Thread by @VictimOfMaths

🚨New paper klaxon🚨

Out now in @AddictionJrnl a really important and excellent piece of work from @jenniferevab systematically reviewing all of the explanations that have been posited for the 'Alcohol Harm Paradox' of inequality in alcohol-related harm

onlinelibrary.wiley.com/doi/10.1111/ad…

Study after study has shown that more deprived groups drink less, but suffer more harm, compared to their more affluent peers. But why?

This review identifies 79 different papers which have collectively suggested 41 different possible explanations for this paradox (the 'AHP').

These can be grouped into six domains:

1) Individual - factors within individuals affecting susceptibility to alcohol-related harm (e.g. poor health)

2) Lifestyle - differences in health behaviour, particularly around risk behaviours (e.g. drinking patterns)

3) Contextual - differences in immediate environment (e.g. where you live and where you drink)

4) Disadvantage - how the lived experience of poverty/disadvantage might affect health outcomes

5) Upstream - wider social determinants of health (e.g. economic factors)

6) Artefactual - the AHP isn't real, it's just an artefact of some bias in the data

The evidence for all of these explanations is reviewed comprehensively in the paper. One key finding is that the overwhelming number of studies which have actually tried to empirically test these explanations have focused on lifestyle/risk behaviours as the cause for the AHP.

While there may be a lot of merit in the other explanations, these are overwhelmingly found as speculative comments in the discussion sections of papers, rather than robustly tested hypotheses.

We can, and should, do more to test these.

Anyway, it's a super paper and @jenniferevab has done an amazing job of synthesising a huge body of evidence into a single, very readable, article 👏