Abstract
ObjectivesAlcohol use disorders (AUD) is well known to aggregate in families and is associated with socioeconomic status (SES). The objective was to study the effect of education, income and neighborhood SES in adulthood on AUD, and to explore whether the potential associations were confounded by shared familial factors, by using a co-relative control design.MethodsData on AUD was drawn from the Swedish inpatient and outpatient care registers; prescription drug register; and crime data. Through national population registers we collected information on income, education and neighborhood SES at age 25, 30, 35 and 40 years in all individuals born in Sweden between 1950 and 1980. Each sex-specific stratum consisted of approximately 750,000–1,200,000 individuals, who were followed for AUD for a mean follow-up time ranging between 10 and 15 years until the end of 2013. Cox proportional hazards models were used to investigate the risk of AUD as a function of income, education and neighborhood SES in the general population and in pairs of first cousins and full siblings within the same sex, who differed in their exposure to the SES measure.ResultsHigher educational level, higher income and higher neighborhood SES were all associated with a reduced risk for AUD for both males and females in all ages. The potentially protective effect remained but was attenuated when comparing pairs of first cousins and full siblings.ConclusionsHigh educational level and income in adulthood, as well as high neighborhood socioeconomic status, may represent protective factors against alcohol use disorders, even when shared familial factors, e.g. childhood socioeconomic status and genetic factors, have been taken into account.
Highlights
Alcohol consumption is related to a wide range of negative acute and chronic health consequences and causes a considerable part of the global burden of disease [1]
Socioeconomic status and alcohol use disorders data in our research databases outside Sweden and the EU according to Swedish and EU legislation
An application for use of the same minimal dataset, which we have used in this study, should include a motivation, a referral to the present study and an addition of a list of variables, before submission of a data request to the Swedish National Board of Health and Welfare, Statistics Sweden and BRÅ using the contact addresses above
Summary
Alcohol consumption is related to a wide range of negative acute and chronic health consequences and causes a considerable part of the global burden of disease [1]. The association is complex and may be affected by sex and levels of alcohol consumption, which has been shown to be higher in affluent and more educated populations [9, 10]. The association between low SES and later AUD may be affected by the age of first intake, as initiating alcohol use at an early age increases the likelihood of later AUD [4, 14, 15]. A review of the literature of alcohol consumption, AUD and SES concluded that the association between these is complex, and that there is a lack of studies exploring this relationship in depth [5]. The present study will make a novel contribution to the field by studying the relationship between different socioeconomic indicators and AUD in both males and females at different ages
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