A bottle of red wine and a broken glass
Foto: Iyrii Seleznev/Mostphotos

“We see a clear pattern, the increase of alcohol-related mortality is significantly higher in the category with a lower level of education than for those with higher education, when the total consumption of alcohol increases.”

This according to Thor Norström, professor emeritus of sociology at the Swedish Institute for Social Research (SOFI) at Stockholm University. Together with researcher Jonas Landberg at the Department of Public Health Sciences, he has used sales figures from the Swedish alcohol monopoly “Systembolaget” to study how changes in alcohol consumption affect alcohol-related mortality in different educational groups in Sweden.

In the study, the population has been divided into three categories depending on their level of education, with low, intermediate and high education. Two types of mortality have been measured in each group: alcohol-specific mortality – where alcohol has been a direct or indirect cause (such as alcohol poisoning or alcohol related illness) – and the so called for "violent deaths" where alcohol is often a contributing factor (e.g. fatal accidents, murders, suicides).


Greater effect on group with lower level of education

The results show that it is in the group with a lower level of education that both the alcohol-specific mortality and violent deaths increases most when the total alcohol consumption in society increases.

Thor Norström, preofessor emeritus in sociology
Thor Norström, professor emeritus in sociology at the Swedish Institute for Social Reseaerch (SOFI) at Stockholm University. Photo: Eva Dalin

“The conclusion that we can draw is that an increase in alcohol consumption has a much greater impact on the group with a lower level of education, compared to the groups with medium or high level of education. The effect of the alcohol-specific mortality rate is more than ten times higher for people with a low level of education compared to those with high education”, says Thor Norström.

There is a lot of research done on how the total consumption of alcohol in society affects alcohol-related harm and mortality in the entire population. But this study, recently published in the scientific journal Drug and Alcohol Review, is the first of its kind because it estimates the effect on mortality in different educational groups, says Thor Norström.


Drinking increased equally as much in all groups

According to Norström there are several possible explanations for the strong effect on mortality in the group with a lower level of education. One of them is that a larger part of the total increase of alcohol consumption is concentrated to this particular group. The researchers have investigated this explanation in a follow-up study that was recently accepted for publication.
“We have looked at alcohol consumption over time in the three groups and the results indicate that this is not the explanation. The drinking increased more or less equally in all three groups” says Thor Norström.

Another possible explanation, according to Thor Norström, is that the group with a low level of education generally have more risk factors, the effect on this group then might get higher.

“Previous studies have shown that for example smoking is more common among people with a lower level of education, and it probably reinforces the harmful effect of alcohol.”, says Thor Norström.


More about the results:

According to calculations in the study, an increase in alcohol consumption has almost 14 times higher effect on the alcohol-specific mortality for the group with low level of education, compared to the group with higher education. The trend is similar for the violent deaths, with a significantly higher impact on the group with low level of education.

During the period of this study, alcohol consumption varied between 6.3 and 7.1 litres of pure alcohol per year and resident 15 years and above in Sweden. All alcohol sold at Systembolaget is included in the study.

How the study was carried out:

Sales of alcoholic beverages from the Swedish alcohol monopoly Systembolaget were measured quarterly during the years 1991 to 2017. Alcohol consumption per capita (all Swedish residents 15 years and above) was then compared to two categories of mortality in three different groups based on the level of education.
Two categories of mortality:
1. Alcohol-specific mortality, where alcohol has had a direct or indirect effect on the cause of death, e.g. alcohol poisoning, liver diseases, etc.
2. Violent deaths, such as fatal accidents, murders, suicides, etc.

Three groups of the population:
1. Low level of education: 9 years of education or less (including elementary school)
2. level of education: 10-12 years of education
3. Higher level of education: 13 years or more


Read more about the research:

Norström, T. and Landberg, J. (2020), The link between per capita alcohol consumption and alcohol‐related harm in educational groups. Drug and Alcohol Review. doi:10.1111/dar.13114


Thor Norström, Professor Emeritus of Sociology
Phone: (00)46816 23 14
Email: thor.norstrom@sofi.su.se