The socioeconomic profile of alcohol use in Europe: Findings from a cross-sectional survey of 33 European countries

Background: Alcohol's detrimental health effects do not affect everyone equally, but accumulate in people with low socioeconomic status (SES). This has been posited as partly due to differences in consumption patterns, and previous studies have provided evidence of such SES-linked differences, with low-SES individuals being more likely to abstain or drink heavily than their high-SES counterparts. Using data from the 2021 Standard European Alcohol Survey, we explore gender-and SES-specific alcohol consumption patterns, as well as COVID-19-related changes in alcohol consumption, in the largest and most recent pan-European alcohol study.Methods: Cross-sectional population-based survey data from 54,354 adults in 33 European countries, were analysed. Five alcohol indicators were of interest: prevalence of past-year alcohol use; and-among past-year alcohol users only-prevalence of monthly/more frequent risky single-occasion drinking (monthly+ RSOD); prevalence of high-risk alcohol use (40+/60+ grams pure alcohol daily for women/men); mean daily grams of pure alcohol consumed; and self-reported consumption changes during COVID-19. Alcohol indicators were weighted and stratified by gender and SES (educational attainment), and analysed using logistic and linear regression models with location-specific random intercepts. Results: Across jurisdictions, we observed distinct gender-specific socioeconomic profiles of alcohol use. While high-SES men and women were generally more likely to report past-year alcohol use compared to those with low/mid-SES (odds ratio [OR]: 1.37, 95% CI [1.29, 1.46]), monthly+ RSOD (OR: 0.91, 95% CI [0.86, 0.96]) and high-risk drinking (OR: 0.83, 95% CI [0.77, 0.91]) were less prevalent among currently drinking high-SES men. No such SES differences were observed among women (all p > .5), however, mean daily drinking levels were on average 13% higher (95% CI [0.09, 0.18]) in high-SES than low/mid-SES female alcohol users. High-SES women (but not men) were more likely to have either increased or decreased their drinking during COVID-19 compared to low/mid-SES counterparts.Conclusions: High consumption levels and distinct socioeconomic profiles among men and women highlight the need for nuanced, effective alcohol policies to reduce European health inequalities.