Effects of increased alcohol availability during adolescence on the risk of all‐cause and cause‐specific disability pension: a natural experiment

Abstract

AimTo test if being exposed to increased alcohol availability during adolescence is associated with an increased risk of receiving disability pension due to all‐cause, alcohol use disorders and mental disorders.DesignRegister‐based population‐based study using a natural experiment setting, the alcohol policy change in Sweden (1967–68), with increased access to strong beer in a narrow time window and geographical area. The individuals exposed to the policy change were compared with non‐exposed individuals living in the rest of Sweden, excluding a border area.SettingSweden.ParticipantsA total of 518 810 individuals (70 761 in the intervention group; 448 049 in the control group) born 1948–1953, aged 14–20 years during the policy change.MeasurementsDate and diagnosis of the outcome variable of disability pension due to all‐cause, alcohol use disorders and mental disorders were obtained from the Swedish National Social Insurance Agency database from 1971 to 2013. Individual and family level socio‐demographic and health‐related covariates, as well as a regional level covariate, were included.FindingsCompared with the control group, adolescents exposed to the alcohol policy change were at an increased risk of receiving disability pension due to all‐causes [hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.07–1.11], alcohol use disorders (HR = 1.17, 95% CI = 1.05–1.30) and mental disorders (HR = 1.19, 95% CI = 1.15–1.23).ConclusionIn Sweden, a natural experiment with a 43‐year follow‐up suggests that exposure to increased alcohol availability during adolescence is associated with an increased risk of receiving a disability pension due to all‐cause, alcohol use disorder and mental disorder diagnoses.

No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment

“…Our results suggest that there could be other factors driving the initial differences between the groups unrelated to the policy change. It is difficult to hypothesise the potential influence such a regional level might have on similar research previously published,6–8 since the positive association between increased alcohol availability and disability pension remained in our previous study using the same policy change, even after adjusting for population density of locality 9…”

“…This is a limitation of the study design as it could have weakened the potential effect of the strong beer exposure. However, results from previous research using the same alcohol policy change suggest an increased risk of disability pensions among adolescents exposed to the strong beer alcohol policy change 9. The underlying mechanisms of the relationship between adolescent alcohol consumption and later alcohol-related problems is not fully understood, and since we do not have individual level data on alcohol consumption, it is difficult to speculate about potential reasons for the differences in findings 10 13…”

“…Furthermore, two studies using the same policy experiment as in the current paper, that is, the strong beer experiment, have been published. Results of the first study suggests a positive association between exposure to increased alcohol availability during adolescence and receiving disability pension due to all-cause, alcohol abuse and mental disorders later in life 9. Results of the second study suggest that children of younger mothers (below 21 years) exposed to the alcohol policy change in utero had worse economic outcomes at age 30 years 19…”

Transitioning from sickness absence to disability pension—the impact of poor health behaviours: a prospective Swedish twin cohort study

“…Being male and a heavy drinker has previously shown to be associated with a higher risk of SA,40 and for both women and men a higher risk for DP 41. In addition, a natural experiment showed that those that had more access to alcohol in adolescents were more likely to go on DP in adulthood 42…”

Medical justification for increasing the minimum legal drinking age

“…Исключительно интересное и важное исследование в плане влияния либерализации алкогольной политики на подростков провели E. Thern и соавт. [26] в 2017 г., проанализировав данные по более чем 500 тыс. шведов, родившихся в 1948-1953 гг., которым на момент облегчения доступности алкоголя (1967-1968) было 14-20 лет.…”