Associations between income inequality and alcohol consumption patterns and problems

Income inequality contributes to poor health, but few studies have focused on inequality's relationship to health risk behaviors. We examined whether associations between state-level income inequality and four alcohol outcomes differed by measure of inequality or outcome, as well as whether associations were moderated by individual-level disadvantage (minority race/ethnicity, household income, neighborhood poverty). Survey data from 2000 and 2005 National Alcohol Surveys (N = 11,107) were linked to state-level indicators of income from the 2000 US Decennial Census. Measures of inequality were the Gini coefficient, Black-to-White poverty ratio (BWPR), and Hispanic-to-White poverty ratio (HWPR). Past-year alcohol outcomes were volume consumed during light-to-moderate-drinking occasions (1-4 drinks); volume consumed during heavy-drinking occasions (5+ drinks); interpersonal, health, legal and work-related consequences of drinking; and DSM-IV dependence. Multilevel linear and logistic regression models adjusted for individual demographics, state-level urbanicity and state-level median income. Main effects models showed the Gini coefficient was not related to the outcomes. Neither household nor neighborhood poverty moderated inequality's effects. High inequality was associated with increased light and heavy drinking by Whites, but not by Hispanics or Blacks. For both Blacks and Hispanics, high inequality was associated with increased risk of consequences compared to Whites. Findings suggest Blacks and Hispanics in areas characterized by high levels of inequality may be at particular risk for alcohol-related consequences, but this may not be due to increased consumption. Further examination of types of consequences experienced by Blacks and Hispanics in states with race-linked poverty are needed to reduce disparities in alcohol-related problems.