Socioeconomic inequities in alcohol-attributable mortality by sex/gender and age in Canada: a 13-year population-representative cohort study

Abstract

Individuals with low socioeconomic position (SEP) experience greater rates of alcohol-attributable mortality, contributing to health inequities in mortality and life expectancy. We examined the association between SEP and alcohol-attributable mortality by sex/gender and age in Canada. Census records from the 2006 Canadian Census Health and Environment Cohort (ages 12+; n = 5038790) were linked to mortality data from 2006 to 2019. SEP was measured by educational attainment and household income. Poisson and Fine and Gray subdistribution hazard models estimated rate differences (RDs) per 100000 person-years and hazard ratios (HRs). Both educational attainment and household income were inversely associated with alcohol-attributable mortality. Absolute SEP inequities were greater among men than women, with an RD of 30.81 (95% CI, 28.04-33.57) for men and 9.86 (95% CI, 8.49-11.22) for women when comparing the lowest to the highest income quintile. Age-stratified analyses showed absolute SEP inequities were most pronounced in middle and older adulthood, above age 30 for women and age 50 for men, with smaller RDs in ages 12 to 29. Relative SEP inequities were similar in women and men, with greater HRs at younger ages. Public health policies addressing social determinants and population-level alcohol policies should consider patterning of SEP inequities by sex/gender and age group.