Inequalities in alcohol-related mortality in Europe

December 01, 2015

Alcohol-related conditions are an important contributing factor to the socioeconomic inequality in total mortality in many European countries, according to a study published this week in PLOS Medicine. The database analysis, conducted by Johan Mackenbach at Erasmus University Medical Center, Rotterdam, The Netherlands, and colleagues indicates that in some countries, alcohol-related causes account for 10% or more of the socioeconomic inequality in total mortality among men.

Globally, about three million people die from alcohol-related causes every year. In many European countries, the frequency of drinking and the levels of alcohol consumption are greater in higher socioeconomic groups, whereas binge drinking and other problematic forms of alcohol consumption occur more frequently in lower socioeconomic groups. Mackenbach and colleagues obtained data on deaths from alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental alcohol poisoning from the mortality registers of 17 European countries. Rates of alcohol-related mortality were higher in individuals with less education or with manual (as opposed to non-manual) occupations in all 17 countries. Absolute inequalities were largest in Eastern Europe, Finland and Denmark. Moreover, the absolute inequalities increased markedly in Hungary, Lithuania, Estonia, Finland, and Denmark because of a rapid rise in alcohol-related mortality in lower socioeconomic groups.

The accuracy of these findings is likely to be affected by the use of routinely collected underlying causes of death. However, these findings indicate that to reduce socioeconomic inequalities in mortality, health professionals and governments need to introduce interventions and policies designed to counter recent increases in alcohol-related mortality in lower socioeconomic groups. The authors state, "[s]tudies of why such increases [in inequality] have not occurred in countries like France, Switzerland, Spain, and Italy can help in developing evidence-based policies in other European countries.
Research Article


Supported by a grant to JPM (FP7-CP-FP grant no. 278511) from the European Commission Research and Innovation Directorate General, as part of the "Developing methodologies to reduce inequalities in the determinants of health" (DEMETRIQ) project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.


Mackenbach JP, Kulhánová I, Bopp M, Borrell C, Deboosere P, Kovács K, et al. (2015) Inequalities in Alcohol-Related Mortality in 17 European Countries: A Retrospective Analysis of Mortality Registers. PLoS Med 12(12): e1001909. doi:10.1371/journal.pmed.1001909

Author Affiliations:

Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands

Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

Agència de Salut Pública de Barcelona, Barcelona, Spain

Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium

Demographic Research Institute, Hungarian Central Statistical Office, Budapest, Hungary

Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden

Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia

National Institute for Health and Welfare, Helsinki, Finland

Department of Sociology, University of Helsinki, Helsinki, Finland

Sorbonne Universités, Université Pierre et Marie Curie (Paris 6), INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France

Department of Demography, Charles University, Prague, Czech Republic



Johan Mackenbach
Erasmus University
Public Health
Dr. Molewaterplein 50
P.O. Box 2040
Rotterdam, 3015 GD


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