Crum R M, Anthony J C
Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA.
Ethn Dis. 2000 Winter;10(1):39-52.
Using prospective data, we extend and strengthen prior evidence on the relationship of educational level and the risk of alcohol abuse and dependence among adults. Hypothesizing that risk of alcohol disorders would be greater among individuals who dropped out of high school without getting a diploma, and among those who entered college but then failed to get a degree, relative to those with a college or higher degree, we examined these relationships by race-ethnicity.
Data are from the total of 18,571 adult participants selected for the Epidemiologic Catchment Area (ECA) program by probability sampling of households and census tracts between 1980 and 1984. To assess occurrence of psychiatric conditions over time, staff administered the Diagnostic Interview Schedule soon after sampling and again at followup approximately one year later. The final sample for this report was stratified: African Americans (N = 2856) and whites (N = 7889).
In multiple logistic regression analyses, we found that dropping out of high school was associated with elevated risk for alcohol disorders, relative to those with an Associate of Arts degree or higher, among both African Americans (estimated relative risk [RR] = 4.0, 95% confidence interval [CI], 1.1-14.3, P = .03), and whites (RR = 4.7, 95% CI, 2.2-10.0, P = .0001). In contrast, entering college but failing to get a degree was associated with a significantly increased risk only for whites; however, African Americans were less numerous in the sample, causing attenuation of power. In order to assess whether this relationship was confounded by macrosocial factors of the neighborhood environment, cases were matched to non-cases by age and census tract, and initial conditional logistic regression analyses also were completed.
If confirmed in other investigations, these findings may help to identify groups that are at higher risk for developing alcohol abuse and alcohol dependence in adulthood, and may aid in the development of prevention or early intervention programs.
利用前瞻性数据，我们扩展并强化了先前关于教育水平与成年人酒精滥用及依赖风险之间关系的证据。我们假设，相对于拥有大学或更高学位的人，未获得高中文凭而辍学的人以及进入大学但未获得学位的人患酒精障碍的风险更高，我们按种族对这些关系进行了研究。
数据来自1980年至1984年间通过家庭和普查区概率抽样入选流行病学集水区（ECA）项目的18571名成年参与者。为了评估一段时间内精神疾病的发生情况，工作人员在抽样后不久以及大约一年后的随访时进行了诊断访谈表调查。本报告的最终样本进行了分层：非裔美国人（N = 2856）和白人（N = 7889）。
在多项逻辑回归分析中，我们发现，相对于拥有文学副学士学位或更高学位的人，在非裔美国人（估计相对风险[RR] = 4.0，95%置信区间[CI]，1.1 - 14.3，P = 0.03）和白人（RR = 4.7，95% CI，2.2 - 10.0，P = 0.0001）中，高中辍学都与酒精障碍风险升高有关。相比之下，进入大学但未获得学位仅与白人的风险显著增加有关；然而，样本中的非裔美国人数量较少，导致检验效能降低。为了评估这种关系是否受到邻里环境宏观社会因素的混淆，按年龄和普查区将病例与非病例进行匹配，并完成了初始条件逻辑回归分析。
如果在其他调查中得到证实，这些发现可能有助于识别成年后患酒精滥用和酒精依赖风险较高的群体，并可能有助于制定预防或早期干预项目。
