title: Alcohol-induced morbidity and mortality by occupation: a population-based follow-up study of working Finns.
abstract: BACKGROUND
  To justify alcohol-related health promotion programs and target them at the correct workplaces, it is important to identify occupations with increased risk of severe health outcomes caused by alcohol.
  
  
  METHODS
  Data on hospital admissions (854,555 men and 801,653 women) from the Finnish health care register and data on deaths from Statistics Finland from 1 January 2001 to 31 December 2004 were merged with information from the 2000 population census. We assessed the age- and education-adjusted relationship between occupation and the sum of hospitalizations and death primarily caused by alcohol, using Cox proportional hazards regression. We also estimated the fraction of incidence of severe alcohol-induced health outcomes that are attributable to factors related to one's occupation (population attributable fraction).
  
  
  RESULTS
  Most of the cases were men (80%), middle-aged and usually had no more than a secondary level of education. When the reference was professionals, who were at the lowest risk, those at increased risk were mostly manual workers in craft work, construction and service. However, we also found several non-manual occupations at a high risk. According to population attributable fraction, the proportion of severe alcohol-induced health outcomes would have been 31% lower among men and 20% lower among women if all occupational groups had been at the same risk as professionals.
  
  
  CONCLUSIONS
  We detected considerable occupational differences in alcohol-induced morbidity and mortality among a nationally representative working population. This indicates a need for alcohol-focused health promotion programs in these high-risk occupations.
authors.affiliation: 1 Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland leena.kaila-kangas@ttl.fi.
authors.forename: Leena
authors.initials: L
authors.lastname: Kaila-Kangas
authors.affiliation: 2 Creating Solutions, Statistics and Health Economics Team, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Aki
authors.initials: A
authors.lastname: Koskinen
authors.affiliation: 1 Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Pensola
authors.affiliation: 3 Alcohol and Drugs Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Mäkelä
authors.affiliation: 1 Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Leino-Arjas
mesh_terms: D017677:Age Distribution; D000437:Alcoholism / Q000453:epidemiology* / Q000401:mortality; D004522:Educational Status; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009790:Occupations / Q000706:statistics & numerical data*; D012307:Risk Factors; D017678:Sex Distribution