Health Disparities
State-Level Socioeconomic Status and Drinking Behavior: An Ecological Analysis Rikki Fan* Rikki Fan National Institute of Health
Introduction: The alcohol harm paradox states that lower socioeconomic groups bear a disproportionate burden of alcohol-related harm despite sometimes reporting lower average consumption than wealthier individuals. This is mainly attributed to differences in drinking patterns (e.g., heavy episodic drinking). This study addresses the gap in ecological, state-level analyses by examining the relationship between state socioeconomic status (SES) and residents’ drinking habits.
Methods: This research used a five-year pooled dataset (2019–2023) from the Behavioral Risk Factor Surveillance System (BRFSS). State SES was measured using five-year averages of four metrics from the American Community Survey (ACS): Median Household Income (MHI), educational attainment (proportion of adults over 25 with > high school education), Proportion Under Federal Poverty Line (PFPL), and Unemployment Rate (UER) (age 20–64). Path analysis was employed to examine the associations between these SES factors and various drinking behaviors (e.g., drinking days, binge frequency, Maxdrinks).
Results: The analysis showed complex associations. A higher proportion of educated adults was positively associated with overall drinking in general, but negatively associated with Maxdrinks and binge frequency among current drinkers. A higher MHI was consistently linked to less drinking, showing strong negative associations with binge drinking rate and binge frequency in both the general population and among current drinkers. A higher PFPL was negatively associated with drinking days and binge drinking rate overall, but was positively associated with Maxdrinks and binge drinking rate among current drinkers. A higher UER was associated with less heavy drinking, Maxdrinks, and binge frequency across the population and among current drinkers.
Conclusion: This state-level analysis reveals a complex link between SES and drinking behavior. States with advantageous SES (higher education, higher MHI) may offer some protection against unhealthy drinking patterns. Conversely, while poverty (higher PFPL) may correlate with lower overall drinking rates, it is associated with more intense and potentially dangerous drinking patterns (Maxdrinks, binge drinking rate) among those residents who consume alcohol, providing ecological support for the alcohol harm paradox.