Socio-economic status and problem alcohol use: the positive relationship between income and the DSM-IV alcohol abuse diagnosis
Socio-economic status and problem alcohol use: the positive relationship between income and the DSM-IV alcohol abuse diagnosis
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DOI：
10.1111/j.1360-0443.2008.02218.x
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发表时间：
2008-07-01
期刊：
影响因子：
6
通讯作者：
Hasin, Deborah S.
中科院分区：
文献类型：
--
作者：
Keyes, Katherine M.;Hasin, Deborah S.
流行病学证据表明，在一般人群中，收入和酗酒的流行率之间存在正相关关系，但收入和酒精依赖之间存在负相关关系。在被诊断为酗酒的人中，最普遍的标准是危险使用，这通常需要足够的资源来拥有或使用汽车。本研究调查了收入与当前酗酒流行率之间的关联是否被危险使用标准所解释;具体而言，危险使用标准的饮酒和驾驶症状。设计在2001 - 02年全国流行病学调查中进行的面对面调查酒精和相关条件，与酒精使用障碍和相关残疾访谈第4版（AUDADIS-IV）。背景美国和哥伦比亚特区，包括阿拉斯加和夏威夷。18岁以上的住户和集体宿舍居民。排除了终生依赖病例（n = 4781）。衡量收入被定义为过去一年的个人收入。结果是特定的酒精滥用标准和症状问题。进行Logistic回归，控制人口统计学。酒精滥用的严重程度指标和收入之间的关系进行了建模，使用多分类回归。结果在酒精滥用的标准，危险使用是最普遍的和唯一的标准，有一个显着的正相关关系与收入（F = 20.3，df = 3，P <0.0001）。在危险使用症状中，酒后驾驶（F = 13.0，df = 3，P <0.0001）和酒后驾驶（F = 9.2，df = 3，P <0.0001）与收入呈正相关。结论：由于危险使用是最普遍认可的酒精滥用标准，与收入的联系提出了问题，目前的酒精滥用诊断是否可以捕捉到所有社会经济阶层的酒精滥用者的全部范围。虽然许多精神疾病表现出与社会经济地位的反比关系，但选择偏差可能会导致酒精滥用诊断与收入存在人为的正相关关系，因为需要获得待诊断的车辆。
Aims Epidemiological evidence indicates a positive relationship between income and the prevalence of alcohol abuse in the general population, but an inverse relationship between income and alcohol dependence. Among those with a diagnosis of alcohol abuse, the most prevalent criterion is hazardous use, which commonly requires sufficient resources to own or access a car. The present study investigated whether the association between income and the prevalence of current alcohol abuse is accounted for by the hazardous use criterion; specifically, the drinking and driving symptoms of the hazardous use criterion. Design Face-to-face survey conducted in the 2001-02 National Epidemiologic Survey on Alcohol and Related Conditions, interviewed with the Alcohol Use Disorders and Associated Disabilities Interview 4th edition (AUDADIS-IV). Setting The United States and District of Columbia, including Alaska and Hawaii. Participants Household and group-quarters residents aged > 18 years. Life-time dependence cases were excluded (n = 4781). Measurements Income was defined as past-year personal income. Outcomes were specific alcohol abuse criteria and symptom questions. Logistic regressions were performed controlling for demographics. The relationship between alcohol abuse severity indicators and income was modeled using polytomous regression. Findings Among the alcohol abuse criteria, hazardous use is the most prevalent and the only criterion to have a significant positive relationship with income (F = 20.3, df = 3, P < 0.0001). Among the hazardous use symptoms, driving after drinking (F = 13.0, df = 3, P < 0.0001) and driving while drinking (F = 9.2, df = 3, P < 0.0001) were related positively to income. Conclusions Because hazardous use is the most commonly endorsed criterion of alcohol abuse, the link with income raises questions about whether the current alcohol abuse diagnosis can capture the full range of alcohol abusers in every socio-economic class. While many psychiatric disorders exhibit an inverse relationship with socio-economic status, a selection bias may cause the alcohol abuse diagnosis to have an artificially positive relationship with income due to the necessity for access to a vehicle to be diagnosed.