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The association between macro-level structural discrimination and alcohol outcomes: A systematic review

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  • Bright, Sophie
  • Buckley, Charlotte
  • Holman, Daniel
  • Henney, Madeleine
  • Tabb, Loni Philip
  • Purshouse, Robin

Abstract

Alcohol consumption is a major risk factor for death and disability, disproportionately harming disadvantaged groups. While a positive association between interpersonal discrimination and alcohol use is established, structural discrimination's impact remains unclear. We conducted a systematic review of the association between macro-level structural discrimination and alcohol consumption or related health outcomes. We searched four databases and grey literature, identifying 25 eligible studies, which considered racism (n = 11), sexism (n = 7), heterosexism (n = 4), and intersectional discrimination (n = 3). Most considered alcohol consumption (n = 17); fewer addressed harm (n = 4) or both (n = 4). The majority were US-based (n = 21), with four making cross-country comparisons. Associations varied by discrimination type, exposure measurement, alcohol outcome, and sociodemographic factors, though differential effects by sociodemographic factors remain understudied.

Suggested Citation

  • Bright, Sophie & Buckley, Charlotte & Holman, Daniel & Henney, Madeleine & Tabb, Loni Philip & Purshouse, Robin, 2025. "The association between macro-level structural discrimination and alcohol outcomes: A systematic review," Social Science & Medicine, Elsevier, vol. 385(C).
    • Handle: RePEc:eee:socmed:v:385:y:2025:i:c:s027795362500927x
    DOI: 10.1016/j.socscimed.2025.118596
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