Small area associations between social context andalcohol-attributable mortality in a middle income country

Abstract

Background: Little is known about the association between alcohol-attributable mortality and small areasocioeconomic variables when considering causes both wholly and partially attributable to alcohol.Methods: An ecological study was conducted of the entire Chilean population aged 15 and older in 345municipalities nationwide between 2004 and 2009. Deaths were attributed to alcohol consumption eitherwholly or partially, along with the estimated attributable fractions for each specified cause. Each munic-ipality was characterized according to its average income and educational attainment. Estimates of theecological associations were produced using a hierarchical Bayesian model, separating out deaths causedby alcohol and dividing them into seven groups of causes.Results: Alcohol-attributable mortality risk showed an inverse association with income and education atthe ecological level. A one-quintile increase in income was associated with an average decrease in risk of10% (CI 95%: 10–20%) for cardiovascular deaths, 8% (6–10%) for intentional injuries and 7% (3–11%) forunintentional injuries. No associations were found between deaths due to cancers and other causes withincome and education.Conclusions: Municipalities with lower income and education have higher risk of alcohol-attributablemortality in Chile.