Long-term trends in educational inequalities in alcohol-attributable mortality, and their impact on trends in educational inequalities in life expectancy.

BACKGROUND: Previous studies on socio-economic inequalities in mortality have documented a substantial contribution of alcohol-attributable mortality (AAM) to these inequalities. However, little is known about the extent to which AAM has contributed to time trends in socio-economic inequalities in mortality. OBJECTIVE: To study long-term trends in educational inequalities in AAM and assessed their impact on trends in educational inequalities in life expectancy in three European countries. METHODS: We analyzed cause-specific mortality data by educational group (low, middle, high) for individuals aged 30 and older in England and Wales, Finland, and Turin (Italy) over the 1972-2017 period. To estimate AAM, we used the multiple causes of death approach for England and Wales and Finland (1987-2017), and a recently introduced method for Turin (Italy). We used segmented regression analysis to study changes in absolute educational inequalities in AAM, measured by the Slope Index of Inequality (SII). We assessed the contribution of AAM to trends in educational differences in remaining life expectancy at age 30 (e30) using cause-deleted life tables. RESULTS: AAM increased more among the low-educated than the high-educated in England and Wales (1972-2017) and Finland (1987-2007). In contrast, in Finland (2007 onwards) and Turin (1972-2017), AAM decreased more among the low-educated than the high-educated. In England and Wales, AAM contributed 37% (males) and 24% (females) of the increase in educational inequalities in e30. In Finland in 1987-2007, AAM contributed 50% (males) and 34% (females) of the increase in educational inequalities in e30. AAM also contributed to recent trend breaks, such as to the onset of an increase in educational inequalities in e30 in England and Wales, and to the onset of a decline in educational inequalities in e30 in Finland after 2007. DISCUSSION: AAM mortality contributed substantially not only to levels of, but also to changes in educational inequalities in e30 in the studied populations. Reducing the impact of alcohol on mortality among low-educated groups may positively affect trends in educational inequalities in life expectancy.