Educational inequalities in mortality due to alcoholic liver disease in Poland

Introduction
Poland has been experiencing an epidemic of alcohol-attributable deaths in the last decades. There is a growing body of scientific evidence that educational level is linked to health behaviours and health status. The aim of the study was to analyse the impact of educational inequalities on mortality due to alcoholic liver disease (ALD) in Poland in 2002 and 2011.

Material and methods
The analysis included deaths due to alcoholic liver disease which occurred in 2002 and 2011 and information on education among Poles, aged 20 and over. Data originated from records of death certificates obtained from the database of the Central Statistical Office in Poland and the censuses. Attained educational level have been reclassified according to the International Standard Classification of Education. To assess the educational inequalities rate ratio of mortality in the group with lowest education to mortality in the group with highest education was used.

Results
The lowest risk of death due to ALD was in the group with higher education, and the highest risk was in the group with the lowest education in both men and women (i.e. standardised death rate per 100,000 = 0.26 in 2002 and 0.68 in 2011 in higher educated vs 1.40 and 6.23, respectively, in lower educated women). In men, the highest risk of death from ALD was observed in the group with the lowest education aged 45-64 years (20.22/100,000 in 2002, and 44.08/100,000 in 2011). The rate ratio between 2002 and 2011 increased only in women.

Conclusions
Significant differences in deaths from alcoholic liver cirrhosis due to education have been observed in Polish adults. There is an urgent need to implement national alcohol control programs in Poland which would especially deal with alcohol consumption in the groups of population with lower education levels.