Alcohol and the preventive paradox: serious harms and drinking patterns
Article first published online: 7 FEB 2007
Volume 102, Issue 4, pages 571–578, April 2007
How to Cite
Poikolainen, K., Paljärvi, T. and Mäkelä, P. (2007), Alcohol and the preventive paradox: serious harms and drinking patterns. Addiction, 102: 571–578. doi: 10.1111/j.1360-0443.2006.01740.x
- Issue published online: 12 MAR 2007
- Article first published online: 7 FEB 2007
- Submitted 19 August 2005; initial review completed 10 January 2006; final version accepted 22 November 2006
- Alcohol drinking;
- prevention and control
Aims The preventive paradox prevails if the majority of alcohol problems accrue to the lesser-drinking majority of population, not to heavy drinkers. Evidence for the paradox has been criticized for being based on self-report. The aim was to examine whether the paradox also applies to deaths and hospital admissions.
Design Data from four surveys representing the Finnish population aged 15–69 years in 1969, 1976, 1984 and 1992 were pooled; those from1969, 1976 and 1984 (n = 6726) to study alcohol-related hospital admissions and alcohol-related deaths, and those from 1984 and 1992 (n = 5558) to study self-reported problems. The former data were linked with register data on hospital admission and death up to the end of 2002.
Methods Comparisons were made separately for men and women (1) between the 10% of population with the highest average alcohol consumption and the remaining 90% of drinkers and (2) between those who reported and those who did not report drinking to intoxication.
Results A total of 3025 men and 2693 women were available for the study of self-reported problems and 2945 men and 2615 women for deaths and hospital admissions. Seventy per cent of all self-reported problems, 70% of alcohol-related hospitalizations, 64% of alcohol-related deaths and 64% of the premature life-years lost before the age of 65 occurred among the 90% of men consuming less. The respective figures for women were 64%, 60%, 93% and 98%. Drinking five or more drinks per occasion was related to more harm than not drinking that much.
Conclusions In men, the ‘prevention paradox’ appears to apply to a broadly similar degree to hospitalizations and deaths as self-report alcohol-related problems; in women the phenomenon was apparent to a greater degree for deaths than for other markers of harm.