title: Non-employment histories of middle-aged men and women who died from alcohol-related causes: a longitudinal retrospective study.
abstract: BACKGROUND
  Long-term patterning of non-employment among problem drinkers is poorly understood. We determined the level and timing of non-employment, and the relative contribution of various types of non-employment among middle-aged persons who died of alcohol-related causes.
  
  
  METHODS
  We conducted a longitudinal retrospective register-based study of Finnish men and women aged 45-64 years who died of alcohol-related causes (n = 15,552) or other causes (n = 39,166) in the period 2000-07, or who survived (n = 204,422) until the end of 2007. We traced back the number of days in employment and non-employment for up to 17 years before death or before the end of the study period for the survivors.
  
  
  RESULTS
  The majority (≥56%) of persons who died of alcohol-related causes were in employment up to ten years before death. Over the 17-year period before death, those who died of alcohol-related causes were in employment on average two years less (mean 6.3 years, 95%CI 6.2-6.4) than those dying of other causes (8.2, 8.1-8.3), and five years less than survivors (11.6, 11.5-11.7), when sex and age were adjusted for. The relative role of various types of non-employment differed markedly across the two mortality groups. Among those who died of alcohol-related causes, unemployment accounted for 54% of the total burden of non-employment, in comparison with 29% among those who died of other causes. In contrast, disability pension accounted for 41% of the total burden of non-employment among those who died of alcohol-related causes, but 65% among those who died of other causes.
  
  
  CONCLUSIONS
  The results indicate the feasibility of preventing movement out of employment among middle-aged men and women with severe alcohol-related harm, provided that they are identified early on during their working careers and offered effective interventions.
authors.affiliation: Alcohol and Drugs Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Tapio
authors.initials: T
authors.lastname: Paljärvi
authors.affiliation: Population Research Unit, University of Helsinki, Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.affiliation: Population Research Unit, University of Helsinki, Helsinki, Finland.
authors.forename: Taina
authors.initials: T
authors.lastname: Leinonen
authors.affiliation: Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Pensola
authors.affiliation: Alcohol and Drugs Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Mäkelä
mesh_terms: D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D002423:Cause of Death; D004651:Employment; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014478:Unemployment