BACKGROUND: Alcohol-related mortality and morbidity are high in socioeconomically disadvantaged populations compared with individuals from advantaged areas. It is unclear if this increased harm reflects differences in alcohol consumption between these socioeconomic groups, reverse causation (ie, downward social selection for high-risk drinkers), or a greater risk of harm in individuals of low socioeconomic status compared with those of higher status after similar consumption. We aimed to investigate whether the harmful effects of alcohol differ by socioeconomic status, accounting for alcohol consumption and other health-related factors.

METHODS: The Scottish Health Surveys are record-linked cross-sectional surveys representative of the adult population of Scotland. We obtained baseline demographics and data for alcohol consumption (units per week and binge drinking) from Scottish Health Surveys done in 1995, 1998, 2003, 2008, 2009, 2010, 2011, and 2012. We matched these data to records for deaths, admissions, and prescriptions. The primary outcome was alcohol-attributable admission or death. The relation between alcohol-attributable harm and socioeconomic status was investigated for four measures (education level, social class, household income, and area-based deprivation) using Cox proportional hazards models. The potential for alcohol consumption and other risk factors (including smoking and body-mass index [BMI]) mediating social patterning was explored in separate regression models. Reverse causation was tested by comparing change in area deprivation over time.

FINDINGS: 50 236 participants (21 777 men and 28 459 women) were included in the analytical sample, with 429 986 person-years of follow-up. Low socioeconomic status was associated consistently with strikingly raised alcohol-attributable harms, including after adjustment for weekly consumption, binge drinking, BMI, and smoking. Evidence was noted of effect modification; for example, relative to light drinkers living in advantaged areas, the risk of alcohol-attributable admission or death for excessive drinkers was increased (hazard ratio 6.12, 95% CI 4.45-8.41 in advantaged areas; and 10.22, 7.73-13.53 in deprived areas). We found little support for reverse causation.

INTERPRETATION: Disadvantaged 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.

FUNDING: Medical Research Council, NHS Research Scotland, Scottish Government Chief Scientist Office

BACKGROUND: Studies have indicated that moderate alcohol consumption is associated with lower incidence of diabetes in women. However, not only the amount but also the drinking pattern could be of importance when assessing the longitudinal relation between alcohol and glucose. Also, there is a lack of studies on alcohol use beginning in adolescence on adult glucose levels. The aim was to examine the association between total alcohol consumption and binge drinking between ages 16 and 43 and fasting plasma glucose at age 43.

METHODS: Data were retrieved from a 27-year prospective cohort study, the Northern Swedish Cohort. In 1981, all 9th grade students (n = 1083) within a municipality in Sweden were invited to participate. There were re-assessments at ages 18, 21, 30 and 43. This particular study sample consisted of 897 participants (82.8%). Fasting plasma glucose (mmol/L) was measured at a health examination at age 43. Total alcohol consumption (in grams) and binge drinking were calculated from alcohol consumption data obtained from questionnaires.

RESULTS: Descriptive analyses showed that men had higher levels of fasting plasma glucose as compared to women. Men also reported higher levels of alcohol consumption and binge drinking behavior. Linear regressions showed that total alcohol consumption in combination with binge drinking between ages 16 and 43 was associated with elevated fasting plasma glucose at age 43 in women (beta = 0.14, p = 0.003) but not in men after adjustment for BMI, hypertension and smoking at age 43.

CONCLUSIONS: Our findings indicate that reducing binge drinking and alcohol consumption among young and middle-aged women with the highest consumption might be metabolically favorable for their future glucose metabolism.

Published in General Health

OBJECTIVES: Alcohol is a significant source of dietary calories and is a contributor to obesity. Industry pledges to provide calorie information to consumers have been cited as reasons for not introducing mandatory ingredient labelling. As part of the Public Health Responsibility Deal (RD) in England, alcohol retailers and producers committed to providing consumers with information on the calorie content of alcoholic drinks. This study examines what was achieved following this commitment and considers the implications for current industry commitments to provide information on alcohol calories.

STUDY DESIGN: Analysis of RD pledge delivery plans and progress reports. Assessment of calorie information in supermarkets and in online stores.

METHODS: (i) Analysis of the content of pledge delivery plans and annual progress reports of RD signatories to determine what action they had committed to, and had taken, to provide calorie information. (ii) Analysis of the availability of calorie information on product labels; in UK supermarkets; and on online shopping sites and websites.

RESULTS: No information was provided in any of 55 stores chosen to represent all the main UK supermarkets. Calorie information was not routinely provided on supermarkets' websites, or on product labels.

CONCLUSIONS: One of the stated purposes of the RD was to provide consumers with the information to make informed health-related choices, including providing information on the calorie content of alcoholic drinks. This study indicates that this did not take place to any significant extent. The voluntary implementation of alcohol calorie labelling by industry needs to continue to be carefully monitored to determine whether and how it is done.

Published in General Health

INTRODUCTION AND AIMS: This study aims to estimate the prevalence of long-term risky drinking within the Australian population and the proportion of standard drinks that is consumed outside of the long-term risk (LTR) guidelines of two Australian standard drinks (ASD) per day.

DESIGN AND METHODS: Recruited by phone, 2020 Australian adults with an oversampling of risky drinkers were asked detailed questions about how much alcohol they consumed at a range of locations in 2013. Descriptive statistical analyses of data weighted to be representative of the Australian adult population were undertaken, with a focus on the ASD consumed above the LTR guidelines.

RESULTS: Although 28% of respondents drink at levels above the LTR drinking guidelines, 56% of all ASD consumed are above the two per day recommended to reduce LTR. Three-quarters of cask wine and liqueurs were consumed outside of the LTR guidelines, as were 58% of all ASD consumed in the home, similar to the proportion of ASD consumed above the guidelines in pubs (55%).

DISCUSSION AND CONCLUSIONS: While the minority of Australians drink to LTR levels, the majority of alcohol is consumed by long-term risky drinkers. More research and policy focus on the patterns of alcohol consumption that lead to long-term risk, particularly outside of licensed premises, is required.

[Callinan S, Livingston M, Room R, Dietze PM. How much alcohol is consumed outside of the lifetime risk guidelines in Australia?. Drug Alcohol Rev 2017;00:000-000]

Published in Drinking Patterns
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