title: Does low alcohol use increase the risk of sickness absence? A discordant twin study.
abstract: Results from observational studies suggest that people who drink little or no alcohol are less healthy than medium drinkers. This has been demonstrated for many different measures of health, including sick leave. However, whether these associations are causal or due to confounding remains to be clarified. The aim of this study was to use a discordant twin design to determine whether the increased level of sick leave associated with a low level of alcohol consumption, as compared to those with a medium level of consumption, reflects a causal mechanism or is due to genetic or environmental confounding.
  
  
  
  Six thousand seven hundred thirty-four young adult twins from the Norwegian Institute of Public Health's twin panel were in 1998 assessed for frequency of alcohol use and binge drinking. Data were linked to the Norwegian National Insurance Administration's recordings of sick leave over a 10 year period. The associations between alcohol consumption and sick leave were first estimated in the total study population, and then within di- and monozygotic twin pairs discordant for alcohol use.
  
  
  
  Compared to medium consumption, both low and high alcohol consumption was associated with increased risk of sick leave. When low level drinkers were compared to medium level drinkers in a discordant twin design, the results were consistent with the association being due to genetic confounding rather than a causal effect.
  
  
  
  The increased level of sick leave observed with low level drinkers seems to be mainly explained by confounding from genetic factors. In all observational studies of the relationship between alcohol consumption and health, one should be aware that important genetic confounders are likely to influence the results.
authors.affiliation: Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway. Kristian.Ostby@fhi.no.
authors.forename: Kristian Amundsen
authors.initials: KA
authors.lastname: Østby
authors.affiliation: Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.|Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Czajkowski
authors.affiliation: Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Gun Peggy
authors.initials: GP
authors.lastname: Knudsen
authors.affiliation: Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Ystrøm
authors.affiliation: Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.|Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Line C
authors.initials: LC
authors.lastname: Gjerde
authors.affiliation: Virginia Institute for Psychiatric and Behavioral Genetics and Departments of Psychiatry and Human Genetics and Medical College of Virginia ⁄ Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Kendler
authors.affiliation: Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Ragnhild E
authors.initials: RE
authors.lastname: Ørstavik
authors.affiliation: Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.|Department of Psychology, University of Oslo, Oslo, Norway.|Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Reichborn-Kjennerud
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D000437:Alcoholism / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D009784:Occupational Diseases / Q000209:etiology*; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D014427:Twins / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Alcohol; Sick leave; Twin