Alcohol-related hospital utilization and mortality in different occupations in Sweden in 1991-1995

Abstract

Objectives This study investigated alcohol-related hospital utilization and alcohol-related mortality according to occupation among men and women. Whether increased rates of alcoholism in some occupations result from circumstances within the occupation or from selective recruitment of persons prone to alcohol misuse was studied.Methods All Swedish residents were included who reported an occupation in the censuses of 1985 and 1990 and were born in . The relationships between occupation and hospitalization due to an alcoholism diagnosis in 1991-1994 and alcohol-related mortality in 1991-1995 were studied among stable workers (those who held the same occupation in both censuses) and newly recruited workers (those who held different occupations in the two censuses). Incidence and mortality rates were calculated for the different occupations using the person-year method, and standardized rate ratios were used as approximations of the relative risk of disease occurrence and mortality in different occupations as compared with the corresponding statistics of the entire study population.Results Several, mostly manual, occupations showed an increased relative risk of alcoholism diagnoses and alcohol-related mortality. Nonmanual occupations had low risks. Women in male-dominated high-risk occupations often showed increased relative risks. Stable and newly recruited employees in the same occupation showed very similar relative risks.Conclusions New recruits into high-risk occupations often have increased relative risks of at least the same magnitude as persons employed long-term in the same occupations. This finding indicates that the increased relative risk of alcoholism found in some occupations can partly be explained by selective recruitment of heavy drinkers.

Alcohol use among workers in male-dominated industries: A systematic review of risk factors

“…High risk drinking was found to be more prevalent among upper managers (OR = 2.39, 95% CI = 1.07-5.34), middle managers (OR = 1.87, 95% CI = 1.05-3.32), semi-qualified white collar workers (OR = 1.71, 95% CI = 1.18-2.49), and qualified blue collar workers (OR = 2.11, 95% CI = 1.41-3.16) compared to non-qualified blue collar workers (Marchand, 2008). However, manual and unskilled workers were at greater risk of alcohol-related diagnoses than non-manual workers (Hemmingsson et al, 1998), skilled workers (Hemmingsson et al, 1997), and the study population overall (Hemmingsson and Ringback, 2001). In contrast to Marchand's (2008) findings, workers in lower status occupations were more at risk of alcohol use and dependence than workers in higher status occupations (Crum et al, 1995).…”

“…However, one study found that females in male-dominated occupations had an increased relative risk of alcoholism diagnoses in comparison to the study population (Hemmingsson and Ringback, 2001). Another study found female managers had higher levels of alcohol problems, needed more alcohol to feel the effects or be intoxicated than male or female nonmanagers and male managers (p 6 .05) and were more likely to drink immediately after work (OR = 1.27, 95% CI = 1.01-1.60) (Moore et al, 2003).…”

“…Relaxation time 3 Alcohol unwinding predicted alcohol dependence (CAGE scores) & drinking incidents (Patterson et al, 2005) Weak Increased length of time to unwind after finishing work increased heavy drinking odds & average number of alcohol beverages/week (Delaney et al, 2002;Ragland et al, 1995) Length of time to unwind impacted upon overall drinking levels which in turn impacted problem drinking (Delaney et al, 2002) Moderate Structural/Socioeconomic Factors Structural factors as indicated by occupational status 6 Manual workers sig more risk of alcohol-related diagnoses than non-manual workers (Hemmingsson et al, 1997;Hemmingsson and Ringback, 2001) or study population (Hemmingsson and Ringback, 2001) Risky use of alcohol more common in people who would become manual workers than non-manual workers (Hemmingsson et al, 1997) Unskilled workers' risk of alcoholism diagnosis higher when used high risk levels of alcohol, had limited social network, low emotional control, were a smoker, had contact with the police & child care authorities, & father was manual worker (Hemmingsson et al, 1997) Income negatively associated with drinking to cope, heavy drinking, & negative consequences of drinking (Grunberg et al, 1998) Weak Unskilled workers sig more at risk of alcoholism diagnosis than skilled workers (Hemmingsson et al, 1998) Non-qualified blue collar workers sig more risk of low risk & high risk drinking than middle managers, semi-qualified white collar workers, & qualified blue collar workers (Marchand, 2008) Managers more likely to have drunk more in last 6 months, report more alcohol problems, drank to escape, & drank more to feel effect than non-managers (Moore et al, 2003) Moderate Patterson et al, 2005;Ragland et al, 1995). An association between 'unwinding' strategies used after work and alcohol use among workers in small businesses was found (Patterson et al, 2005) (weak methodological strength).…”

“…Gender 10 A negative correlation between gender & problem drinking (Bacharach et al, 2002) When long term employment considered, 37 & 11 occupations increased the risk of alcoholism diagnosis in men & women respectively (Hemmingsson and Ringback, 2001) Problem drinking sig lower in females (Bamberger and Bacharach, 2006) Sig fewer women scored AUDIT positive than men (Hermansson et al, 2003) Weak Males scored sig higher on the CAGE than females Males sig higher overall drinking than females (Delaney et al, 2002) which indirectly effected problem drinking Males more likely than females to drink alone, drink immediately after work, & drink at home (Moore et al, 2003) Non-managerial men more likely to drink alone & to report negative consequences due to alcohol (Moore et al, 2003) Female managers more likely to have alcohol problems, experience negative consequences of drinking, & need more alcohol to feel the effects/become intoxicated than female non-managers, male managers, & male non-managers (Moore et al, 2003) Men in high strain jobs with high psychological demands & low control, & men in high strain jobs with high physical demands & low control had higher risk of alcohol abuse & dependence (Crum et al, 1995) Males more likely to be heavy drinkers than females. Males consumed a higher average amount of alcohol/week than females (Ragland et al, 1995) Being female associated with reduced risk of being both a low risk & high risk drinker (Marchand, 2008) Moderate Education 2 Education negatively associated with heavy drinking & negative consequences of drinking (Grunberg et al, 1998) Problem drinking sig negative correlated with education (p < .01) (Bacharach et al, 2002) Weak Individual factors Attitudes towards work 3 Job satisfaction negatively associated with drinking to cope & negative consequences of drinking.…”

Associations of occupational attributes and excessive drinking

“…Research on the prevalence of alcohol misuse among workers has found those employed manual occupations have higher rates of excessive drinking (Hemmingsson & Ringback Weitoft, 2001). In particular, farm workers and service industry employees have been found to have higher risk and those working in professional occupations lower risk (Jarman et al, 2007;Matano et al, 2002).…”