Abstract
The aim of this paper is to estimate the cumulative effect of childhood household dysfunction (CHD) on alcohol related illness and death later in life and to test the interaction between CHD and socioeconomic background. The study utilised Swedish national registers including data of a Swedish national cohort born 1973–82 (n = 872 912), which was followed from age 18 to 29–40 years. Cox regression analyses were used to calculate hazard ratios (HR) for alcohol related illness or death in young adulthood. The CHD measure consisted of seven indicators: parental alcohol/drug misuse, mental health problems, criminality, death, divorce, social assistance, and child welfare interventions. Childhood socioeconomic position (SEP) was indicated by parental occupational status. Outcomes were alcohol related inpatient hospital care, specialised outpatient care or deaths. Using the highest socioeconomic group without CHD experience as a reference, those in the same socioeconomic group with one indicator of CHD had HRs of 2.1 [95% CI: 1.7–2.5], two CHD indicators 5.6 [4.4–7.1], three or more indicators 9.4 [7.1–12.4] for retrieving inpatient care. Socioeconomic disadvantage further increased the risks–those with low socioeconomic background and three CHD indicators or more had a HR of 12.5 [10.9–14.3]. Testing for interaction suggests that the combined HRs deviates from additivity [Synergy index: 1.6, 95% CI: 1.4–1.9]. The results for outpatient care were similar, but not as pronounced. In conclusion, this Swedish national cohort study shows that childhood household dysfunction is strongly and cumulatively associated to alcohol related illness later in life and that it interacts with socioeconomic disadvantage.
Highlights
Intergenerational social mobility, or the potential of children to reach a higher socioeconomic position (SEP) than their parents, is relatively high in Sweden
This result is contrasted by a systematic review on the topic and the Swedish national public health survey, as they show no association between SEP in childhood or adulthood and alcohol consumption or alcohol misuse [4, 5]
Whereas a majority of the population that went through a parental divorce or death had no other experience of childhood household dysfunction (CHD), only a small proportion of the population experiencing parental alcohol/drug misuse or child welfare intervention had no other CHD experience
Summary
Intergenerational social mobility, or the potential of children to reach a higher socioeconomic position (SEP) than their parents, is relatively high in Sweden. It was shown that alcohol related illness is more common in groups with a low socioeconomic background [3] This result is contrasted by a systematic review on the topic and the Swedish national public health survey, as they show no association between SEP in childhood or adulthood and alcohol consumption or alcohol misuse [4, 5]. This leads us to argue that the overrepresentation of alcohol related illness in groups with low socioeconomic background is not related to higher alcohol consumption (exposure), but rather to increased vulnerability to the adverse effects of alcohol [6]. The risk for poor general health and well-being will be lower in these groups, as will the risk for adverse health effects of alcohol [9]
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