Drinkers from poorer areas suffer worse health than wealthier boozers because they are more likely to combine it with other harmful behaviours, says new research.
Combining drinking with smoking, excess weight, poor diet and little exercise doesn't just add to its health dangers, it multiplies the risk of alcohol-related conditions, it says.
UK researchers set out to explain "the alcohol harm paradox" - why people in deprived communities have higher levels of alcohol-related ill health than more advantaged people, despite drinking the same amounts.
They found people in deprived areas who drank at levels over the weekly recommended upper limit were nearly 11 times more likely than those in non-deprived areas to combine it with smoking, excess weight, and an unhealthy lifestyle of poor diet and little exercise.
Less than one per cent of heavy drinkers in the affluent areas reported all three, while 66.9 per cent reported at least one of the health risks.
This compares to nine per cent and 83.2 per cent for those in the deprived areas.
"Together these combinations can create enormous stresses on people's bodies, overwhelming their ability to limit the health harms caused by alcohol," said one researcher, Professor Mark Bellis from Bangor University.
The study, published in BMC Public Health, involved a phone survey in England involving 6015 randomly selected adults.
Drinkers living in deprived areas were found to be more likely to drink spirits and beer than wine and to be more likely to binge drink than those in non-deprived areas.
"Drinkers in more deprived communities were more likely to drink their weekly alcohol in fewer but heavier drinking sessions," Prof Bellis said.
"Such behaviours can increase risks of injury and heart disease compared to people who drink the same total amount of alcohol but over more occasions."
James Nicholls from Alcohol Research UK said the research findings were important for individual lifestyle choices and for tackling the broader problem of health inequalities.
Action could include targeting the "structural" issues that could make healthier choices harder for people in deprived communities.
