The effect of asset-based wealth inequality on problem drinking among rural Thai elders: A prospective population-based cohort study

TY - JOUR

T1 - The effect of asset-based wealth inequality on problem drinking among rural Thai elders

T2 - A prospective population-based cohort study

AU - Jirapramukpitak, Tawanchai

AU - Abas, Melanie

AU - Tangchonlatip, Kanchana

AU - Punpuing, Sureeporn

PY - 2014/1

Y1 - 2014/1

N2 - Evidence on the link between income inequality and alcohol-related problems is scarce, inconclusive and dominated by studies from the developed world. The use of income as a proxy measure for wealth is also questionable, particularly in developing countries. The goal of the present study is to explore the contextual influence of asset-based wealth inequality on problem drinking among Thai older adults. A population-based cohort study with a one-year follow-up was nested in a Demographic Surveillance System (DSS) of 100 villages in western Thailand. Data were drawn from a random sample of 1104 older residents, aged 60 or over (one per household) drawn from all 100 villages, of whom 982 (89%) provided problem drinking data at follow-up. The primary outcome measure was a validated Thai version of the Alcohol-Used Disorder Identification Test for problem drinking. Living in areas of high wealth inequality was prospectively associated with a greater risk for problem drinking among older people (adjusted odds ratio 2.30, 95% confidence intervals 1.02-5.22), after adjusting for individual-level and village-level factors. A rise in wealth inequality over the year was also independently associated with an increased risk of problem drinking (adjusted odds ratio 2.89, 95% confidence intervals 1.24-6.65). The associations were not explained by the social capital, status anxiety or psychosocial stress variables. The data suggest that wealth inequality and an increase in inequality across time lead to a greater risk of problem drinking. Efforts should be directed towards reducing gaps and preventing large jumps in inequality in the communities. Further research should investigate the effect of asset-based inequality on various health risk behaviors and its specific mediating pathways.

AB - Evidence on the link between income inequality and alcohol-related problems is scarce, inconclusive and dominated by studies from the developed world. The use of income as a proxy measure for wealth is also questionable, particularly in developing countries. The goal of the present study is to explore the contextual influence of asset-based wealth inequality on problem drinking among Thai older adults. A population-based cohort study with a one-year follow-up was nested in a Demographic Surveillance System (DSS) of 100 villages in western Thailand. Data were drawn from a random sample of 1104 older residents, aged 60 or over (one per household) drawn from all 100 villages, of whom 982 (89%) provided problem drinking data at follow-up. The primary outcome measure was a validated Thai version of the Alcohol-Used Disorder Identification Test for problem drinking. Living in areas of high wealth inequality was prospectively associated with a greater risk for problem drinking among older people (adjusted odds ratio 2.30, 95% confidence intervals 1.02-5.22), after adjusting for individual-level and village-level factors. A rise in wealth inequality over the year was also independently associated with an increased risk of problem drinking (adjusted odds ratio 2.89, 95% confidence intervals 1.24-6.65). The associations were not explained by the social capital, status anxiety or psychosocial stress variables. The data suggest that wealth inequality and an increase in inequality across time lead to a greater risk of problem drinking. Efforts should be directed towards reducing gaps and preventing large jumps in inequality in the communities. Further research should investigate the effect of asset-based inequality on various health risk behaviors and its specific mediating pathways.

KW - Aged

KW - Alcohol-related disorders

KW - Inequality

KW - Longitudinal

KW - Thailand

UR - http://www.scopus.com/inward/record.url?scp=84892522337&partnerID=8YFLogxK

U2 - 10.1016/j.socscimed.2013.09.025

DO - 10.1016/j.socscimed.2013.09.025

M3 - Article

C2 - 24444845

AN - SCOPUS:84892522337

SN - 0277-9536

VL - 100

SP - 107

EP - 114

JO - Social Science and Medicine

JF - Social Science and Medicine

ER -