title: Alcohol-related morbidity and mortality within siblings.
abstract: OBJECTIVE
  To estimate the association between educational status and alcohol-related somatic and non-somatic morbidity and mortality among full siblings in comparison with non-related individuals.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Denmark.
  
  
  METHODS
  Approximately 1.4 million full siblings born in Denmark between 1950 and 1979 were followed from age 28-58 years or censoring due to alcohol-related hospitalization and mortality.
  
  
  METHODS
  Cox regression analyses were used to estimate associations of educational status with alcohol-related outcomes. Results from cohort analyses based on non-related individuals and inter-sibling analyses were compared.
  
  
  RESULTS
  A lower educational status was associated with a higher rate of alcohol-related outcomes, especially among the youngest (aged 28-37 years) and individuals born 1970-79. Compared with the cohort analyses, the associations attenuated slightly in the inter-sibling analysis. For example, in the cohort analysis, females with a basic school education born 1970-79 had an increased rate of alcohol-related non-somatic morbidity and mortality [hazard rate ratio (HR) = 4.05, 95% confidence interval (CI) = 3.27-5.02] compared to those with a vocational education. In the inter-sibling analysis, the HR attenuated (HR = 2.66, 95% CI = 1.95-3.63). For alcohol-related somatic outcomes the corresponding figures were HR = 3.47 (95% CI = 2.63-4.58) and HR = 3.36 (95% CI = 2.10-5.38), respectively. In general, the associations were stronger among females than males (aged 28-37) in the analyses of alcohol-related non-somatic outcomes. Health conditions earlier in life explained only a minor part of the associations.
  
  
  CONCLUSIONS
  The association between educational status and alcohol-related somatic and non-somatic morbidity and mortality is only driven by familial factors to a small degree.
authors.affiliation: Research Centre for Prevention and Health, Glostrup University Hospital, Nordre Ringvej 57, Building 84/85, DK-2600, Glostrup, Denmark.
authors.forename: Grethe
authors.initials: G
authors.lastname: Søndergaard
authors.forename: Merete
authors.initials: M
authors.lastname: Osler
authors.forename: Anne-Marie Nybo
authors.initials: AM
authors.lastname: Andersen
authors.forename: Per Kragh
authors.initials: PK
authors.lastname: Andersen
authors.forename: Susanne Oksbjerg
authors.initials: SO
authors.lastname: Dalton
authors.forename: Laust H
authors.initials: LH
authors.lastname: Mortensen
mesh_terms: D000328:Adult; D000367:Age Factors; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012737:Sex Factors; D035781:Siblings; D014829:Vocational Education
keywords: Alcohol; education; family; hospitalization; morbidity; mortality; siblings; social inequality in health