Socioeconomic sequelae of drug abuse in a Swedish national cohort
Socioeconomic sequelae of drug abuse in a Swedish national cohort
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DOI：
10.1016/j.drugalcdep.2020.107990
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发表时间：
2020-07-01
影响因子：
4.2
通讯作者：
Kendler, Kenneth S.
中科院分区：
文献类型：
--
作者：
Edwards, Alexis C.;Ohlsson, Henrik;Kendler, Kenneth S.
背景：药物滥用常常伴随着负面的后遗症，如社会经济功能下降。这些关联在多大程度上可归因于疾病和混杂因素的因果作用，混杂因素增加了药物滥用的风险和负面的社会经济后果，目前尚不清楚。方法：使用瑞典国家医疗、药房和刑事登记来识别药物滥用病例。应用Cox比例风险模型，我们检验了药物滥用与四种结果之间的关系：提前退休、社会救助、失业和50岁时的收入。结果：在调整了出生年份、教育程度和早期外化行为的模型中，药物滥用与提前退休(风险比[HR]=5.13-6.28)、社会救助(HR=6.74-7.89)和50岁时的收入(Beta=-0.19-0.12)密切相关；与失业(HR=1.05-1.20)的关联较弱。对于社会援助和收入(两性)和提前退休(仅限妇女)，部分归因于家庭因素的模型符合数据；剩余的关联支持药物滥用的部分因果作用。对于男性的失业和提前退休，几乎没有证据表明家庭混杂。结论：药物滥用的负面社会经济后遗症可能部分是由于家庭混杂因素与因果关系和/或未测量的非家庭混杂因素共同作用。不同机制的相对贡献因社会经济结果而异，这可能会对理解预防和干预努力的潜在影响产生影响。
Background: Drug abuse is frequently associated with negative sequelae such as reduced socioeconomic functioning. The extent to which these associations are attributable to a causal role of the disorder versus confounding factors that increase risk for both drug abuse and negative socioeconomic outcomes is unclear.Methods: Drug abuse cases were identified using Swedish national medical, pharmacy, and criminal registers. Applying Cox proportional hazard models, we tested the association between drug abuse and four outcomes: early retirement, social assistance, unemployment, and income at age 50. We used co-relative models to determine whether familial confounding factors accounted for observed associations.Results: In models adjusted for birth year, education, and early onset externalizing behavior, drug abuse was strongly associated with early retirement (hazard ratios [HR] = 5.13-6.28), social assistance (HR = 6.74-7.89), and income at age 50 (beta = -0.19 to - 0.12); it was more modestly associated with unemployment (HR = 1.05-1.20). For social assistance and income (both sexes), and early retirement (women only), a model in which the association was partly attributable to familial factors fit the data well; residual associations support a partially causal role of drug abuse. For unemployment and early retirement among men, there was little evidence of familial confounding.Conclusions: The negative socioeconomic sequelae of drug abuse are likely due in part to familial confounding factors in conjunction with a causal relationship and/or unmeasured non-familial confounders. Relative contributions from distinct mechanisms differed across socioeconomic outcomes, which could have implications for understanding the potential impact of prevention and intervention efforts.