Bishop Lauren, Brännström Lars, Almquist Ylva B
Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
Max Planck-University of Helsinki, Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland.
Addiction. 2025 Oct;120(10):2118-2126. doi: 10.1111/add.70107. Epub 2025 Jun 20.
Alcohol-related disorders (ARDs) are associated with severe attributable harms that evolve throughout the life course, comprising distinct trajectories. Yet, how mortality affects the identification, shape and number of trajectory groups remains poorly understood. This study aimed to: (1) derive trajectories of hospital-presenting ARDs between early and late adulthood; (2) compare trajectories that include mortality information versus trajectories excluding individuals who died during follow-up; and (3) predict trajectory membership based on exposure to familial risk factors between ages 0-19.
Prospective cohort study using group-based trajectory modeling to identify hospital-presenting ARD trajectories.
Stockholm, Sweden.
1953 birth cohort (n = 14 608), with 43 years of follow-up data (ages 20-63), comprising two study samples: total sample (alive at age 20, n = 14 559) and surviving sample (alive at age 63, n = 13 276).
Hospital-presenting ARDs were measured using national inpatient care data (1973-2016). Familial risk factors were assessed using national and local records on parental alcohol-related offenses, mental health problems, criminality and investigations by child welfare services.
Five distinct hospital-presenting ARD trajectories were identified in the total sample; four were identified in the surviving sample. Mortality disproportionately affected individuals assigned to the two trajectories characterized by medium-to-high peaks of hospital-presenting ARDs (64.9% and 80.6% attrition due to death, respectively). The most severe trajectory was not identified in the surviving sample. Familial risk factors were significant predictors of trajectory membership for both samples, with odds ratios ranging between 1.67 and 8.10, though with largely overlapping 95% confidence intervals between the two risk groups and across trajectories.
Mortality may disproportionately affect individuals assigned to trajectories of hospital-presenting alcohol-related disorders (ARDs) characterized by severe alcohol-attributable harms. Longitudinal studies of ARDs that exclude deceased participants may therefore underrepresent the most vulnerable groups: those with chronic or escalating ARDs.
酒精相关障碍（ARDs）与严重的可归因危害相关，这些危害在整个生命过程中演变，包括不同的轨迹。然而，死亡率如何影响轨迹组的识别、形状和数量仍知之甚少。本研究旨在：（1）得出成年早期和晚期因ARDs而住院的轨迹；（2）比较包含死亡率信息的轨迹与排除随访期间死亡个体的轨迹；（3）根据0至19岁期间暴露于家族风险因素来预测轨迹成员资格。
前瞻性队列研究，使用基于组的轨迹模型来识别因ARDs而住院的轨迹。
瑞典斯德哥尔摩。
1,953年出生队列（n = 14,608），有43年的随访数据（年龄20至63岁），包括两个研究样本：总样本（20岁时存活，n = 14,559）和存活样本（63岁时存活，n = 13,276）。
使用国家住院护理数据（1973 - 2016年）测量因ARDs而住院的情况。使用国家和地方关于父母与酒精相关犯罪、心理健康问题、犯罪行为以及儿童福利服务调查的记录来评估家族风险因素。
在总样本中识别出五条不同的因ARDs而住院的轨迹；在存活样本中识别出四条。死亡率对被分配到以因ARDs而住院的中到高峰值为特征的两条轨迹的个体影响尤为显著（分别有64.9%和80.6%的个体因死亡而退出）。在存活样本中未识别出最严重的轨迹。家族风险因素是两个样本轨迹成员资格的显著预测因素，比值比在1.67至8.10之间，尽管两个风险组之间以及不同轨迹之间的95%置信区间有很大重叠。
死亡率可能对被分配到以严重酒精可归因危害为特征的因酒精相关障碍（ARDs）而住院轨迹的个体影响尤为显著。因此，排除已故参与者的ARDs纵向研究可能无法充分代表最脆弱的群体：那些患有慢性或病情不断升级的ARDs的个体。
