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

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.

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