This was a systematic literature review of research looking at the relationship between social status and alcohol to help understand the alcohol harm paradox funded by an Alcohol Research UK research and development grant.
- There is good evidence that people with low individual or neighbourhood socioeconomic status (SES) show a greater susceptibility to the harmful effects of alcohol, but a lack of evidence means that it is not possible to conclude what mechanisms and pathways might underlie this difference in risk.
- Lower SES is associated with an almost two fold greater risk of alcohol related death compared with individuals in higher SES classifications.
- Relative to high SES, low SES is associated with an increased risk of head and neck cancers, strokes, hypertension, liver disease and pre-term birth. These findings are independent of a number of other known risk factors for these conditions such as diet and smoking.
- Although people in different SES groups do not differ in the unit amount and frequency of alcohol drunk across the week, there are important differences in ‘binge drinking’, beverage choice, and patterns of heavy drinking.
- There is under-reporting of alcohol use in general population surveys of alcohol use, and this differs by alcohol risk rather than SES.
- The use of alternative survey methodologies captures a greater amount of population alcohol use. This also leads to more people being classified as at increasing and higher risk from their alcohol use.
You can read the full final report pdf here
What interests me is the under-reporting of alcohol use generally and how that is skewing data. As this research states: ‘The alcohol harm paradox may not in fact be genuine and is instead a result of inaccurate reporting of alcohol consumption.‘ That would be my guess as from experience we would routinely double whatever was reported to us as a more accurate reflection of their consumption whether this was alcohol or cigarettes. If someone is talking to a healthcare professional about a substance that we know is bad for us and we shouldn’t be consuming we all have a tendency to say we engage in the behaviour less than we actually do and I was no different in that behaviour which is why I know it happens!
Edited to add 20th July 2016:
Unravelling the alcohol harm paradox: a population-based study of social gradients across very heavy drinking thresholds
Low socioeconomic status groups are more likely to drink at extreme levels, which may partially explain the alcohol harm paradox. Policies that address alcohol-related health inequalities need to consider extreme drinking levels in some sub-groups that may be associated with multiple markers of deprivation. This will require a more disaggregated understanding of drinking practices | BioMed Central, UK