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Using repeated measures to study the contribution of alcohol consumption and smoking to the social gradient in all‐cause mortality: Results from the Stockholm Public Health Cohort
Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.ORCID iD: 0000-0002-8707-180x
Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.ORCID iD: 0000-0001-6114-4436
Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.ORCID iD: 0000-0002-1319-8218
Number of Authors: 32023 (English)In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 42, no 7, p. 1850-1859Article in journal (Refereed) Published
Abstract [en]

Introduction: The social gradient in consumption behaviours has been suggestedto partly explain health inequalities. The majority of previous studies have onlyincluded baseline measurements and not considered potential changes in behav-iours over time. The study aimed to investigate the contribution of alcohol con-sumption and smoking to the social gradient in mortality and to assess whetherthe use of repeated measurements results in larger attenuations of the main asso-ciation compared to using single baseline assessments.

Methods: Longitudinal survey data from the population-based Stockholm PublicHealth Cohort from 2006 to 2014 was linked to register data on mortality until2018 for 13,688 individuals and analysed through Cox regression.

Results: Low socioeconomic position (SEP) was associated with increased mortal-ity compared with high SEP; hazard ratios 1.56 (95% CI 1.30–1.88) for occupa-tional status and 1.77 (95% CI 1.49–2.11) for education, after adjustment fordemographic characteristics. Using repeated measurements, alcohol consumptionand smoking explained 44% of the association between occupational status andall-cause mortality. Comparing repeated and baseline measures, the percentageattenuation due to alcohol consumption increased from 11% to 18%, whereas itremained similar for smoking (25–23%).

Discussion and Conclusions: Smoking and alcohol consumption explained alarge part of the association between SEP and mortality. Comparing results fromtime-fixed and time-varying models, there was an increase in overall percentageattenuation that was mainly due to the increased proportion explained by alcoholconsumption. Repeated measurements provide a better estimation of the contri-bution of alcohol consumption, but not smoking, for the association between SEPand mortality.

Place, publisher, year, edition, pages
2023. Vol. 42, no 7, p. 1850-1859
Keywords [en]
alcohol drinking, mortality, repeated measurements, smoking, socioeconomic position
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:su:diva-223062DOI: 10.1111/dar.13759ISI: 001085504900001PubMedID: 37830637Scopus ID: 2-s2.0-85174073012OAI: oai:DiVA.org:su-223062DiVA, id: diva2:1805449
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017‐01769Available from: 2023-10-17 Created: 2023-10-17 Last updated: 2024-01-16Bibliographically approved

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Berg, LisaLandberg, JonasThern, Emelie

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