A systematic review of the association between alcohol-related deaths and area-level socioeconomic deprivation and other geographic characteristics in high-income countries

Background

There are substantial inequalities in alcohol-related mortality related to individual-level education, income, and employment status, but less is known about the association between alcohol-related mortality and the geographic characteristics of an area. This systematic review aims to explore whether area-level features, including area-level measures of socioeconomic status, are associated with alcohol-attributable mortality.

Methods

We systematically searched Medline (Ovid), CINAHL, EMBASE, PsycINFO, Web of Science, Emerald Insight, and Epistemonikos databases (2004 – 2024), supplemented with searches of grey literature, for primary quantitative studies conducted in high-income countries. Eligible studies examined associations between alcohol-attributable morality and one or more geographic characteristic. Studies were quality appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies, the Critical Appraisal Skills Programme for cohort studies, and the National Heart, Lung and Blood Institute checklist was adapted for assessing ecological studies. The findings were synthesised narratively. PROSPERO ID: CRD42024499928.

Results

The searches identified 73 eligible studies covering mortality from a range of alcohol-attributable conditions, including chronic alcohol-specific conditions (e.g. alcohol-related liver disease) and alcohol-related incidents (e.g. road traffic collisions, suicides). Study quality was found to be good in most cases. Urban–rural location was the most common exposure and alcohol-specific mortality was the most common outcome measured in the included studies. Of the 34 studies examining area-level socioeconomic deprivation, all studies found a positive association between deprived areas and alcohol-attributable mortality. Of the 49 studies that examined urban–rural location, 26 (53.1%) found a positive association between rural location and alcohol-attributable mortality. Fourteen studies (28.6%) found urban location significant. Rural locations were particularly associated with alcohol-related road traffic collisions and suicides.

Conclusions

Greater area-level deprivation and rurality are associated with higher rates of alcohol-related mortality.