Junna Liina, Moustgaard Heta, Martikainen Pekka
Population Research Unit, University of Helsinki, Helsinki, Finland.
Centre for Health Equity Studies, University of Stockholm/Karolinska Institutet, Stockholm, Sweden.
Addiction. 2021 Jan;116(1):74-82. doi: 10.1111/add.15106. Epub 2020 Jun 3.
To assess the importance of health selection in the association between unemployment and alcohol-related mortality by comparing mortalities of those unemployed from workplaces experiencing different levels of downsizing. The more severe the downsizing, the less dependent unemployment would be on personal characteristics and the weaker the role of health selection.
We estimated hazards models of unemployment on alcohol-related diseases and poisonings and external causes with alcohol as a contributing cause over follow-ups of 0-5, 6-10 and 11-20 years and at different levels of downsizing (stable, downsized or closed).
Finland, 1990 to 2009.
A register-based random sample of employees aged 25-63 in privately owned workplaces (n = 275 738).
The outcome was alcohol-related death and the exposure was unemployment. We adjusted for age, sex, year, education, marital status, health status, workplace tenure, industry, region and unemployment rate.
Alcohol-disease mortality was elevated among the unemployed throughout the follow-up, regardless of the level of downsizing. At 11-20 years after baseline, those unemployed from stable workplaces had a 2.46 hazard ratio (HR) (95% confidence interval [CI] = 2.14-2.82), those from downsized workplaces 1.94 (95% CI = 1.64-2.30) and those from closed workplaces 2.13 (95% CI = 1.75-2.59), when compared with the controls. Alcohol-related external-cause mortality at 0-5 years follow-up was only associated with unemployment from stable workplaces (HR = 1.39, 95% CI = 1.22-1.58), but over time, an association emerged among those unemployed following downsizing and closure. At 11-20-year follow-up, the HR following downsizing was 1.83 (CI 95% = 1.37-2.45) and 1.54 (95% CI = 1.03-2.28) following closure.
There is some indication that alcohol-related ill-health may lead to unemployment in Finland. However, the persistent long-term association between unemployment and alcohol-related mortality even after workplace closure may imply a causal relation.
通过比较来自经历不同程度裁员的工作场所的失业者的死亡率，评估健康选择在失业与酒精相关死亡率之间关联中的重要性。裁员越严重，失业对个人特征的依赖程度就越低，健康选择的作用也就越弱。
我们估计了在0至5年、6至10年和11至20年的随访期间以及在不同程度的裁员（稳定、裁员或关闭）情况下，失业与酒精相关疾病、中毒以及以酒精为促成原因的外部原因之间的风险模型。
1990年至2009年的芬兰。
基于登记的25至63岁在私营工作场所工作的员工随机样本（n = 275738）。
结果是酒精相关死亡，暴露因素是失业。我们对年龄、性别、年份、教育程度、婚姻状况、健康状况、工作场所任期、行业、地区和失业率进行了调整。
在整个随访期间，失业者的酒精相关疾病死亡率均升高，与裁员程度无关。在基线后的11至20年，与对照组相比，来自稳定工作场所的失业者的风险比（HR）为2.46（95%置信区间[CI]=2.14 - 2.82），来自裁员工作场所的为1.94（95%CI = 1.64 - 2.30），来自关闭工作场所的为2.13（95%CI = 1.75 - 2.59）。在0至5年随访时，酒精相关外部原因死亡率仅与来自稳定工作场所的失业有关（HR = 1.39，95%CI = 1.22 - 1.58），但随着时间推移，在裁员和关闭后失业的人群中也出现了关联。在11至20年随访时，裁员后的HR为1.83（95%CI = 1.37 - 2.45），关闭后的HR为1.54（95%CI = 1.03 - 2.28）。
有迹象表明在芬兰，酒精相关的健康问题可能导致失业。然而，即使在工作场所关闭后，失业与酒精相关死亡率之间长期持续的关联可能意味着存在因果关系。
