title: Effects of increased alcohol availability during adolescence on the risk of all-cause and cause-specific disability pension: a natural experiment.
abstract: OBJECTIVE
  To test if being exposed to increased alcohol availability during adolescence is associated with an increased risk of receiving disability pension due to all-cause, alcohol use disorders and mental disorders.
  
  
  METHODS
  Register-based population-based study using a natural experiment setting, the alcohol policy change in Sweden (1967-68), with increased access to strong beer in a narrow time window and geographical area. The individuals exposed to the policy change were compared with non-exposed individuals living in the rest of Sweden, excluding a border area.
  
  
  METHODS
  Sweden.
  
  
  METHODS
  A total of 518 810 individuals (70 761 in the intervention group; 448 049 in the control group) born 1948-1953, aged 14-20 years during the policy change.
  
  
  METHODS
  Date and diagnosis of the outcome variable of disability pension due to all-cause, alcohol use disorders and mental disorders were obtained from the Swedish National Social Insurance Agency database from 1971 to 2013. Individual and family level socio-demographic and health-related covariates, as well as a regional level covariate, were included.
  
  
  RESULTS
  Compared with the control group, adolescents exposed to the alcohol policy change were at an increased risk of receiving disability pension due to all-causes [hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.07-1.11], alcohol use disorders (HR = 1.17, 95% CI = 1.05-1.30) and mental disorders (HR = 1.19, 95% CI = 1.15-1.23).
  
  
  CONCLUSIONS
  In Sweden, a natural experiment with a 43-year follow-up suggests that exposure to increased alcohol availability during adolescence is associated with an increased risk of receiving a disability pension due to all-cause, alcohol use disorder and mental disorder diagnoses.
authors.affiliation: Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Emelie
authors.initials: E
authors.lastname: Thern
authors.affiliation: Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jeroen
authors.initials: J
authors.lastname: de Munter
authors.affiliation: Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.|Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Hemmingsson
authors.affiliation: MRC Integrative Epidemiology Unit (IEU), University of Bristol, School of Social and Community Medicine, Bristol, UK.
authors.forename: George
authors.initials: G
authors.lastname: Davey Smith
authors.affiliation: The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Ramstedt
authors.affiliation: Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Tynelius
authors.affiliation: Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden.
authors.forename: Finn
authors.initials: F
authors.lastname: Rasmussen
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D010415:Pensions / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013548:Sweden; D000066608:Underage Drinking / Q000331:legislation & jurisprudence*; D055815:Young Adult
keywords: Adolescent alcohol consumption; Sweden; alcohol availability; alcohol policy; disability pension; natural experiment