Social and economic consequences of alcohol use disorder: a longitudinal cohort and co-relative analysis
Social and economic consequences of alcohol use disorder: a longitudinal cohort and co-relative analysis
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DOI：
10.1017/s0033291716003032
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发表时间：
2017-04-01
影响因子：
6.9
通讯作者：
Sundquist, K.
中科院分区：
文献类型：
--
作者：
Kendler, K. S.;Ohlsson, H.;Sundquist, K.
背景虽然酒精使用障碍（AUD）与心理社会功能障碍的未来风险有关，但AUD对功能的直接因果影响与相关风险因素（也称为混杂因素）的直接因果影响程度尚不清楚。AUD是从瑞典医学、刑事和药房登记处评估的。在一个大型的一般人群队列中，使用考克斯比例风险和回归模型，我们从澳元的开始预测了四个结果：提前退休，失业，社会援助和个人收入。然后我们检查了这些关联被相关混杂因素以及使用不一致的堂兄弟姐妹、同父异母兄弟姐妹、同母异父兄弟姐妹和同卵双生子所减弱的程度。在男性中，AUD对社会援助的预测最强[风险比（HR）8.27，95%置信区间（CI）7.96-8.59]，其次是提前退休（HR 5.63，95% CI 5.53-5.72）和失业（HR 2.75，95% CI 2.65-2.85）。对于50岁时的收入，澳元与收入减少0.24 S.D.s（95% CI -0.25至-0.23）相关。女性的结果相似。在添加相关协变量后，在两种性别中均观察到这些相关性的中度至中度衰减。这些协会减少，但仍然强大的不一致的相关对，包括同卵双胞胎。我们的研究结果表明，AUD对一系列反映心理社会功能障碍的措施具有因果影响。这些发现为漂移假说提供了强有力的支持。然而，AUD和功能障碍之间的一些关联似乎是非因果关系的，并且是由共同的风险因素引起的，其中许多可能是家族性的。
Background. Although alcohol use disorder (AUD) is associated with future risk for psychosocial dysfunction, the degree to which this arises from a direct causal effect of AUD on functioning v. from correlated risk factors (also known as confounders) is less clearly established.Method. AUD was assessed from Swedish medical, criminal and pharmacy registries. In a large general population cohort, using Cox proportional hazard and regression models, we predicted from the onset of AUD four outcomes: early retirement, unemployment, social assistance, and individual income. We then examined the degree to which these associations were attenuated by relevant confounders as well as by the use of discordant cousin, half-sibling, full-sibling, and monozygotic twin pairs.Results. In males, AUD most strongly predicted social assistance [hazard ratio (HR) 8.27, 95% confidence interval (CI) 7.96-8.59], followed by early retirement (HR 5.63, 95% CI 5.53-5.72) and unemployment (HR 2.75, 95% CI 2.65-2.85). For income at age 50, AUD was associated with a decrease in income of 0.24 S.D.s (95% CI -0.25 to -0.23). Results were similar in females. Modest to moderate attenuation of these associations was seen in both sexes after the addition of relevant covariates. These associations were reduced but remained robust in discordant co-relative pairs, including monozygotic twins.Conclusions. Our results suggest that AUD has a causal impact on a range of measures reflective of psychosocial dysfunction. These findings provide strong support for the drift hypothesis. However, some of the associations between AUD and dysfunction appear to be non-causal and result from shared risk factors, many of which are likely familial.