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Education and race-ethnicity differences in the lifetime risk of alcohol dependence
  1. S E Gilman1,
  2. J Breslau2,
  3. K J Conron3,
  4. K C Koenen1,
  5. S V Subramanian3,
  6. A M Zaslavsky4
  1. 1
    Departments of Society, Human Development, & Health, and Epidemiology, Harvard School of Public Health, Boston, MA, USA
  2. 2
    Center for Reducing Health Disparities, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, CA, USA
  3. 3
    Department of Society, Human Development, & Health, Harvard School of Public Health, Boston, MA, USA
  4. 4
    Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
  1. Stephen E Gilman, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; sgilman{at}


Objectives: While lower socioeconomic status (SES) is related to higher risk for alcohol dependence, minority race-ethnicity is often associated with lower risk. This study attempts to clarify the nature and extent of social inequalities in alcohol dependence by investigating the effects of SES and race-ethnicity on the development of alcohol dependence following first alcohol use.

Design: Cross-sectional analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 43 093). Survival analysis was used to model alcohol dependence onset according to education, race-ethnicity and their interaction.

Setting: United States, 2001–2.

Results: Compared with non-Hispanic white people, age-adjusted and sex-adjusted risks of alcohol dependence were lower among black people (odds ratio (OR) = 0.70, 95% confidence interval (CI) = 0.63 to 0.78), Asians (OR = 0.65, CI = 0.49 to 0.86) and Hispanics (OR = 0.68, CI = 0.58 to 0.79) and higher among American Indians (OR = 1.37, CI = 1.09 to 1.73). Individuals without a college degree had higher risks of alcohol dependence than individuals with a college degree or more; however, the magnitude of risk varied significantly by race-ethnicity (χ2 for the interaction between education and race-ethnicity = 19.7, df = 10, p = 0.03); odds ratios for less than a college degree were 1.12, 1.46, 2.24, 2.35 and 10.99 among Hispanics, white people, black people, Asians, and American Indians, respectively. There was no association between education and alcohol dependence among Hispanics.

Conclusions: Race-ethnicity differences in the magnitude of the association between education and alcohol dependence suggest that aspects of racial-ethnic group membership mitigate or exacerbate the effects of social adversity.

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  • Competing interests: None.

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