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Influence of affordability of alcohol on educational disparities in alcohol-related mortality in Finland and Sweden: a time series analysis
  1. Kimmo Herttua1,2,
  2. Olof Östergren3,
  3. Olle Lundberg3,
  4. Pekka Martikainen2,3,4
  1. 1 Department of Public Health, Centre of Maritime Health and Society, University of Southern Denmark, Esbjerg, Denmark
  2. 2 Department of Social Research, Population Research Unit, University of Helsinki, Helsinki, Finland
  3. 3 Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden
  4. 4 The Max Planck Institute for Demographic Research, Rostock, Germany
  1. Correspondence to Dr Kimmo Herttua, Public Health, CMSS, University of Southern Denmark, Esbjerg 6700, Denmark; kherttua{at}


Background Prices of alcohol and income tend to influence how much people buy and consume alcohol. Price and income may be combined into one measure, affordability of alcohol. Research on the association between affordability of alcohol and alcohol-related harm is scarce. Furthermore, no research exists on how this association varies across different subpopulations. We estimated the effects of affordability of alcohol on alcohol-related mortality according to gender and education in Finland and Sweden.

Methods Vector-autoregressive time series modelling was applied to the quarter-annual aggregations of alcohol-related deaths and affordability of alcohol in Finland in 1988–2007 and in Sweden in 1991–2008. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. We calculated affordability of alcohol index using information on personal taxable income and prices of various types of alcohol.

Results Among Finnish men with secondary education, an increase of 1% in the affordability of total alcohol was associated with an increase of 0.028% (95% CI 0.004 to 0.053) in alcohol-related mortality. Similar associations were also found for affordability for various types of alcohol and for beer only in the lowest education group. We found few other significant positive associations for other subpopulations in Finland or Sweden. However, reverse associations were found among secondary-educated Swedish women.

Conclusions Overall, the associations between affordability of alcohol and alcohol-related mortality were relatively weak. Increased affordability of total alcoholic beverages was associated with higher rates of alcohol-related mortality only among Finnish men with secondary education.

  • alcohol
  • education
  • mortality
  • public health policy
  • time series
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  • Contributors KH and PM designed the study. KH performed data analysis and wrote the manuscript. PM, OO and OL contributed to writing of the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. KH is the guarantor.

  • Funding PM is supported by the Academy of Finland. This study is part of the DEMETRIQ project. The research leading to these results has received funding from the Commission of the European Communities Seventh Framework Programme under grant agreement number 278511. The study does not necessarily reflect the Commission’s views and in no way anticipates the Commission’s future policy in this area. This research was also conducted as part of the Nordic project, Contingent Life Courses (C-LIFE), funded by Nordforsk, the Nordic Programme on Health and Welfare (grant number 75970). The funders had no role in the study design, the data collection and analysis, the decision to publish or the preparation of the manuscript.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval Statistics Finland gave ethical approval for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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