Racial and Ethnic Disparities in the Outcomes of Alcohol Consumption: The Roles of Poverty and Discrimination

Background/Purpose: Racial/ethnic disparities in the consequences of alcohol consumption and alcohol use disorders (AUDs) have been well documented. African Americans and Hispanics experience more social consequences related to drinking when controlling for alcohol consumption and are less likely to recover from alcohol problems when compared to Whites. Evidence suggests that psychosocial stressors, including perceived discrimination and poverty, significantly contribute to health inequities. Theories of cumulative stress state that multiple unique stressors or forms of disadvantage interact to produce worse health outcomes beyond what would be experienced if exposure to various stressors were simply additive. We sought to investigate whether racial/ethnic disparities in the outcomes of alcohol consumption could be due to the cumulative effects of poverty or perceived racial/ethnic discrimination.

Methods:We conducted longitudinal analyses of Wave 1 (W1; 2001-2002) and Wave 2 (W2; 2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The sample included 19,709 respondents who were drinking during both W1 and W2. The dependent variable was the number of DSM-IV alcohol use disorder symptoms experienced at W2 (range 0-11). Poverty was assessed as a dichotomous variable at W1 using the official poverty threshold established by the Bureau of the Census. Race/ethnicity was assessed with five groups including African American, American Indian or Alaskan Native, Hispanic/Latino, Asian, and White. Perceived racial/ethnic discrimination was ascertained in the W2 interview with 6 items assessing the frequency that respondents experienced discrimination in institutional or social settings (summed scale α=0.69). We used negative binomial regression to predict W2 use disorder symptoms while controlling for sociodemographic and clinical characteristics, including W1 alcohol consumption and alcohol use disorder symptoms. Product terms were created for the interactions of perceived discrimination and poverty status with race/ethnicity. We used the method of recycled predictions to estimate the number of incident alcohol use disorder symptoms experienced as a function of race/ethnicity, poverty status, and perceived discrimination.

Results: Over three years of follow-up, African Americans (RRR=1.42, 95% CI=1.28-1.59) and persons living below the poverty threshold (RRR=1.18, 95% CI=1.04-1.35) experienced significantly more alcohol use disorder symptoms than Whites and those living above the poverty threshold. Regardless of poverty status, Blacks experienced more AUD symptoms than Whites above the poverty threshold. Somewhat unexpectedly, American Indians and Alaskan Natives below the poverty threshold experienced fewer alcohol use disorder symptoms than whites below the poverty threshold. Compared to Whites, the positive association between perceived discrimination and alcohol use disorder symptoms was stronger for African Americans.

Conclusions/Implications: These findings suggest that cumulative stress may play a role in racial/ethnic disparities that exist in the harms associated with alcohol consumption. Health policies aimed at alleviating racial/ethnic disparities may need to concurrently reduce poverty and discrimination. The relatively smaller sample sizes for Asian persons and American Indians and Alaskan Natives may be considered a limitation of this study and point to a need for future surveys to oversample all racial/ethnic minority groups.