Associations between interrelated dimensions of socio-economic status, higher risk drinking and mental health in South East London: A cross-sectional study

Aim
To examine patterns of hazardous, harmful and dependent drinking across different socio-economic groups, and how this relationship may be explained by common mental disorder.
Methods and findings
Between 2011–2013, 1,052 participants (age range 17–91, 53% female) were interviewed for Phase 2 of the South East London Community Health study. Latent class analysis was used to define six groups based on multiple indicators of socio-economic status in three domains. Alcohol use (low risk, hazardous, harmful/dependent) was measured using the Alcohol Use Disorders Identification Test and the presence of common mental disorder was measured using the revised Clinical Interview Schedule. Multinomial regression was used to explore associations with hazardous, harmful and dependent alcohol use, including after adjustment for common mental disorder.
Harmful and dependent drinking was more common among people in Class 2 ‘economically inactive renters’ (relative risk ratio (RRR) 3.05, 95% confidence interval (CI) 1.07–8.71), Class 3 ‘economically inactive homeowners’ (RRR 4.11, 95% CI 1.19–14.20) and Class 6 ‘professional renters’ (RRR 3.51, 95% CI 1.14–10.78) than in Class 1 ‘professional homeowners’. Prevalent common mental disorder explained some of the increased risk of harmful or dependent drinking in Class 2, but not Class 3 or 6.
Conclusions
Across distinct socio-economic groups in a large inner-city sample, we found important differences in harmful and dependent drinking, only some of which were explained by common mental disorder. The increased risk of harmful or dependent drinking across classes which are very distinct from each other suggests differing underlying drivers of drinking across these groups. A nuanced understanding of alcohol use and problems is necessary to understand the inequalities in alcohol harms.

研究目的：探究不同社会经济群体的危险饮酒、有害饮酒与酒精依赖模式，以及常见精神障碍对上述关联的介导作用。
研究方法与结果：2011—2013年，针对伦敦东南部社区健康研究（South East London Community Health Study）第二阶段，研究人员对1052名参与者（年龄范围17~91岁，女性占比53%）开展访谈。研究采用潜类别分析（Latent Class Analysis），基于三个维度下的多项社会经济地位指标，将参与者划分为6个组别。使用酒精使用障碍识别测试（Alcohol Use Disorders Identification Test）评估酒精使用情况（分为低风险、危险饮酒、有害饮酒/酒精依赖），采用修订版临床访谈量表（revised Clinical Interview Schedule）评估常见精神障碍的检出情况。采用多分类回归分析探究危险饮酒、有害饮酒与酒精依赖的关联，并校正常见精神障碍的混杂影响。
相较于第1组“专业人士房主群体”，第2组“无经济活动的租房群体”（相对风险比（relative risk ratio, RRR）3.05，95%置信区间（confidence interval, CI）1.07~8.71）、第3组“无经济活动的自有住房群体”（RRR 4.11，95%CI 1.19~14.20）及第6组“专业人士租房群体”（RRR 3.51，95%CI 1.14~10.78）的有害饮酒与酒精依赖检出率更高。常见精神障碍的流行可部分解释第2组有害饮酒或酒精依赖风险升高的现象，但无法解释第3组与第6组的此类风险升高。
研究结论：在大型中心城区样本的不同社会经济群体中，有害饮酒与酒精依赖的检出情况存在显著差异，其中仅部分差异可由常见精神障碍解释。不同特征组别间有害饮酒或酒精依赖风险均出现升高，提示不同群体的饮酒行为潜在驱动因素存在差异。要厘清酒精相关伤害的社会经济不平等问题，需对酒精使用及相关问题形成精细化的认知。