The disadvantage of being advantaged?--on a social gradient in excess mortality among alcohol abusers

Do alcohol abusers from upper social classes have a more elevated excess mortality than alcohol abusers from lower social classes? This question was empirically assessed by analyses on data from a 40-year prospective study of more than 40,000 Norwegian conscripts on whom data on social class (i.e. educational level), alcohol abuse (admission to treatment) and cause specific mortality before the age of 60 years were available. The results demonstrated a social gradient in excess mortality: relative risk of premature death was 2.7 among those with the lowest educational level (primary school only) increasing to 6.2 among those with the highest educational level at conscription (grammar school). Among the alcohol abusers the risk of premature death, was slightly, but not significantly higher among those highly educated as compared to those with less education. Thus, alcohol abuse was not only found to elevate the individual's risk of premature death, but it also appeared to outweigh the advantages of those more socially privileged with respect to health and mortality. The question as to whether social class differences in selection to treatment could account for the observed social gradient in excess mortality is focused in the discussion.