The alcohol harm paradox: using a national survey to explore how alcohol may disproportionately impact health in deprived individuals
The alcohol harm paradox: using a national survey to explore how alcohol may disproportionately impact health in deprived individuals
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DOI：
10.1186/s12889-016-2766-x
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发表时间：
2016-02-18
影响因子：
4.5
通讯作者：
Jones, Lisa
中科院分区：
文献类型：
--
作者：
Bellis, Mark A.;Hughes, Karen;Jones, Lisa
背景：国际上的研究表明，贫困社区（与较富裕社区）相似的酒精消费水平会导致更高水平的与酒精相关的疾病。解释这种酒精危害悖论的假设包括：饮酒不足的人：遭受更大的综合健康挑战（例如吸烟、肥胖），从而加剧酒精危害的影响；表现出更有害的消费模式（例如暴饮暴食）；有有害消费史；以及不成比例地少报消费。我们使用定制的全国调查来评估每个假设。方法：对英国成年人（n = 6015）进行了一项全国电话调查（2013 年 5 月至 2014 年 4 月），旨在测试这种酒精危害悖论。剥夺是按居住地区分配的。问题考察的因素包括：当前和历史的饮酒模式；综合健康挑战（吸烟、饮食、运动和体重）；以及漏报的消费情况（加强对非典型/特殊场合饮酒的询问）。对于每个因素，分析检查了在控制总饮酒量的情况下，贫困人群和较富裕人群之间的差异。结果：与总饮酒量无关，贫困饮酒者更有可能吸烟、超重，并报告不良饮食和运动。因此，被剥夺的高风险饮酒者（男性> 168-400克，女性> 112-280克酒精/周）比未剥夺的饮酒者高出10倍以上，出现吸烟、超重和不良饮食/运动相结合的行为综合症。剥夺带来的差异显着，但在高风险饮酒者（男性>400克，女性>280克酒精/周）中差异不那么明显。当前的酗酒与剥夺有关，与总消费量无关，并且酗酒史也与低风险和高风险饮酒者的剥夺有关。结论：与富裕的饮酒者相比，被剥夺的增加/较高饮酒者更有可能饮酒，作为一系列危害健康行为的一部分，包括吸烟、超重和不良饮食/运动。这些因素共同会对完全（例如酒精性肝病）和部分（例如癌症）酒精相关疾病的风险产生倍增效应。尽管饮酒总量与富裕人群没有什么不同，但贫困人群的更多酗酒也会增加受伤和心脏病的风险。需要有关吸烟、不良饮食/锻炼和暴饮暴食如何加剧与酒精相关的健康风险的公共卫生信息，特别是在贫困社区，因为这些信息的缺失将导致健康不平等。
Background: Internationally, studies show that similar levels of alcohol consumption in deprived communities (vs. more affluent) result in higher levels of alcohol-related ill health. Hypotheses to explain this alcohol harm paradox include deprived drinkers: suffering greater combined health challenges (e.g. smoking, obesity) which exacerbate effects of alcohol harms; exhibiting more harmful consumption patterns (e.g. bingeing); having a history of more harmful consumption; and disproportionately under-reporting consumption. We use a bespoke national survey to assess each of these hypotheses.Methods: A national telephone survey designed to test this alcohol harm paradox was undertaken (May 2013 to April 2014) with English adults (n = 6015). Deprivation was assigned by area of residence. Questions examined factors including: current and historic drinking patterns; combined health challenges (smoking, diet, exercise and body mass); and under-reported consumption (enhanced questioning on atypical/special occasion drinking). For each factor, analyses examined differences between deprived and more affluent individuals controlled for total alcohol consumption.Results: Independent of total consumption, deprived drinkers were more likely to smoke, be overweight and report poor diet and exercise. Consequently, deprived increased risk drinkers (male >168-400 g, female >112-280 g alcohol/week) were >10 times more likely than non-deprived counterparts to drink in a behavioural syndrome combining smoking, excess weight and poor diet/exercise. Differences by deprivation were significant but less marked in higher risk drinkers (male >400 g, female >280 g alcohol/week). Current binge drinking was associated with deprivation independently of total consumption and a history of bingeing was also associated with deprivation in lower and increased risk drinkers.Conclusions: Deprived increased/higher drinkers are more likely than affluent counterparts to consume alcohol as part of a suite of health challenging behaviours including smoking, excess weight and poor diet/exercise. Together these can have multiplicative effects on risks of wholly (e.g. alcoholic liver disease) and partly (e.g. cancers) alcohol-related conditions. More binge drinking in deprived individuals will also increase risks of injury and heart disease despite total alcohol consumption not differing from affluent counterparts. Public health messages on how smoking, poor diet/exercise and bingeing escalate health risks associated with alcohol are needed, especially in deprived communities, as their absence will contribute to health inequalities.