Socio-economic differences in all-cause mortality in people with alcohol use disorder: a prospective cohort study

While alcohol-attributable mortality rates are higher in low socio-economic status (SES) groups, less is known about SES differences in all-cause mortality in alcohol use disorder (AUD). The aim of this study was to explore whether there are SES differences in people with AUD, regarding (i) treatment admission, (ii) all-cause mortality risk and (iii) relative mortality risk.

A prospective cohort study in Norway, follow-up period from 2009-10 to 2013. Data on SES and mortality were obtained through linkages to national registries, using national unique ID numbers.

AUD patients (age 20+) admitted to treatment in 2009-10 (n = 11 726) and age and gender frequency-matched controls from the general population (n = 12 055).

The SES indicator was education level (low, intermediate and high). Mortality was calculated as deaths per 1000 person-years during the 4-year observation period.

Admission to AUD treatment was elevated in the low compared with the high SES categories (OR = 3.31, 95% CI = 3.09, 3.55). Among AUD patients, mortality risk was elevated in the low SES category (HR = 1.23, 95% CI = 1.04, 1.45). Relative mortality risk from AUD was significantly higher in the high SES (HR = 8.65, 95% CI = 6.16, 12.14) compared with the low SES categories (HR = 3.29, 95% CI = 2.61, 4.15).

Admission to treatment for alcohol use disorders in Norway appears to decrease with increasing socio-economic status, and relative mortality risk from alcohol use disorder appears to increase with increasing socio-economic status.