Lower Educational Attainment Widens Racial/Ethnic Disparities in Alcohol Use Disorder.

Objective: Lower education is a risk factor for alcohol-related deaths, but it is unknown if the impact of education varies by race/ethnicity. We evaluated the interaction between education and race/ethnicity on the odds of alcohol use disorder (AUD) and the significance of employment and poverty as potential mediators.

Method: The 2016-19 National Survey on Drug Use and Health was used to obtain weighted prevalence of AUD in participants 26+ years. Using AUD as the outcome, multivariable logistic regression analyses were performed, stratified by four levels of education, ranging from less than high school (|10%| change implying significant mediating or confounding effect.

Results: AUD prevalence was highest among American Indian/Native Alaskans (AI/ANs) (8.06%), and similar among non-Hispanic Whites (5.37%) and Blacks (5.09%). When stratified by education, the odds of AUD among Blacks and AI/ANs increased with decreasing education [(OR 1.45, 95% CI 1.07-1.96) for Blacks v. Whites with

Conclusions: Lower education significantly increased the odds of AUD among Blacks and AI/ANs. Employment and poverty did not significantly change the association, implying there are likely other mechanisms accounting for racial/ethnic disparities in AUD.