Mind the Gap: Exploring Social Inequalities in Alcohol Consumption using Nationally Representative Data from the 2019 and 2021 Health Survey for England

Alcohol-related health inequalities remain a major public health challenge in England, with those from more disadvantaged socioeconomic backgrounds experiencing the greatest burden of harm despite consuming similar or lower levels of alcohol compared to those from more advantaged backgrounds. Yet, most research in this area has relied on single or composite measures of socioeconomic status (SES) that do not capture the overlapping dimensions of advantage and disadvantage that shape people’s lives and can be difficult for policymakers to interpret. We used a person-centred approach to examine how differing latent SES profiles relate to alcohol consumption before and during the COVID-19 pandemic. We analysed data from 8,204 adults in 2019 and 5,880 adults in 2021 from the Health Survey for England. A latent class analysis was conducted on seven indicators of SES in 2019 (income, education, occupational grade, housing tenure, benefit receipt, car ownership and employment status), and six in 2021 as occupational grade was not collected that year. Multinomial logistic regression, adjusting for age, sex, ethnicity and marital status, examined associations between latent SES classes and four alcohol consumption risk categories (non-drinker, low-risk, increasing-risk and high-risk). Analysis revealed five latent classes in 2019 and four in 2021, each representing different constellations of social and economic conditions. Across both years, similar latent classes were identified and drinking patterns across classes were consistent despite the disrupting effects of the COVID-19 pandemic. Compared to non-drinkers in the Professional/Employed Homeowners class, (Skilled) Low-Income Renters and Retired Homeowners had far lower odds of drinking at all risk levels, while Professional/Employed Private Renters had odds of increasing and high-risk drinking similar to the reference group. The identification of similar latent SES classes in 2019 and 2021 supports the utility of latent class analysis for capturing the multidimensional nature of SES over time and strengthens the case for future research to employ person-centred approaches when examining the relationship between alcohol consumption and SES. Capturing these constellations of SES indicators through latent class analysis may provide a stronger evidence base for designing targeted interventions and assessing the equity impacts of population-level alcohol control policies.