Unemployment and Hospitalization Owing to an Alcohol-Related Diagnosis Among Middle-Aged Men in Sweden


Reprint requests: Andreas Lundin, MSc, Division of Occupational and Environmental Medicine, Department of Public Health Sciences, Karolinska Institutet, Norrbacka plan 5, 171 76 Stockholm, Sweden; Tel.: +46(0)852487604; Fax: +46(0)8334333; E-mail: andreas.lundin@ki.se


Background:  Unemployment is associated with alcohol-related morbidity. However, the extent to which the association is causal is unclear, and it is not known whether other risk factors remain uncontrolled for. This study examines the association between unemployment and later alcohol-related hospitalization, adjusted for preexisting alcohol disorders, psychiatric diagnoses, behavioral risk factors, and social factors.

Methods:  The study was based on a military conscription cohort (men born in 1949 to 1951), with information on psychiatric diagnosis and psychological assessment and from a drug-use survey, which was then linked to national registers. The analyses were performed on data on the 37,798 individuals who were in paid employment in 1990 to 1991.

Results:  It was found that short- and long-term unemployment (1 to 89 days and ≥90 days) were associated with hospitalization owing to an alcohol-related diagnosis at 12-year follow-up (HRcrude = 2.25, 95% CI 1.64 to 3.09 and HRcrude = 2.95, 95% CI 2.51 to 3.48, respectively). After adjustment for confounders, the hazard ratios (HRs) decreased but were still significantly elevated (HRadjusted = 1.52, 95% CI 1.10 to 2.10 and HRadjusted = 1.61, 95% CI 1.36 to 1.92, respectively). When follow-up was split into 3 time bands, it was found that the short- and medium-term associations were about the same and independent of unemployment duration, with adjusted HRs ranging between 1.70 and 1.76. No significant long-term associations were found after adjustment.

Conclusions:  Unemployment was related to becoming hospitalized owing to an alcohol-related diagnosis. A substantial part of the elevated relative risk of alcohol-related hospitalization related to unemployment was found to be associated with already existing individual risk factors.