Alcohol control policies and socioeconomic inequalities in risky drinking: a 22-year cross-sectional study in a Swiss urban population

José Luis Sandoval, Teresa Leão, Jean-Marc Theler, Thierry Favrod-Coune, Barbara Broers, Jean-Michel Gaspoz, Pedro Marques-Vidal, Idris Guessous.
Alcohol control policies and socioeconomic inequalities in hazardous alcohol consumption: a 22-year cross-sectional study in a Swiss urban population., BMJ Open, May 2019, doi:10.1136/bmjopen-2019-028971

Abstract

Aims: Harmful alcohol consumption represents a significant socioeconomic and health burden, and displays a socioeconomic status (SES) gradient. Several alcohol control laws have been developed and implemented, but their impact on equity remains undetermined. We investigated whether a SES gradient in risky drinking existed in Geneva (Switzerland) and assessed the impact on equity of alcohol control laws implemented over the last two decades.

Design: Study based on repeated cross-sectional surveys.

Setting: We used data from non-abstinent participants aged 35 to 74 from the Bus Santé population-based cross-sectional study (n=16,725), between 1993 and 2014.

Methods: The SES indicators included level of education (primary, secondary and tertiary) and professional level (high, medium and low). We defined four survey periods based on alcohol control laws implemented and risky drinking (outcome variable) defined as >30 g/day for men and >20 g/day for women. The slope inequality index (SII) and relative inequality index (RII) were used to quantify absolute and relative inequality, respectively, and were compared between legislative periods.

Results: Less-educated men had a higher frequency of risky drinking (RII=1.87 (1.57; 2.22) and SII=0.14 (0.11; 0.17)). Less educated women consumed less risky alcohol (RII=0.76 (0.60; 0.97) and SII=-0.04 (-0.07; -0.01)). Over time, risky drinking decreased, except among less-educated men. Inequalities related to education were observed among men in all legislative periods and did not vary between them. Similar results were observed using occupational level as an indicator of SES. For women, significant inverse SES gradients were observed based on education level, but not for occupational level.

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