Alcohol-related Outcomes and All-cause Mortality in the Health 2000 Survey by Participation Status and Compared with the Finnish Population

Association between genetic risk of alcohol consumption and alcohol-related morbidity and mortality under different alcohol policy conditions: Evidence from the Finnish alcohol price reduction of 2004

AIMS

Harmful alcohol consumption is influenced by both genetic susceptibility and the price of alcohol. Many previous studies have observed that genetic susceptibility to consumption of alcohol is more predictive in less restrictive drinking conditions. We assess whether such a pattern applies when the prices of alcoholic beverages are decreased.

DESIGN

Data consist of genetically informed population-representative surveys (FINRISK 1992, 1997, 2002 and Health 2000) linked to administrative registers. We analysed the interaction between a polygenic score (PGS) for alcoholic drinks per week consumed and price reduction in predicting the incidence of alcohol-related hospitalizations and deaths in difference-in-difference and interrupted time-series frameworks.

SETTING

Individuals in Finland were followed quarter-yearly from 1 March 2000 to 31 May 2008.

PARTICIPANTS

A total of 22 152 individuals (607 132-person quarter-years, 1399 outcome events) aged 30-79 years.

INTERVENTION

A natural experiment stemming from the alcohol tax reduction in March 2004 and import deregulation in May 2004.

MEASUREMENTS

Outcome was quarter-yearly-measured alcohol-related death or hospitalization. The independent variables of main interest were PGS and a price reform indicator. We adjusted for gender, age, age squared, season, 10 first principal components of the genome, data collection round and genotyping batch.

FINDINGS

Both alcohol price reduction and one standard deviation change in PGS were associated with alcohol-related health outcomes; odds ratios (ORs) were 1.32, 95% confidence interval (CI) = 1.13, 1.53 and 1.26, 95% CI = 1.12, 1.42 in the 8-year follow-up, respectively. The association between PGS and alcohol-related morbidity was similar before and after the alcohol price reform (PGS × price reform interaction OR = 0.96, 95% CI = 0.81, 1.14). These results were robust across different follow-up periods and measurement and analysis strategies.

CONCLUSIONS

Although the decrease of alcohol price in Finland in 2004 substantially increased overall alcohol-related morbidity and mortality, the genetic susceptibility to alcohol consumption did not become more manifest in predicting them.

Educational Gradients in Drinking Amount and Heavy Episodic Drinking among Working-Age Men and Women in Spain

Alcohol-related harm decreases as socioeconomic position increases, although sometimes the opposite happens with alcohol intake. The objective was to know the educational gradient in monthly measures of drinking amount and heavy episodic drinking (HED) among people aged 25−64 years in Spain from 1997−2017. Such gradient was characterized with the relative percent change (PC) in drinking measures per year of education from generalized linear regression models after adjusting for age, year, region, marital status and immigration status. Among men, the PCs were significantly positive (p < 0.05) for prevalence of <21 g alcohol/day (2.9%) and 1−3 HED days (1.4%), and they were negative for prevalences of 21−40 g/day (−1.1%), >40 g/day (−6.0%) and ≥4 HED days (−3.2%), while among women they ranged from 3.6% to 5.7%. The gradient in prevalences of >40 g/day (men) and >20 g/day (women) was greatly attenuated after additionally adjusting for HED, while that of ≥4 HED days was only slightly attenuated after additionally adjusting for drinking amount. Among women, the gradients, especially in HED measures, seem steeper in 2009−2017 than in 1997−2007. Educational inequality remained after additional adjustment for income and occupation, although it decreased among women. These results can guide preventive interventions and help explain socioeconomic inequalities in alcohol-related harm.

Profiles of subjective health among people living alone: a latent class analysis

Background

Living alone has increased globally and especially in Finland where 45% of all households are single occupancy. Epidemiological research has found that living alone a risk factor for a wide range of adversities related to quality of life but the rapidly-changing demographics of people living alone calls for a more detailed investigation of their subjective health status.

Methods

Using a cross-sectional survey sent for a random sample of Finnish residents in single-person households (n = 884), we explored with latent class analysis whether the respondents form different health profiles based on the three health dimensions defined by the World Health Organization: physical, social, and mental well-being. The identified groups were then compared in terms of demographic characteristics with the χ² test and quality of life using linear regression models. Sensitivity analyses were run using more refined, manual 3-step BCH method.

Results

Four distinct health profiles were found: Languishing (4%), Managing (35%), Healthy (30%), and Flourishing (31%). The groups differed in most socio-demographic aspects such as marital and employment status, but not in terms of geographic location or gender (apart from group Languishing that contained more men). Controlling for these socio-demographic differences, all groups showed different average levels of perceived quality of life to the expected direction.

Conclusions

Our findings suggest that people living alone are indeed a very heterogeneous group in terms of subjective health. Instead of seeing living alone as a mere risk for low quality of life, concept of living alone should be understood more broadly both in public discussion and scientific research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11396-2.

History of healthcare use and disease burden in older adults with different levels of alcohol use. A register-based cohort study

BACKGROUND

Only a minority of individuals with problematic alcohol use ever seek alcohol treatment. Knowledge of general help-seeking behavior in the healthcare system can identify possibilities for prevention and intervention.

METHOD

The current study describes healthcare use, burden of disease, and prior morbidities over a 15-year period by current alcohol use behavior among Danish adults aged 60-70. The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2014-2016) were linked to Danish national registers to collect annual information on healthcare use and morbidity for the 15 years prior to inclusion. Participants from the 3 largest Danish municipalities were divided into 4 groups with varying drinking patterns and no recent treatment [12-month abstinent (n = 691), low-risk drinkers (n = 1978), moderate-risk drinkers (n = 602), and high-risk drinkers (n = 467)], and a group of treatment-seeking individuals with a 12-month DSM-5 alcohol use disorder (AUD; n=262). Negative binomial regression models were utilized to compare rates of healthcare use and logistic regressions were used to compare odds of diagnoses.

RESULTS

Low-, moderate-, and high-risk drinkers had similar rates of past healthcare utilization (low-risk mean yearly number of contacts for primary care 7.50 (yearly range 6.25-8.45), outpatient care 0.80 (0.41-1.32) and inpatient care 0.13 (0.10-0.21)). Higher rates were observed for both the 12-month abstinent group (adjusted RR = 1.16-1.26) and the group with AUD (ARR = 1.40-1.60) compared to the group with low-risk alcohol consumption. Individuals with AUD had higher odds of previous liver disease (adjusted OR = 6.30), ulcer disease (AOR = 2.83), and peripheral vascular disease (AOR 2.71). Twelve-month abstinence was associated with higher odds of diabetes (AOR = 1.97) and ulcer disease (AOR = 2.10).

CONCLUSIONS

Looking back in time, we found that older adults had regular healthcare contacts, with those who received treatment for AUD having had the highest contact frequency and prevalence of alcohol-related diseases. Thus, healthcare settings are suitable locations for efforts at AUD prevention and intervention.