TY - JOUR
T1 - Socioeconomic inequalities in alcohol-related harm in adolescents
T2 - a prospective cohort study of 68,299 Danish 15–19-year-olds
AU - Tolstrup, Janne S.
AU - Kruckow, Sofie
AU - Becker, Ulrik
AU - Andersen, Ove
AU - Sawyer, Susan M.
AU - Katikireddi, Srinivasa Vittal
AU - Møller, Sanne Pagh
N1 - Funding Information:
The authors would like to thank all schools and students who participated in the Danish National Youth Study 2014. In addition, we thank the teachers who helped coordinate the data collection. The study was funded by Tryg Foundation (ID: 153539 ). SVK acknowledges funding from the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SCAF/15/02).
PY - 2023/8
Y1 - 2023/8
N2 - Background: Evidence shows that similar levels of alcohol consumption lead to greater harm in adults with low socioeconomic position (SEP) compared to high SEP. We investigated if SEP is associated with alcohol-related hospital contacts in adolescents, and whether differences in risk can be explained by differences in levels of alcohol consumption, drinking pattern, and substance use. Methods: This is a prospective cohort study of 68,299 participants aged 15–19 years old from the Danish National Youth Cohort 2014. SEP was operationalised as parent educational level, family income and perceived financial strain in the family. Data were linked to national registers and participants were followed up for five years from 2014 to 2019. Outcomes were hospital contacts due to alcohol. Multilevel Poisson regression was used to estimate incidence rates (IR) and incidence rate ratios (IRR). Findings: During 280,010 person years of follow-up, 872 participants had an alcohol-attributable hospital contact; intoxications (n = 778, 89%) were the most common diagnosis. Low as compared to high SEP was associated with higher IRR of alcohol-attributable hospital contacts for all three SEP measures. The adjusted IRR of harm was 1.73 (95% CI: 1.29–2.33) for elementary school as the highest parent education compared to longer parent education and 1.57 (95% CI: 1.30–1.89) for family financial strain compared to those without financial strain. Adjustment for weekly alcohol intake, drinking pattern and substance use did not substantially change results. Cubic spline analysis of the association between family income and alcohol-attributable hospital contacts revealed a dose–response relationship with decreasing risk of alcohol-related harm with higher income. Interpretation: Our findings suggested that alcohol-related harm is more common in socioeconomically disadvantaged adolescents despite similar levels of alcohol consumption, regardless of differences in drinking pattern or substance use. Future preventive strategies should prioritise young adolescents, including those who are most disadvantaged. Funding: Tryg Foundation (ID: 153539).
AB - Background: Evidence shows that similar levels of alcohol consumption lead to greater harm in adults with low socioeconomic position (SEP) compared to high SEP. We investigated if SEP is associated with alcohol-related hospital contacts in adolescents, and whether differences in risk can be explained by differences in levels of alcohol consumption, drinking pattern, and substance use. Methods: This is a prospective cohort study of 68,299 participants aged 15–19 years old from the Danish National Youth Cohort 2014. SEP was operationalised as parent educational level, family income and perceived financial strain in the family. Data were linked to national registers and participants were followed up for five years from 2014 to 2019. Outcomes were hospital contacts due to alcohol. Multilevel Poisson regression was used to estimate incidence rates (IR) and incidence rate ratios (IRR). Findings: During 280,010 person years of follow-up, 872 participants had an alcohol-attributable hospital contact; intoxications (n = 778, 89%) were the most common diagnosis. Low as compared to high SEP was associated with higher IRR of alcohol-attributable hospital contacts for all three SEP measures. The adjusted IRR of harm was 1.73 (95% CI: 1.29–2.33) for elementary school as the highest parent education compared to longer parent education and 1.57 (95% CI: 1.30–1.89) for family financial strain compared to those without financial strain. Adjustment for weekly alcohol intake, drinking pattern and substance use did not substantially change results. Cubic spline analysis of the association between family income and alcohol-attributable hospital contacts revealed a dose–response relationship with decreasing risk of alcohol-related harm with higher income. Interpretation: Our findings suggested that alcohol-related harm is more common in socioeconomically disadvantaged adolescents despite similar levels of alcohol consumption, regardless of differences in drinking pattern or substance use. Future preventive strategies should prioritise young adolescents, including those who are most disadvantaged. Funding: Tryg Foundation (ID: 153539).
KW - Adolescents
KW - Alcohol harm paradox
KW - Alcohol-attributable hospital contact
KW - Alcohol-related harm
KW - Intoxication
KW - Poisoning
KW - Socioeconomic inequality
U2 - 10.1016/j.eclinm.2023.102129
DO - 10.1016/j.eclinm.2023.102129
M3 - Journal article
C2 - 37576460
AN - SCOPUS:85169783958
SN - 2589-5370
VL - 62
JO - eClinicalMedicine
JF - eClinicalMedicine
M1 - 102129
ER -