Socioeconomic status and alcohol use disorders across the lifespan: A co-relative control study

ObjectivesAlcohol use disorders (AUD) is well known to aggregate in families and is associated with socioeconomic status (SES). The objective was to study the effect of education, income and neighborhood SES in adulthood on AUD, and to explore whether the potential associations were confounded by shared familial factors, by using a co-relative control design.MethodsData on AUD was drawn from the Swedish inpatient and outpatient care registers; prescription drug register; and crime data. Through national population registers we collected information on income, education and neighborhood SES at age 25, 30, 35 and 40 years in all individuals born in Sweden between 1950 and 1980. Each sex-specific stratum consisted of approximately 750,000–1,200,000 individuals, who were followed for AUD for a mean follow-up time ranging between 10 and 15 years until the end of 2013. Cox proportional hazards models were used to investigate the risk of AUD as a function of income, education and neighborhood SES in the general population and in pairs of first cousins and full siblings within the same sex, who differed in their exposure to the SES measure.ResultsHigher educational level, higher income and higher neighborhood SES were all associated with a reduced risk for AUD for both males and females in all ages. The potentially protective effect remained but was attenuated when comparing pairs of first cousins and full siblings.ConclusionsHigh educational level and income in adulthood, as well as high neighborhood socioeconomic status, may represent protective factors against alcohol use disorders, even when shared familial factors, e.g. childhood socioeconomic status and genetic factors, have been taken into account.研究目的：众所周知，酒精使用障碍（Alcohol Use Disorders, AUD）具有家族聚集性，且与社会经济地位（Socioeconomic Status, SES）相关。本研究旨在探讨成年时期的受教育程度、收入水平与社区社会经济地位对酒精使用障碍的影响，并通过亲属对照研究设计，探究潜在关联是否受到共享家族因素的混杂影响。 研究方法：本研究的酒精使用障碍相关数据取自瑞典住院与门诊医疗登记系统、处方药物登记系统以及犯罪记录数据库。通过全国人口登记系统，我们收集了1950年至1980年间在瑞典出生的所有个体在25、30、35及40岁时的收入、受教育程度与社区社会经济地位信息。按性别分层的每个队列约包含75万至120万个体，对这些个体进行平均10至15年的酒精使用障碍随访，随访截止至2013年底。本研究采用Cox比例风险模型，分别在普通人群以及暴露于不同社会经济地位水平的同性第一代堂/表兄妹与全同胞兄弟姐妹对子中，探讨收入、受教育程度与社区社会经济地位对酒精使用障碍发病风险的影响。 研究结果：无论男女、各年龄段人群中，更高的受教育程度、收入水平与社区社会经济地位均与酒精使用障碍发病风险降低显著相关。在对第一代堂/表兄妹及全同胞兄弟姐妹对子进行比较分析时，这种潜在的保护效应依然存在，但强度有所减弱。 研究结论：即使在控制了共享家族因素（如儿童时期社会经济地位与遗传因素）的影响后，成年时期较高的受教育程度、收入水平以及较高的社区社会经济地位，仍可能是酒精使用障碍的保护因素。