The contribution of alcohol use and other lifestyle factors to socioeconomic differences in all-cause mortality in a Swedish cohort

Introduction and Aims: A relationship between socioeconomic position (SEP) and mortality has been found in high-income countries. One possible explanation is socioeconomic differentials in health behaviours. The aim was to investigate to what degree the association between SEP and all-cause mortality is explained by differences in alcohol use and other lifestyle factors. Design and Methods: The study was based on data from a large public health survey from Stockholm County in 2002, with 5year follow-up for all-cause mortality. Proportional hazard models estimated the effect of education, occupational class and income on all-cause mortality, before and after adjusting for alcohol use (both separate and combined effects of levels and patterns of drinking), smoking, physical activity and body mass index. Results: The prevalence of lifestyle factors showed a marked social gradient. All three SEP indicators showed higher mortality for the most disadvantaged SEP group than in the least disadvantaged group. Adjusting for a combined measure of alcohol use attenuated the SEP differences in mortality by a fifth, whereas adjusting for volume of consumption resulted in considerably smaller attenuations. Adjusting for smoking resulted in attenuations of 6-18%. In the fully adjusted model, physical activity and body mass index did not account for the socioeconomic differences in mortality beyond that of alcohol and smoking.<> Discussion and Conclusions: Irrespective of whether SEP is defined by education, occupational class or income, the unequal distribution of hazardous alcohol use and smoking contributes to a notable proportion of the socioeconomic differences in mortality in Sweden.