title: Unemployment Is a Risk Factor for Hospitalization Due to Alcohol Problems: A Longitudinal Study Based on the Stockholm Public Health Cohort (SPHC).
abstract: This study examined the associations between unemployment and alcohol-related hospitalization or mortality and to what extent these associations may be confounded by alcohol consumption and alcohol problems before unemployment.
  
  
  
  The study was based on the Stockholm Public Health Cohort (SPHC), a population-based stratified random sample with a baseline questionnaire in 2002/2003 and record linkages up to year 2011. The final sample in the study consists of 15,841 people aged 18-60 years. Unemployment was defined as any registration at the public employment services during 2003-2005. The outcome was alcohol-related hospitalization and alcohol-related mortality during 2006-2011. Confounders were age, sex, and education, and we further adjusted for baseline alcohol consumption and alcohol-related hospitalization before the study period. Cox proportional hazard models were fit, and associations were expressed as hazard ratios (HRs).
  
  
  
  In the fully adjusted model, unemployment was associated with an increased risk of alcohol-related hospitalization or mortality, with a more than threefold hazard (HR = 3.38, 95% CI [1.81, 6.31]) compared with no unemployment during the exposure period. There was a moderate attenuating effect of prior alcohol consumption and alcohol-related hospitalization.
  
  
  
  Any unemployment in 2003-2005 was highly related to having experienced an alcohol-related diagnosis during the 6-year follow-up, even after controlling for risky use of alcohol and prior hospitalization.
authors: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Centre for Epidemiology and Community Health, Stockholm County Council, Solna, Sweden.
authors: Mona Christina
authors: MC
authors: Backhans
authors: Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
authors: Natalja
authors: N
authors: Balliu
authors: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Centre for Epidemiology and Community Health, Stockholm County Council, Solna, Sweden.
authors: Andreas
authors: A
authors: Lundin
authors: Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.|The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors: Tomas
authors: T
authors: Hemmingsson
mesh_terms: D000293:Adolescent; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011634:Public Health; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D014478:Unemployment / Q000706:statistics & numerical data*; D055815:Young Adult