研究方法
作者在Embase、Medline、PsycINFO和Web of Science中搜索饮酒、社会经济地位和死亡率的研究报告(发布于2013年1月1日至2019年6月30日)，进行了系统综述。通过纵向研究设计，对普通成年人（≥15岁）进行了观察、定量研究。提取了两个结果指标：首先，通过饮酒可以解释死亡率中社会经济不平等的比例；第二，社会经济地位与饮酒对于死亡风险的影响修正或相互作用。
调查结果
在确定的1941 个记录中，有10 个符合纳入标准。纳入的研究包括400,000多名成年人，各种原因导致的30,000 多人死亡以及3000 多个100％酒精导致死亡事件。饮酒可解释高达27％的社会经济不平等性死亡率。社会经济不平等的比例因饮酒方式而系统性地有所不同，偶发性严重酗酒具有潜在的重要解释价值。尽管数量较少，但有证据表明，社会经济地位和饮酒之间有效应修正或相互作用。
解释
为了减少死亡率方面的社会经济不平等，值得将其作为一项公共卫生战略加以探索，特别是解决偶发性严重酗酒问题，而不是一般性饮酒问题
Abstract
The role of alcohol use and drinking patterns in socioeconomic inequalities in mortality: a systematic review
Carolin Kilian, Sherald Sanchez, Shannon Lange, Prof Jürgen Rehm
Background
Individuals with low socioeconomic status (SES) experience disproportionately greater alcohol-attributable health harm than individuals with high SES from similar or lower amounts of alcohol consumption. Our aim was to provide an update of the current evidence for the role of alcohol use and drinking patterns in socioeconomic inequalities in mortality, as well as the effect modification or interaction effects between SES and alcohol use, as two potential explanations of this so-called alcohol-harm paradox.
Methods
We did a systematic review, searching Embase, Medline, PsycINFO, and Web of Science (published between Jan 1, 2013, and June 30, 2019) for studies reporting alcohol consumption, SES, and mortality. Observational, quantitative studies of the general adult population (aged ≥15 years) with a longitudinal study design were included. Two outcome measures were extracted: first, the proportion of socioeconomic inequalities in mortality explained by alcohol use; and second, the effect modification or interaction between SES and alcohol use regarding mortality risks. This study is registered with PROSPERO (CRD42019140279).
Findings
Of 1941 records identified, ten met the inclusion criteria. The included studies contained more than 400?000 adults, more than 30?000 deaths from all causes, and more than 3000 100% alcohol-attributable events. Alcohol use explained up to 27% of the socioeconomic inequalities in mortality. The proportion of socioeconomic inequalities explained systematically differed by drinking pattern, with heavy episodic drinking having a potentially significant explanatory value. Although scarce, there was some evidence of effect modification or interaction between SES and alcohol use.
Interpretation
To reduce socioeconomic inequalities in mortality, addressing heavy episodic drinking in particular, rather than alcohol use in general, is worth exploring as a public health strategy.
