title: The arrest of drivers under the influence as a predictor of subsequent social disadvantage and death.
abstract: BACKGROUND
  The association between DUI (driving under the influence) and disadvantaged social background has been shown in cross-sectional studies, but less is known about the processes behind this phenomenon. We aimed to examine the effect of DUI arrest on subsequent social disadvantage in Finland during 1993-2006 to provide more understanding about the dynamics of DUI and marginalization and to study DUI arrest as a potential point of intervention.
  
  
  METHODS
  In this longitudinal, register-based study the Register of DUI suspects (n=68894) was linked with the Employment Register. An age- and gender-matched reference population (n=67740) was drawn from the general Finnish population. A multi-state model was used to estimate the transition intensities between three different states (advantaged social status/disadvantaged social status/death) among three different DUI groups (alcohol only, prescription drugs, illicit drugs).
  
  
  RESULTS
  Compared to references, the movement of DUI suspects between different social states was more dynamic in that they were more likely to either move to a disadvantaged social state or to an improved status (except DUI suspects using prescription drugs). A DUI's relative risk of death compared to references was high, especially if currently in advantaged social status. The effect of DUI did not diminish over time.
  
  
  CONCLUSIONS
  Driving under the influence is associated with an increased long-term risk for social disadvantage. DUI arrest could serve as an opportunity for intervention in the marginalization process.
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; School of Health Sciences, FI-33014 University of Tampere, Finland. Electronic address: karoliina.karjalainen@thl.fi.
authors.forename: Karoliina
authors.initials: K
authors.lastname: Karjalainen
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; Hjelt-Institute, Department of Public Health, P.O. Box 41, FI-00014 University of Helsinki, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Haukka
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Lillsunde
authors.affiliation: School of Health Sciences, FI-33014 University of Tampere, Finland; The Finnish Foundation for Alcohol Studies, P.O. Box 30, FI-00271 Helsinki, Finland.
authors.forename: Tomi
authors.initials: T
authors.lastname: Lintonen
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Mäkelä
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000435:Alcoholic Intoxication / Q000401:mortality* / Q000523:psychology; D001334:Automobile Driving / Q000523:psychology; D057237:Criminals / Q000523:psychology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012042:Registries; D012307:Risk Factors; D012931:Social Environment; D035862:Vulnerable Populations / Q000523:psychology; D055815:Young Adult
keywords: Driving under the influence (DUI); Longitudinal study; Social disadvantage