title: Unemployment and hospitalization owing to an alcohol-related diagnosis among middle-aged men in Sweden.
abstract: BACKGROUND
  Unemployment is associated with alcohol-related morbidity. However, the extent to which the association is causal is unclear, and it is not known whether other risk factors remain uncontrolled for. This study examines the association between unemployment and later alcohol-related hospitalization, adjusted for preexisting alcohol disorders, psychiatric diagnoses, behavioral risk factors, and social factors.
  
  
  METHODS
  The study was based on a military conscription cohort (men born in 1949 to 1951), with information on psychiatric diagnosis and psychological assessment and from a drug-use survey, which was then linked to national registers. The analyses were performed on data on the 37,798 individuals who were in paid employment in 1990 to 1991.
  
  
  RESULTS
  It was found that short- and long-term unemployment (1 to 89 days and ≥90 days) were associated with hospitalization owing to an alcohol-related diagnosis at 12-year follow-up (HR(crude) = 2.25, 95% CI 1.64 to 3.09 and HR(crude) = 2.95, 95% CI 2.51 to 3.48, respectively). After adjustment for confounders, the hazard ratios (HRs) decreased but were still significantly elevated (HR(adjusted) = 1.52, 95% CI 1.10 to 2.10 and HR(adjusted) = 1.61, 95% CI 1.36 to 1.92, respectively). When follow-up was split into 3 time bands, it was found that the short- and medium-term associations were about the same and independent of unemployment duration, with adjusted HRs ranging between 1.70 and 1.76. No significant long-term associations were found after adjustment.
  
  
  CONCLUSIONS
  Unemployment was related to becoming hospitalized owing to an alcohol-related diagnosis. A substantial part of the elevated relative risk of alcohol-related hospitalization related to unemployment was found to be associated with already existing individual risk factors.
authors: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. andreas.lundin@ki.se
authors: Andreas
authors: A
authors: Lundin
authors: Mona
authors: M
authors: Backhans
authors: Tomas
authors: T
authors: Hemmingsson
mesh_terms: D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D016208:Databases, Factual; D004522:Educational Status; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D016016:Proportional Hazards Models; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data; D012931:Social Environment; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D014478:Unemployment / Q000706:statistics & numerical data*