Area of residence and alcohol-related mortality risk: a five-year follow-up study

Aims To examine differences in alcohol-related mortality risk between areas, while adjusting for the characteristics of the individuals living within these areas. Design A 5-year longitudinal study of individual and area characteristics of those dying and not dying from alcohol-related deaths. Setting The Northern Ireland Mortality study. Participants A total of 720 627 people aged 25-74, enumerated in the Northern Ireland 2001 Census, not living in communal establishments. Measurements Five hundred and seventy-eight alcohol-related deaths. Findings There was an increased risk of alcohol-related mortality among disadvantaged individuals, and divorced, widowed and separated males. The risk of an alcohol-related death was significantly higher in deprived areas for both males [hazard ratio (HR) 3.70; 95% confidence interval (CI) 2.65, 5.18] and females (HR 2.67 (95% CI 1.72, 4.15); however, once adjustment was made for the characteristics of the individuals living within areas, the excess risk for more deprived areas disappeared. Both males and females in rural areas had a reduced risk of an alcohol-related death compared to their counterparts in urban areas; these differences remained after adjustment for the composition of the people within these areas. Conclusions Alcohol-related mortality is higher in more deprived, compared to more affluent areas; however, this appears to be due to characteristics of individuals within deprived areas, rather than to some independent effect of area deprivation per se. Risk of alcohol-related mortality is lower in rural than urban areas, but the cause is unknown.