Educational Gradients in Drinking Amount and Heavy Episodic Drinking among Working-Age Men and Women in Spain.

Alcohol-related harm decreases as socioeconomic position increases, although sometimes the opposite happens with alcohol intake. The objective was to know the educational gradient in monthly measures of drinking amount and heavy episodic drinking (HED) among people aged 25-64 years in Spain from 1997-2017. Such gradient was characterized with the relative percent change (PC) in drinking measures per year of education from generalized linear regression models after adjusting for age, year, region, marital status and immigration status. Among men, the PCs were significantly positive ( p < 0.05) for prevalence of <21 g alcohol/day (2.9%) and 1-3 HED days (1.4%), and they were negative for prevalences of 21-40 g/day (-1.1%), >40 g/day (-6.0%) and ≥4 HED days (-3.2%), while among women they ranged from 3.6% to 5.7%. The gradient in prevalences of >40 g/day (men) and >20 g/day (women) was greatly attenuated after additionally adjusting for HED, while that of ≥4 HED days was only slightly attenuated after additionally adjusting for drinking amount. Among women, the gradients, especially in HED measures, seem steeper in 2009-2017 than in 1997-2007. Educational inequality remained after additional adjustment for income and occupation, although it decreased among women. These results can guide preventive interventions and help explain socioeconomic inequalities in alcohol-related harm.