Explanations of differences in alcoholism between social classes and occupations among Swedish men : a register based follow-up study

Sammanfattning: The general aim of this thesis is to explain differences in alcoholism diagnosis between social classes and occupations. The explanatory factors considered are individual characteristics among people of specific occupations and social classes and their later occupational environments. The thesis is based on material from two databases. The first comprises a cohort of persons who lived in thirteen counties in Sweden in 1980, and held the same occupation in both 1960 and 1970 who were followed in regard to alcoholism diagnosis in in-patient care 1981-83. The second is a cohort of those who, at the age of 18-20 years, were enrolled for compulsory military service in 1969/70, where data on circumstances in childhood and adolescence were collected. Data on occupation and socioeconomic group concerning all cohort members were also collected from the censuses in 1970 and 1975, as were data on alcoholism diagnosis, other psychiatric diagnosis, mortality and early retirement. Based on the first cohort, an increased relative risk of alcoholism diagnoses was found in lower social strata in both sexes and in several manual occupations among men stable in the same occupation for several years. A high level of association was also found between the relative risks of alcoholism diagnoses and liver cirrhosis in socioeconomic groups, and the relative risk of alcoholism diagnoses in occupations, and the average alcohol consumption in the same socioeconomic groups/occupations among males. Such associations were not evident among women. Based on the second cohort, it is concluded that risk factors for poor health established in late adolescence could explain much of the increased relative risk of alcoholism among young unskilled and skilled workers. Social mobility associated with health-related factors contributed considerably to increasing the differences in alcoholism between socio-economic groups in this study. The negative health-related selection found for the occupation of seaman could only partly explain the increased relative risks in the occupation for several outcomes in this study, when compared with other unskilled workers. The occupation remained a strong risk indicator also after control for a large number of selection factors. Low work control, in particular in combination with low work demands, and low work social support were found to be related to later alcoholism even after controlling for previously known risk factors (including risk use of alcohol). Although the previously known risk factors were of great importance, the results suggest that young men may respond to an undemanding occupational environment by increasing their alcohol consumption. Individuals with risk use of alcohol, or who were smokers, in late adolescence were more susceptible when later exposed to a work environment characterized by low work control, both by itself and in combination with low job demands, in relation to alcoholism. An accumulation of risk factors throughout the life course is suggested.