Table 1.

Alcohol-harm paradox in liver-related studies.

Authors	Region	Study design	Main findings
	Europe
Petrovski et al., 201189,90	Eastern Europe (Hungary)	Case control study	•Increased risk of chronic liver disease in patients with low socio-economic status only partially explained by conventional behavioural risk factors (age, smoking, alcohol use and physical activity)
Sadler et al., 20172	United Kingdom (England)	Use of national health service hospital admissions (2010 – 2013)	•Socio-economic gradient for most alcohol-associated hospital admissions •Greatest inequalities in conditions associated with alcohol dependence, such as liver disease and mental and behavioural conditions •Steeper gradients for men than women
Askgaard et al., 202153	Northern Europe (Denmark)	Use of national registries (2009 – 2018)	•Among patients newly diagnosed with ALD: low or medium-low educational level in 86%; employment in 20% •Inverse correlation between incidence of ALD and educational level •Inverse correlation between incidence of ALD and employment status •Relative difference in incidence of ALD between educational levels larger in younger age groups (age 30–39)
	Latin America
Arab et al., 202056	Latin America	Regional Health Reports	•In Latin America, lower-income countries have higher mortality due to alcohol-related cirrhosis despite reporting lower alcohol consumption per capita
Oneto et al., 202191	Latin America (Chile)	National health survey (2016 -2017)	•In women: hazardous alcohol consumption only increased ALD among those with high income level who also presented obesity or metabolic syndrome in combination with type 2 diabetes •In men, hazardous alcohol consumption only increased ALD among those with low-income level (even those without comorbidities)
	North America
Major et al., 201464	North America (USA)	NIH American Association of Retired Persons Health study	•Area socio-economic deprivation is associated with increased risk of chronic liver disease after accounting for health risk factors, including alcohol consumption (HR 1.78)
Case and Deaton, 201792	North America (USA)	National surveys	•Increase in ALD-related mortality between 1998 and 2015 among White non-Hispanics aged 50-54 with a lower educational level (high school or less vs. bachelor or more)
Damjanovska et al., 202393	North America (USA)	Electronic records from health care systems (1999 - 2021)	•Highest relative increase in alcohol-related hepatitis admissions in African American patients (OR 2.63) during the COVID-19 pandemic
Ayares et al., 202494	North America (USA)	National databases (2011 – 2018)	•After accounting for key social and biological health determinants, the Hispanic population showed an increased risk of ALD, even with lower overall alcohol consumption. •Higher prevalence of heavy episode drinkers among this group

ALD, alcohol-related liver disease; HR, hazard ratio; OR, odds ratio.