and joint effects among them, (ii) differential vulnerability resulting from individual factors, such as biological characteristics, psychological traits or stress, cumulative disadvantage and broader community and societal upstream factors, and (iii) differential biases in the measurement of alcohol exposure.
A crucial weakness of existing empirical studies comes from the operationalization of alcohol harm. With few exceptions, a vast majority of studies has used a composite endpoint combining several causes of alcohol-attributable deaths or hospitalizations or even merging alcohol-attributable hospital admissions with deaths in a single outcome. While this strategy increases the statistical power to analyse rare events, composite endpoints are prone to misclassification bias by masking divergent underlying patterns and associations.
Cause-specific analyses might shed light on different mechanisms driving the socioeconomic differences in overall alcohol-attributable harm, as well as opening potential avenues for policy interventions to reduce them. The study will take advantage of a recently formed dataset covering the total Finnish population to explore associations between socioeconomic status and cause-specific alcohol-attributable events. An additional contribution to the literature will be reporting both relative and absolute inequalities in alcohol-attributable harm. Absolute differences have been rarely reported even though might be as relevant as relative differences because, from a pragmatic standpoint, they are more feasible to reduce.
The study will aim to (1) examine the relative and absolute socioeconomic differences in cause-specific alcohol-attributable hospital admissions and deaths; (2) describe the geographical differences in cause-specific alcohol-attributable hospital admissions and deaths; and (3) quantify the relative contribution of each specific alcohol-attributable cause to the overall alcohol-attributable harm.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Lowest income groups Deciles of equivalized net household income. The method compares the whole socioeconomic distribution. |
Other: Not applicable, this is an observational study
Not applicable, this is an observational study
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Outcome Measures
Primary Outcome Measures
- Alcohol intoxication - Hospitalization [January 1, 2016 to February 28, 2020]
Incidence of alcohol intoxication hospitalization (ICD-10 F10.0-1)
- Alcohol intoxication - Death [January 1, 2016 to February 28, 2020]
Death due to alcohol intoxication (ICD-10 F10.0-1)
- Alcohol dependence - Hospitalization [January 1, 2016 to February 28, 2020]
Incidence of hospitalization due to alcohol dependence (F10.2)
- Alcohol dependence - Death [January 1, 2016 to February 28, 2020]
Death due to alcohol dependence (F10.2)
- Psycho-organic syndrome caused by alcohol - Hospitalization [January 1, 2016 to February 28, 2020]
Incidence of hospitalization due to psycho-organic syndrome caused by alcohol (F10.3-9)
- Psycho-organic syndrome caused by alcohol - Death [January 1, 2016 to February 28, 2020]
Death due to psycho-organic syndrome caused by alcohol (F10.3-9)
- Alcoholic liver disease - Hospitalization [January 1, 2016 to February 28, 2020]
Incidence of hospitalization due to alcoholic liver disease(K70)
- Alcoholic liver disease - Death [January 1, 2016 to February 28, 2020]
Death due to alcoholic liver disease(K70)
- Pancreatic diseases caused by alcohol - Hospitalization [January 1, 2016 to February 28, 2020]
Incidence of hospitalization due to pancreatic diseases caused by alcohol (K85.2, K86.0)
- Pancreatic diseases caused by alcohol - Death [January 1, 2016 to February 28, 2020]
Death due to pancreatic diseases caused by alcohol (K85.2, K86.0)
- Gastritis caused by alcohol - Hospitalization [January 1, 2016 to February 28, 2020]
Incidence of hospitalization due to gastritis caused by alcohol (K29.2)
- Gastritis caused by alcohol - Death [January 1, 2016 to February 28, 2020]
Death due to gastritis caused by alcohol (K29.2)
- Alcoholic cardiomyopathy - Hospitalization [January 1, 2016 to February 28, 2020]
Incidence of hospitalization due to alcoholic cardiomyopathy (I42.6)
- Alcoholic cardiomyopathy - Death [January 1, 2016 to February 28, 2020]
Death due to alcoholic cardiomyopathy (I42.6)
- Nervous system disorders caused by alcohol - Hospitalization [January 1, 2016 to February 28, 2020]
Incidence of hospitalization due to degeneration of the nervous system due to alcohol, epileptic seizures related to alcohol, alcoholic polyneuropathy, alcoholic myopathy (G312, G4051, G621, G721)
- Nervous system disorders caused by alcohol - Death [January 1, 2016 to February 28, 2020]
Death due to degeneration of the nervous system due to alcohol, epileptic seizures related to alcohol, alcoholic polyneuropathy, alcoholic myopathy (G312, G4051, G621, G721)
- Alcohol poisoning - Hospitalization [January 1, 2016 to February 28, 2020]
Incidence of hospitalization due to alcohol poisoning (T51, X45)
- Alcohol poisoning - Death [January 1, 2016 to February 28, 2020]
Death due to alcohol poisoning (T51, X45)
Eligibility Criteria
Criteria
Inclusion Criteria:
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Permanent residents (defined by Statistics Finland as those Finnish and foreign nationals who have a legal domicile in Finland and intend to stay (or have stayed) for at least one year) alive in Finland by December 31, 2015
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Age 25 years or older by January 1, 2016
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Not having an alcohol-attributable hospitalization during the past three years ((January 2013-December 2015
Exclusion Criteria:
- Temporary residents, including foreign nationals living in Finland for less than a year, asylum seekers who have not been granted a legal domicile, temporary migrant workers and Finnish nationals living temporarily abroad by December 31, 2015
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Finnish Institute for Health and Welfare
- Social Insurance Institution, Finland
Investigators
- Principal Investigator: Sebastián Peña, MD, PhD, Finnish Institute for Health and Welfare
- Study Chair: Sonja Lumme, PhD, Finnish Institute for Health and Welfare
- Study Chair: Päivikki Koponen, PhD, Finnish Institute for Health and Welfare
Study Documents (Full-Text)
More Information
Additional Information:
Publications
- GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018 Sep 22;392(10152):1015-1035. doi: 10.1016/S0140-6736(18)31310-2. Epub 2018 Aug 23. Erratum In: Lancet. 2018 Sep 29;392(10153):1116. Lancet. 2019 Jun 22;393(10190):e44.
- Katikireddi 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 May 10;2(6):e267-e276. doi: 10.1016/S2468-2667(17)30078-6. eCollection 2017 Jun.
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- Mackenbach JP. Should we aim to reduce relative or absolute inequalities in mortality? Eur J Public Health. 2015 Apr;25(2):185. doi: 10.1093/eurpub/cku217. No abstract available.
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- Manthey J, Hassan SA, Carr S, Kilian C, Kuitunen-Paul S, Rehm J. What are the Economic Costs to Society Attributable to Alcohol Use? A Systematic Review and Modelling Study. Pharmacoeconomics. 2021 Jul;39(7):809-822. doi: 10.1007/s40273-021-01031-8. Epub 2021 May 10.
- Pena S, Makela P, Harkanen T, Heliovaara M, Gunnar T, Mannisto S, Laatikainen T, Vartiainen E, Koskinen S. Measurement error as an explanation for the alcohol harm paradox: analysis of eight cohort studies. Int J Epidemiol. 2021 Jan 23;49(6):1836-1846. doi: 10.1093/ije/dyaa113.
- Pena S, Makela P, Laatikainen T, Harkanen T, Mannisto S, Heliovaara M, Koskinen S. Joint effects of alcohol use, smoking and body mass index as an explanation for the alcohol harm paradox: causal mediation analysis of eight cohort studies. Addiction. 2021 Aug;116(8):2220-2230. doi: 10.1111/add.15395. Epub 2021 Jan 28.
- Probst C, Kilian C, Sanchez S, Lange S, Rehm J. The role of alcohol use and drinking patterns in socioeconomic inequalities in mortality: a systematic review. Lancet Public Health. 2020 Jun;5(6):e324-e332. doi: 10.1016/S2468-2667(20)30052-9.
- Probst C, Lange S, Kilian C, Saul C, Rehm J. The dose-response relationship between socioeconomic deprivation and alcohol-attributable mortality risk-a systematic review and meta-analysis. BMC Med. 2021 Nov 5;19(1):268. doi: 10.1186/s12916-021-02132-z.
- Room R, Ferris J, Laslett AM, Livingston M, Mugavin J, Wilkinson C. The drinker's effect on the social environment: a conceptual framework for studying alcohol's harm to others. Int J Environ Res Public Health. 2010 Apr;7(4):1855-71. doi: 10.3390/ijerph7041855. Epub 2010 Apr 21.
- Sadler S, Angus C, Gavens L, Gillespie D, Holmes J, Hamilton J, Brennan A, Meier P. Understanding the alcohol harm paradox: an analysis of sex- and condition-specific hospital admissions by socio-economic group for alcohol-associated conditions in England. Addiction. 2017 May;112(5):808-817. doi: 10.1111/add.13726. Epub 2017 Feb 6.
- Syden L, Sidorchuk A, Makela P, Landberg J. The contribution of alcohol use and other behavioural, material and social factors to socio-economic differences in alcohol-related disorders in a Swedish cohort. Addiction. 2017 Nov;112(11):1920-1930. doi: 10.1111/add.13889. Epub 2017 Jul 17.
- KKO-Inv 4-Johto-VPT-Terveysind