Social inequalities in alcohol-related mortality by NS-SEC

(England and Wales, 2001-03)

Véronique Siegler, Alaa Al-Hamad, Brian Johnson

Office for National Statistics (ONS), Health and Life Events Division (HLED)

Nick Sheron, Southampton University

Overview of presentation

• Aim of study (Historical perspective ; inequalities and gender; inequalities and age)

• Methods (Causes of death included in the analysis, NS-SEC, data sources, measures

of inequalities)

• Findings (Mortality rates by NS-SEC; by gender, age and region)

• Possible causes of inequalities in alcohol-related mortality

• Conclusion

Aim of study

- Recent literature suggest social gradient in alcohol-related mortality for men

(Breakwell et al., 2007; Romeri et al., 2007; Harrison and Gardiner, 1999)

- By contrast, earlier data suggest a reversed social gradient in alcohol-related mortality for men in the middle of the 20th century

(OPCS, 1951)

- Recent literature suggest a possible change in the pattern of inequalities in alcohol-related mortality for women in the last 20 years

(Erskine et al., 2010; Breakwell et al., 2007; Harrison and Gardiner, 1999)

Aim of study

- People in England and Wales are increasingly dying from alcohol-related causes at earlier ages (ONS Mortality data, 2011)

- Inequalities in mortality wider at younger ages over the past 20 years for both men and women (Erskine et al., 2010; Harrison and Gardiner, 1999)

Our study is the first analysis of the social inequalities in adult alcohol-related mortality in England and Wales using the National Statistics Socio-economic Classification (NS-SEC)

Causes of death included in the analysis

ICD-10 Code

Description

F10 Mental and behavioural disorders due to use of alcohol

G31.2 Degeneration of nervous system due to alcohol

G62.1 Alcoholic polyneuropathy

I42.6 Alcoholic cardiomyopathy

K29.2 Alcoholic gastritis

K70 Alcoholic liver disease

K73 Chronic hepatitis, not elsewhere classified

K74 Fibrosis and cirrhosis of liver (excluding K74.3-K74.5; Biliary cirrhosis)

K86.0 Alcoholic induced chronic pancreatitis

X45 Accidental poisoning and exposure to alcohol

X65 Intentional self-poisoning by and exposure to alcohol

Y15 Poisoning by and exposure to alcohol, intent undetermined

National Statistics Socio-economic Classification (NS-SEC)

NS-SEC analytic classes Examples of occupations included

1.1 Large employers,higher managers

Chief executives and senior officials; officers in armed forces; senior officersin police, fire, prison etc.; marketing, sales, financial directors.

1.2 Higher professionalsCivil engineers; medical practitioners; lawyers; architects; scientists;programmers and software development professionals; aircraft pilots.

2Lower managerial,professional

Journalists; primary/secondary teachers; nurses; midwives; social workers;artists; sports players; business sales executives; estate agents.

3 IntermediateParamedics; dispensing opticians; police officers (sergeant and below);administrative occupations; bank and post office clerks; secretaries.

4Small employers,own account workers

Managers and proprietors of hairdressing/ beauty salon, restaurant, garage,etc.; shopkeepers; farmers; self-employed carpenters or plasterers.

5Lower supervisorytechnical

Electricians; plumbers; vehicle technicians and mechanics; train drivers; TV,video and audio engineers; bakers; chefs.

6 Semi-routinePolice community support officers. When not employers or self employed: Fitness instructors; receptionists;dental nurses; care workers; telephonists; farm workers; shelf fillers.

7 Routine

Bus and coach drivers; waiters and waitresses; bar staff; cleaners; car parkattendants; metal plates workers and riveters; window fitters. When not employers or self-employed: Bricklayers, masons, roofers,carpenters, plasterers, painters; hairdressers.

Data sources

Data for men aged 25-64 and women aged 25-59, in Wales, England and the regions of England:

• DEATH REGISTRATIONS - numerator- Cause of death (ICD-10) - Age, sex, occupation and employment status (NS-SEC) - Region

• CENSUS 2001 - denominator (Person Years at Risk)- Age, sex, occupation and employment status (NS-SEC) - Region

Measure of inequalities

• Age-specific mortality rates by five-year age group and by NS-SEC

• European Age-standardised mortality rates by NS-SEC and region

Adjustments to mortality and population data – for more details see Siegler et al., HSQ 50

• Socio-economic gradients (ratios between mortality rates in NS-SEC class 7 and in NS-SEC class 1)

Adjusted number of alcohol-related deaths by NS-SEC, 2001-03

England and Wales

NS-SEC analytic classes Men aged 25-64

Women aged 25-59

1 Higher managerial and professional 603 239

1.1 Large employers and higher managerial

207 124

1.2 Higher professional 396 116 2 Lower managerial & professional 1,282 709 3 Intermediate 347 427

4 Small employers & own account workers

1,122 289

5 Lower supervisory and technical 1,115 376 6 Semi-routine 1,250 668 7 Routine 1,875 578

Non-occupied 1,344 327 All classes 8,938 3,613

Age-specific mortality from alcohol-related causes of death by five-year age group and NS-SEC, men aged 25-64, England and Wales,

2001-03

Age-specific mortality from alcohol-related causes of death by five-year age group and NS-SEC, women aged 25-59, England and Wales, 2001-03

Socio-economic gradients

(Mortality ratios NS-SEC class 7: NS-SEC class 1)

England and Wales

Ratio 7:1 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Men 15.5 (3.7, 65.0)

6.6 (3.9, 11.3)

7.2 (4.9, 10.5)

6.5 (4.9, 8.7)

27.1 (4.0, 6.3)

3.0 (2.5, 3.6)

2.6 (2.1, 3.1)

1.8 (1.4, 2.2)

Women 1.5 (0.4, 5.7)

8.7 (3.9, 19.4)

6.8 (4.2, 11.1)

8.7 (5.9, 12.9)

6.5 (4.8, 8.8)

5.4 (3.9, 7.3)

3.6 (2.6, 5.0)

*

Age-standardised mortality rates from alcohol-related causes of death by NS-SEC, men aged 25-64 and women aged 25-59, England and Wales, 2001-03

Overall mortality rates and socio-economic gradients in mortality for alcohol-related cause of death, regions of England and Wales, 2001-03

Men Women Regions of England

and Wales Mortality rate (All classes)

Ratio 7:1 Mortality rate (All classes)

Ratio 7:1

England and Wales

19.0 (18.6,19.4)

3.5 (3.2, 3.8)

9.0 (8.7, 9.4)

5.7 (4.7, 6.9)

North East 23.7 (21.4,25.9)

3.6 (2.5, 5.3)

13.2 (11.5,14.9)

3.0 (1.9, 4.8)

North West 26.9 (25.5,28.3)

3.5 (2.8, 4.3)

14.1 (13.0,15.2)

5.9 (4.3, 8.2)

Yorkshire and the Humber

18.3 (17.0,19.7)

4.0 (3.0, 5.4)

8.4 (7.4, 9.3)

6.0 (3.8, 9.4)

East Midlands

15.5 (14.1,16.8)

2.5 (1.8, 3.4)

7.8 (6.8, 8.8)

4.0 (2.5, 6.2)

West Midlands

23.6 (22.1,25.1)

2.9 (2.3, 3.6)

10.3 (9.2, 11.3)

7.2 (4.8, 10.8)

East of England

12.4 (11.3,13.4)

2.7 (2.0, 3.6)

5.9 (5.1, 6.6)

3.8 (2.6, 5.7)

London 21.3 (20.0,22.7)

3.4 (2.6, 4.3)

8.3 (7.4, 9.2)

7.4 (4.9, 11.2)

South East 15.5 (14.5,16.5)

4.2 (3.4, 5.3)

7.0 (6.3, 7.7)

6.6 (4.5, 9.5)

South West

15.2 (14.0,16.4)

3.0 (2.2, 4.0)

7.2 (6.4, 8.1)

4.5 (2.9, 6.8)

Wales 21.0 (19.0,22.9)

4.5 (3.1, 6.6)

10.5 (9.1, 11.9)

5.0 (3.2, 8.1)

Summary of results (1)

• Substantial inequalities in adult alcohol-related mortality were observed

• Inequalities in mortality were greater for women than for men

• Both men and women in the less advantaged classes (NS-SEC classes 5, 6, 7) had significantly higher mortality rates than in England and Wales as a whole

• Greater inequalities in mortality were observed for younger men aged 25-49 than for men aged 50-64

• Highest mortality rate of men: Routine workers (NS-SEC 7) aged 50-54 (52.2 per 100,000)

Summary of results (2)

• Women in Routine occupations (NS-SEC class 7) experienced mortality rates markedly higher than other classes

• Mortality rate of women in Routine occupations (22.4 per 100,000) was similar to that of men in the Lower supervisory and technical class (NS-SEC class 5)

• Highest mortality rate of women: Routine workers (NS-SEC 7) aged 45-49 (42.0 per 100,000)

Summary of results (3)

- Within England, the largest overall mortality rate was found in the North-West, with particularly high mortality rates in the Routine class for both men and women

- The highest inequalities were observed in Wales for men and in London for women, although with no statistical significance

- The inequalities in mortality were higher for women than for men in all regions with the exception of the North East

- In general, there was no association between levels of mortality and inequalities in mortality across the English regions and Wales

Possible reasons for inequalities in alcohol-related mortality

• Co-factors (Hart et al., 2010; Liu et al., 2010)

• Social selection effects (Blane et al., 1999)

• Alcohol intake; however, inverse relationship in alcohol intake

suggested by repeated population-based sampling surveys (GLS, 2009).

• Drinking patterns might vary across socio-economic classes (Marmot review, 2010; Jefferis et al., 2007). Those patterns might have been acquired at a young age (Baker and

Rooney, 2003: birth cohort effect). • Trends in alcohol pricing (Brennan et al., 2009). The fact that

alcohol has become more affordable might affect different socio-economic groups differently.

Conclusion

The large inequalities in alcohol-related mortality cannot be readily explained in terms of differences in the amounts of alcohol consumed.

Further research is needed to identify what additional factors may determine the higher mortality risk found in the less advantaged NS-SEC classes.

You can download the paper at:

http://www.statistics.gov.uk/cci/article.asp?id=2685

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