Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Alcohol Clin Exp Res. 2012 Apr;36(4):663-9. doi: 10.1111/j.1530-0277.2011.01666.x. Epub 2011 Oct 13.
Unemployment is associated with alcohol-related morbidity. However, the extent to which the association is causal is unclear, and it is not known whether other risk factors remain uncontrolled for. This study examines the association between unemployment and later alcohol-related hospitalization, adjusted for preexisting alcohol disorders, psychiatric diagnoses, behavioral risk factors, and social factors.
The study was based on a military conscription cohort (men born in 1949 to 1951), with information on psychiatric diagnosis and psychological assessment and from a drug-use survey, which was then linked to national registers. The analyses were performed on data on the 37,798 individuals who were in paid employment in 1990 to 1991.
It was found that short- and long-term unemployment (1 to 89 days and ≥90 days) were associated with hospitalization owing to an alcohol-related diagnosis at 12-year follow-up (HR(crude) = 2.25, 95% CI 1.64 to 3.09 and HR(crude) = 2.95, 95% CI 2.51 to 3.48, respectively). After adjustment for confounders, the hazard ratios (HRs) decreased but were still significantly elevated (HR(adjusted) = 1.52, 95% CI 1.10 to 2.10 and HR(adjusted) = 1.61, 95% CI 1.36 to 1.92, respectively). When follow-up was split into 3 time bands, it was found that the short- and medium-term associations were about the same and independent of unemployment duration, with adjusted HRs ranging between 1.70 and 1.76. No significant long-term associations were found after adjustment.
Unemployment was related to becoming hospitalized owing to an alcohol-related diagnosis. A substantial part of the elevated relative risk of alcohol-related hospitalization related to unemployment was found to be associated with already existing individual risk factors.
失业与与酒精相关的发病率有关。然而，这种关联是否具有因果关系尚不清楚，也不知道是否还有其他风险因素未得到控制。本研究通过调整先前存在的酒精障碍、精神科诊断、行为风险因素和社会因素，检验了失业与之后因酒精相关住院的关联。
该研究基于兵役征召队列（1949 年至 1951 年出生的男性），包括精神科诊断和心理评估的信息，以及药物使用调查的信息，然后与国家登记册进行了链接。分析对象是 1990 年至 1991 年处于有薪就业状态的 37798 人。
研究发现，短期和长期失业（1 至 89 天和≥90 天）与 12 年随访时因酒精相关诊断住院有关（粗 HR(crude) = 2.25，95%CI 1.64 至 3.09 和 HR(crude) = 2.95，95%CI 2.51 至 3.48）。在调整混杂因素后，危险比（HR）虽有所下降，但仍显著升高（调整后 HR(adjusted) = 1.52，95%CI 1.10 至 2.10 和 HR(adjusted) = 1.61，95%CI 1.36 至 1.92）。当随访时间分为 3 个时间段时，发现短期和中期关联基本相同，且与失业持续时间无关，调整后的 HR 在 1.70 至 1.76 之间。调整后未发现明显的长期关联。
失业与因酒精相关诊断而住院有关。失业与酒精相关住院的相对风险升高的很大一部分与已经存在的个体风险因素有关。
