Occupation As a Risk Factor for Alcohol-Related Harm
Alcohol use and misuse is of concern to insurers because alcohol-related illnesses represent a significant cause of claim. The latest report from the UK Office of National Statistics (ONS) described the highest levels of alcohol-related deaths in England and Wales since it started specifically identifying these deaths in 2001. In fact, the 5,460 deaths from January to September 2020 represented a 16.4% increase on the same period the previous year. First quarter 2020 mortality rates were raised (in keeping with a long-term trend for deaths in the first quarter) but in the second and third quarters the difference was statistically significant.1
The headlines in the popular press – e.g., “Alcohol-related deaths spiked during lockdown” – over simplified the situation, but some articles did go on to note that the majority of deaths were from “alcohol abuse over years”.2 Despite some media coverage, levels of abstinence from alcohol have been higher since the first national lockdown in the UK but the number of those who reported drinking more than 35 units per week has also increased.3 Other studies have found that lockdown has been particularly difficult for those with recognised alcohol use disorders, resulting in increased consumption and relapse.4
Because most deaths are due to chronic misuse, the effects of lockdown, if any, will only unfold over many years. But the challenge to identify those who will develop problems many years hence remains for underwriters. Identifying occupational risk has become a well-developed tool in both Disability and Life underwriting, but recognising its importance for alcohol risk has probably relied too much on dated stereotypes rather than reliable data. New data, which has emerged from analysing the UK Biobank dataset, potentially offers a way forward.
The UK Biobank is a large population cohort of approximately half a million people aged between 40 and 69 at recruitment. From this population, Thompson and Pirmohamed identified two groups; heavy drinkers (>35 units per week for women and >50 for men) and drinkers who did not meet these criteria.5 Abstainers were not included as it was unclear why they were abstinent. The two authors developed a model adjusted for age, gender, location, and deprivation to explore the associations of heavy drinking with specific job types (353 occupations were included).
Unsurprisingly, the highest association for both sexes (measured by prevalence ratios) was with publicans and bar managers, but this was stronger for females than for males. Other professions with high associations included industrial cleaners, plasterers, bricklayers, bar staff, workers in refuse and salvage, and auto electricians. More broadly, the association for men who drink heavily was with those working in “skilled trade” occupations, traditionally male-dominated areas with cultures of high alcohol use. Women in managerial posts and more specifically corporate manager roles were more likely to be heavy drinkers than their male counterparts. By contrast, professional occupations had the lowest associations with heavy drinking but the low numbers of females in these groups made interpretation difficult. Being a member of the clergy appeared protective against heavy drinking as was being a doctor – a reflection, perhaps, of the increasingly diverse recruitment to medical schools.
These results confirm longstanding findings about the high risk for those working directly with alcohol and the low risk for clergy. The results strengthen existing, if less robust, data concerning the association with skilled trades, particularly in construction, but also highlight specific groups that may be at risk, e.g., female police officers.
Ultimately, occupation is only one factor that contributes to problem drinking. Genes, poverty, employment status, age of first drink and social milieu, all play their part. This data provides the underwriter with evidence, rather than reliance on stereotyping, to identify those occupations that are potentially at long-term risk of alcohol problems. For group insurers, targeting their wellbeing proposition to those at greatest risk has the potential for significant rewards as there is evidence that tackling organisational factors may be more effective than individually focussed approaches.6
- Quarterly alcohol-specific deaths in England and Wales, Office for National Statistics (ons.gov.uk), 6 May 2021.
- Alcohol-related deaths spiked during lockdown: Fatalities were highest level since records began, Daily Mail Online, 2 February 2021.
- Ibid at Note 1.
- Kim, et al., Effect of COVID‑19 lockdown on alcohol consumption in patients with pre‑existing alcohol use disorder, The Lancet Gastroenterology & Hepatology, 4 August 2020.
- Thompson & Pirmohamed, Associations between occupation and heavy alcohol consumption in UK adults aged 40‑69 years: a cross-sectional study using the UK Biobank (biomedcentral.com), BMC Public Health (2021) 21:190.
- Roche AM, Lee NK, Battams S, Fischer JA, Cameron J, McEntee A. Alcohol use among workers in male-dominated industries: a systematic review of risk factors. Saf Sci. 2015; 78:124–41.