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Social and economic consequences of alcohol use disorder : a longitudinal cohort and co-relative analysis

Kendler, K. S. LU ; Ohlsson, H. LU ; Karriker-Jaffe, K. J.; Sundquist, J. LU and Sundquist, K. LU (2017) In Psychological Medicine 47(5). p.925-935
Abstract

Background: Although alcohol use disorder (AUD) is associated with future risk for psychosocial dysfunction, the degree to which this arises from a direct causal effect of AUD on functioning v. from correlated risk factors (also known as confounders) is less clearly established. Method: AUD was assessed from Swedish medical, criminal and pharmacy registries. In a large general population cohort, using Cox proportional hazard and regression models, we predicted from the onset of AUD four outcomes: early retirement, unemployment, social assistance, and individual income. We then examined the degree to which these associations were attenuated by relevant confounders as well as by the use of discordant cousin, half-sibling, full-sibling,... (More)

Background: Although alcohol use disorder (AUD) is associated with future risk for psychosocial dysfunction, the degree to which this arises from a direct causal effect of AUD on functioning v. from correlated risk factors (also known as confounders) is less clearly established. Method: AUD was assessed from Swedish medical, criminal and pharmacy registries. In a large general population cohort, using Cox proportional hazard and regression models, we predicted from the onset of AUD four outcomes: early retirement, unemployment, social assistance, and individual income. We then examined the degree to which these associations were attenuated by relevant confounders as well as by the use of discordant cousin, half-sibling, full-sibling, and monozygotic twin pairs. Results: In males, AUD most strongly predicted social assistance [hazard ratio (HR) 8.27, 95% confidence interval (CI) 7.96–8.59], followed by early retirement (HR 5.63, 95% CI 5.53–5.72) and unemployment (HR 2.75, 95% CI 2.65–2.85). For income at age 50, AUD was associated with a decrease in income of 0.24 s.d.s (95% CI −0.25 to −0.23). Results were similar in females. Modest to moderate attenuation of these associations was seen in both sexes after the addition of relevant covariates. These associations were reduced but remained robust in discordant co-relative pairs, including monozygotic twins. Conclusions: Our results suggest that AUD has a causal impact on a range of measures reflective of psychosocial dysfunction. These findings provide strong support for the drift hypothesis. However, some of the associations between AUD and dysfunction appear to be non-causal and result from shared risk factors, many of which are likely familial.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Alcohol use disorder, co-relative design, drift, early retirement, income, social assistance, unemployment
in
Psychological Medicine
volume
47
issue
5
pages
11 pages
publisher
Cambridge University Press
external identifiers
  • scopus:85002083593
  • wos:000396305100011
ISSN
0033-2917
DOI
10.1017/S0033291716003032
language
English
LU publication?
yes
id
cbb279fc-87a0-4a88-b636-35c52a63b937
date added to LUP
2016-12-28 08:37:45
date last changed
2018-03-04 04:56:57
@article{cbb279fc-87a0-4a88-b636-35c52a63b937,
  abstract     = {<p>Background: Although alcohol use disorder (AUD) is associated with future risk for psychosocial dysfunction, the degree to which this arises from a direct causal effect of AUD on functioning v. from correlated risk factors (also known as confounders) is less clearly established. Method: AUD was assessed from Swedish medical, criminal and pharmacy registries. In a large general population cohort, using Cox proportional hazard and regression models, we predicted from the onset of AUD four outcomes: early retirement, unemployment, social assistance, and individual income. We then examined the degree to which these associations were attenuated by relevant confounders as well as by the use of discordant cousin, half-sibling, full-sibling, and monozygotic twin pairs. Results: In males, AUD most strongly predicted social assistance [hazard ratio (HR) 8.27, 95% confidence interval (CI) 7.96–8.59], followed by early retirement (HR 5.63, 95% CI 5.53–5.72) and unemployment (HR 2.75, 95% CI 2.65–2.85). For income at age 50, AUD was associated with a decrease in income of 0.24 s.d.s (95% CI −0.25 to −0.23). Results were similar in females. Modest to moderate attenuation of these associations was seen in both sexes after the addition of relevant covariates. These associations were reduced but remained robust in discordant co-relative pairs, including monozygotic twins. Conclusions: Our results suggest that AUD has a causal impact on a range of measures reflective of psychosocial dysfunction. These findings provide strong support for the drift hypothesis. However, some of the associations between AUD and dysfunction appear to be non-causal and result from shared risk factors, many of which are likely familial.</p>},
  author       = {Kendler, K. S. and Ohlsson, H. and Karriker-Jaffe, K. J. and Sundquist, J. and Sundquist, K.},
  issn         = {0033-2917},
  keyword      = {Alcohol use disorder,co-relative design,drift,early retirement,income,social assistance,unemployment},
  language     = {eng},
  number       = {5},
  pages        = {925--935},
  publisher    = {Cambridge University Press},
  series       = {Psychological Medicine},
  title        = {Social and economic consequences of alcohol use disorder : a longitudinal cohort and co-relative analysis},
  url          = {http://dx.doi.org/10.1017/S0033291716003032},
  volume       = {47},
  year         = {2017},
}