Do the consequences of a given pattern of drinking vary by socioeconomic status? A mortality and hospitalization follow-up for alcohol-related causes of the Finnish Drinking Habits surveys

Background: Socioeconomic differences in alcohol-related mortality and hospitalisations, as based on register data, are larger than socioeconomic differences in various types of harmful drinking, as based on survey data. Objective: The aim was to use a follow-up study to examine whether differential drinking patterns between socioeconomic groups explain the observed differences in alcohol-related mortality and hospitalisations, or whether similar drinking patterns predict higher mortality among lower socioeconomic groups. Method: The study population included Finns who participated in cross-sectional surveys on drinking habits in 1969, 1976 or 1984 when aged 25–69 (n = 6406). They were followed up for alcohol-related mortality and hospitalisations (n = 180) for 16 years. Drinking patterns were measured by total consumption, frequency of subjective intoxication and of drinking different amounts of alcohol at a time, and by volume of consumption that was drunk in heavy drinking occasions and non-heavy drinking occasions. Results: Compared with non-manual workers, manual workers had a 2.06-fold hazard of alcohol-related death or hospitalisation. Adjustment for drinking patterns explained only a small fraction of the excess hazard among manual workers. Additionally, in each category of total consumption and in each level of the volume drunk in heavy drinking occasions, the risk of alcohol-related death and hospitalisation was higher for manual than for non-manual workers. Conclusions: Consequences of similar drinking patterns are more severe for those with lower socioeconomic status. Future studies are needed to explain how higher socioeconomic groups manage to escape the consequences of drinking that others have to face

Negative health system effects of Global Fund's investments in AIDS, tuberculosis and malaria from 2002 to 2009: systematic review.

OBJECTIVES: By using the Global Fund as a case example, we aim to critically evaluate the evidence generated from 2002 to 2009 for potential negative health system effects of Global Health Initiatives (GHI). DESIGN: Systematic review of research literature. SETTING: Developing Countries. PARTICIPANTS: All interventions potentially affecting health systems that were funded by the Global Fund. MAIN OUTCOME MEASURES: Negative health system effects of Global Fund investments as reported by study authors. RESULTS: We identified 24 studies commenting on adverse effects on health systems arising from Global Fund investments. Sixteen were quantitative studies, six were qualitative and two used both quantitative and qualitative methods, but none explicitly stated that the studies were originally designed to capture or to assess health system effects (positive or negative). Only seemingly anecdotal evidence or authors' perceptions/interpretations of circumstances could be extracted from the included studies. CONCLUSIONS: This study shows that much of the currently available evidence generated between 2002 and 2009 on GHIs potential negative health system effects is not of the quality expected or needed to best serve the academic or broader community. The majority of the reviewed research did not fulfil the requirements of rigorous scientific evidence

Heavy and nonheavy drinking occasions, all-cause and cardiovascular mortality and hospitalizations: a follow-up study in a population with a low consumption level

Objective: The purpose of this study was to separate the effects of heavy and nonheavy episodic drinking on mortality and hospitalizations from ischemic heart disease (IHD) and other cardiovascular disease (OCVD) and on all-cause mortality. Method: The respondents in Finnish drinking habit surveys in 1969, 1976 and 1984 (N = 6,394) were followed up for mortality and hospitalizations. There were 1,144 total deaths from all causes, 854 hospitalizations or deaths from IHD and 1,270 from OCVD. The main variables included total volume of consumption and total volume divided into volume consumed on heavy drinking occasions and nonheavy drinking occasions. Four alternative measures of heavy episodic drinking (HED) were also used. Results: Among males, the total volume of consumption showed a protective effect against IHD. A high volume consumed on light drinking occasions was associated with a decreased risk of IHD (hazard ratio [HR] = 0.56, confidence interval [CI]: 0.34-0.92) and an increased risk of OCVD (HR = 1.48, CI: 1.00-2.18). A high volume consumed on heavy drinking occasions was associated with an increased risk of all-cause mortality (HR = 1.34, CI: 1.04-1.73). Among females, a protective effect of total and non-HED volume against all-cause mortality and non-HED volume against IHD was observed. Conclusions: The findings contribute to the cumulating evidence that drinking pattern matters. Moderate drinking is associated with a lower risk of IHD, whereas drinking in a heavy episodic manner (often referred to as "binge drinking") is not. The results underline the importance of considering, in addition to the volume of consumption, the pattern of drinking in epidemiological studie