Lower Educational Attainment Widens Racial/Ethnic Disparities in Alcohol Use Disorder

Lower education is a risk factor for alcohol-related deaths, but it is unknown if the impact of education varies by race/ethnicity. We evaluated the interaction between education and race/ethnicity on the odds of alcohol use disorder (AUD) and the significance of employment and poverty as potential mediators.

The 2016-2019 National Survey on Drug Use and Health was used to obtain the weighted prevalence of AUD in participants 26 years and older. Using AUD as the outcome, multivariable logistic regression analyses were performed, stratified by four levels of education, ranging from less than high school to 4-year college+; odds ratios (ORs) for each race/ethnicity were compared across models for interaction. The second model included employment and poverty as covariates; changes in ORs were calculated to assess for >|10%| change implying significant mediating or confounding effects.

AUD prevalence was highest among American Indian/Alaskan Natives (AI/ANs) (8.06%) and similar among non-Hispanic Whites (5.37%) and Blacks (5.09%). When stratified by education, the odds of AUD among Blacks and AI/ANs increased with decreasing education (OR = 1.45, 95% CI [1.07, 1.96]) for Blacks versus Whites with less than high school, compared with 0.55 [0.46, 0.67] for Blacks versus Whites with 4-year college+; 2.55 [1.53, 4.24] for AI/ANs versus Whites with less than high school versus 1.01 [0.45, 2.28] for AI/ANs versus Whites with 4-year college+. Including employment and poverty resulted in <|10%| change in ORs.

Lower education significantly increased the odds of AUD among Blacks and AI/ANs. Employment and poverty did not significantly change the association, implying that there are likely other mechanisms accounting for racial/ethnic disparities in AUD.