Socioeconomic inequalities behind alcohol-related deaths in Slovenia: a nationwide register-based study

Socioeconomic inequalities remain a major determinant of health and mortality across populations. This study examined the association between multiple dimensions of socioeconomic status (SES)—education, occupation, and employment status—as well as marital status, and deaths fully attributable to alcohol in Slovenia. Using linked individual-level data from the national Death Register and the Statistical Office of the Republic of Slovenia, we analysed all deaths among residents aged 30–69 years between 2013 and 2023 ( n = 61,160). Alcohol-related deaths ( n = 6,598) were identified based on ICD-10-AM (version 11) codes 100% attributable to alcohol. Odds ratios (OR) and 95% confidence intervals (CI) for alcohol-related deaths compared with deaths from other causes were estimated using multivariate logistic regression. The odds of alcohol-related death were significantly higher among individuals with lower education, the unemployed, farmers, and those who were divorced or widowed. Among the employed, occupational differences were pronounced: Skilled Agricultural, Forestry and Fishery Workers had the highest odds of alcohol-related death compared with Professionals (men: OR = 2.8; women: OR = 5.9; p < 0.001). While education was a significant factor overall, its statistical significance diminished when occupation was included, suggesting the work environment and occupational context may be linked to variations in alcohol-related deaths. These findings highlight persistent and multifaceted socioeconomic disparities in alcohol-related mortality, emphasizing the need for public health measures that address both social inequality and alcohol use across all population groups. Furthermore, targeted interventions for drinkers at risk or with health consequences from alcohol use are needed.