1. |
- Ahacic, Kozma, et al.
(author)
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Alcohol abstinence, non-hazardous use and hazardous use a decade after alcohol-related hospitalization : registry data linked to population-based representative postal surveys
- 2014
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14, s. 874-
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Journal article (peer-reviewed)abstract
- Background: Although there is evident association between alcohol-related hospitalization and alcohol use, the relationship has not been well examined. This study analyzed the extent of alcohol abstinence, non-hazardous use and hazardous use among people who had experienced alcohol-related hospitalization during the preceding decade. Method: Registry data concerning alcohol-related hospitalizations between 1996 and 2007 were linked to two representative surveys, in 2006 and 2007, of residents of Stockholm County. Relevant contrasts were modeled, using logistic regression, in the pooled sample (n = 54 955). Ages were 23-84 years at follow-up. Results: Among persons previously hospitalized (n = 576), half reported non-hazardous use. Non-hazardous use was less prevalent than in the general population - and the extent of non-hazardous use did not change over time following hospitalization. There were no significant age differences, but non-hazardous use was less frequent among people with repeated episodes of care. One in six was abstinent. Abstinence was more common among the old, while hazardous use (exceeding 14 drinks per week for men, and 9 drinks per week for women) decreased with age. Abstinence also increased over time; among persons hospitalized ten years ago, the abstinence rate was twice that of the general population. Associations with hazardous use over time were less conclusive. Hazardous use among those previously hospitalized decreased over time in one sample but not in the other. After pooling the data, there were indications of a decrease over time following hospitalization, but more prevalent hazardous use than in the general population. Conclusions: Following alcohol-related hospitalization, abstinence increased, and there was no evidence of regression towards the mean, i.e., towards non-hazardous use. Abstinence was also more widespread among previously hospitalized persons of older ages. With advancing age, changing hazardous alcohol habits among previously hospitalized appears to yield a trend towards promotion of abstinence.
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2. |
- Ahacic, Kozma, et al.
(author)
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Changes in sobriety in the Swedish population over three decades : age, period or cohort effects?
- 2012
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In: Addiction. - Abingdon : Carfax. - 0965-2140 .- 1360-0443. ; 107:4, s. 748-755
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Journal article (peer-reviewed)abstract
- Aims This study aimed to examine age, cohort and period trends in alcohol abstinence.Design Two surveys, the Level of Living Survey collected in 1968, 1974, 1981, 1990 and 2000, and the Swedish Panel Study of the Oldest Old (SWEOLD) collected in 1992 and 2002, were studied with graphical depictions of cross-sectional and longitudinal data presented over time and over age. Cross-sectional 10-year age group differences, time-lag differences between waves and within-cohort differences between waves for 10-year birth cohorts were examined. Logistic regression models were applied to confirm the observed patterns.Setting The samples were representative of the Swedish population.Participants Participants ranged in age from 18 to 75 (n = 5000 per wave), and 77+ at later waves (n = 500).Measurements Alcohol abstinence was determined by asking ‘Do you ever drink wine, beer, or spirits?’, where a ‘no’ response indicated abstinence.Findings Decreases in abstinence rates were observed from 1968 to 2000/02. While cross-sectional analysis indicated increased abstinence with advancing age, the longitudinal analysis suggested otherwise. Inspection of cohort differences revealed little change within cohorts and large differences between cohorts; abstinence rates declined in later-born cohorts up to the 1940s birth cohorts; stability was observed in cohorts born since the 1940s. Logistic regression models indicated that neither age nor period were significant (P > 0.05) predictors of abstinence when cohort (P < 0.001) was included.Conclusion Decreasing proportions of total alcohol abstainers in Sweden from 1968 to 2000 appear to be attributable primarily to decreases in successive cohorts rather than drinkers becoming abstainers.
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3. |
- Ahacic, Kozma, et al.
(author)
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Income and education as predictors of stroke mortality after the survival of a first stroke
- 2012
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In: Stroke Research and Treatment. - : Hindawi Publishing Corporation. - 2090-8105 .- 2042-0056.
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Journal article (peer-reviewed)abstract
- Background. It is well known that socioeconomic indicators, such as income and education, predict both stroke incidence and stroke mortality. This means that persons in lower socioeconomic positions are less likely to survive their stroke, and there will be a selective survival in the group discharged from hospital after their first stroke. Question. Does socioeconomic position continue to predict mortality, stroke specific, or from other causes, among patients surviving their first stroke in spite of this selective survival? Methods. All persons in Sweden aged 40–59 years who were discharged after a first hospitalization for stroke in 1996–2000 were included (n = 10,487), then followed up until the end of the fourth calendar year after discharge. Data were analysed with Cox regressions controlling for age, sex, and stroke type. Results. Persons with high socioeconomic position, measured by education and income, have lower mortality than those of low position. Education was not significant when adjusted for income, however. The risk of dying was similar for stroke-specific mortality and all-cause mortality, for those with cerebral infarction as well as for all patients. Conclusions. Socioeconomic position predicted stroke-specific mortality also in the selective group of persons who survived their first stroke.
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4. |
- Ahacic, Kozma, et al.
(author)
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Non-response bias and hazardous alcohol use in relation to previous alcohol-related hospitalization : comparing survey responses with population data
- 2013
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In: Substance Abuse Treatment, Prevention, and Policy. - 1747-597X. ; 8, s. 10-
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Journal article (peer-reviewed)abstract
- Background: This study examines whether alcohol-related hospitalization predicts survey non-response, and evaluates whether this missing data result in biased estimates of the prevalence of hazardous alcohol use and abstinence. Methods: Registry data on alcohol-related hospitalizations during the preceding ten years were linked to two representative surveys. Population data corresponding to the surveys were derived from the Stockholm County registry. The alcohol-related hospitalization rates for survey responders were compared with the population data, and corresponding rates for non-responders were based on the differences between the two estimates. The proportions with hazardous alcohol use and abstinence were calculated separately for previously hospitalized and non-hospitalized responders, and non-responders were assumed to be similar to responders in this respect. Results: Persons with previous alcohol-related admissions were more likely currently to abstain from alcohol (RR=1.58, p<.001) or to have hazardous alcohol use (RR=2.06, p<.001). Alternatively, they were more than twice as likely to have become non-responders. Adjusting for this skewed non-response, i. e., the underrepresentation of hazardous users and abstainers among the hospitalized, made little difference to the estimated rates of hazardous use and abstinence in total. During the ten-year period 1.7% of the population were hospitalized. Conclusions: Few people receive alcohol-related hospital care and it remains unclear whether this group's underrepresentation in surveys is generalizable to other groups, such as hazardous users. While people with severe alcohol problems - i.e. a history of alcohol-related hospitalizations -are less likely to respond to population surveys, this particular bias is not likely to alter prevalence estimates of hazardous use.
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5. |
- Ahacic, Kozma, et al.
(author)
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Recurring alcohol-related care between 1998 and 2007 among people treated for an alcohol-related disorder in 1997 : a register study in Stockholm County
- 2011
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 11, s. 574-
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Journal article (peer-reviewed)abstract
- BACKGROUND: Inpatient care for alcohol intoxication is increasing in Sweden, especially among young women. Since it is well known that alcohol disorder is a chronic relapsing illness, this study examines the extent to which people return for more care. METHOD: All inpatients with alcohol-related diagnoses in Stockholm County during 1997 were followed prospectively to 2007 through registers. The proportion reappearing for the same diagnosis, other alcohol-related inpatient, or outpatient care each year after baseline, as well as the number of years the inpatients reappeared were calculated (n = 2735). Three diagnoses were examined separately; alcohol dependence, harmful use of alcohol, and alcohol intoxication. RESULTS: Three out of five inpatients with an alcohol diagnoses reappeared for more alcohol-related inpatient care during the following decade. The proportion returning was largest the year after baseline and then decreased curvilinearly over time. The inclusion of outpatient care increased proportions, but did not change patterns. Of those with an alcohol dependence diagnosis at baseline 42 percent returned for more alcohol-related inpatient care the first, 28 percent the fifth, and 25 percent the tenth year. Corresponding proportions for harmful use and intoxication were smaller. One in five among those with an alcohol dependence returned for more than five of the ten years. Ordered logistic regressions confirmed that besides diagnosis, age and gender were independently related to the number of years returning to care. CONCLUSIONS: While middle-aged males with alcohol dependence were in a revolving door, young female inpatients with intoxication diagnosis returned to a comparably lower degree.
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6. |
- Ansker, Fredrik G., et al.
(author)
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The beliefs about pros and cons of drinking and intention to change among hazardous and moderate alcohol users : a population-based cross-sectional study
- 2014
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In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 24:4, s. 566-571
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Journal article (peer-reviewed)abstract
- Background: Fundamental to supporting hazardous alcohol users are the rationales for reducing alcohol intake highlighted by the users themselves. This study analyses the relative importance of beliefs about pros and cons of drinking in relation to having an intention to reduce intake among both hazardous and moderate alcohol users. Methods: Intention to change was assessed in a representative sample of Stockholm's population (n = 4278, response rate 56.5%). Alcohol use was assessed using the Alcohol Use Disorders Identification Test measure. A decisional balance inventory was used to examine various beliefs about the pros and cons of drinking, which covered affect changes, social gains and losses, and possible adverse effects. Independent correlations were determined by logistic regression using a backward exclusion procedure (P > 0.05). Results: Higher ratings of importance were generally related to intent, whether or not the contrast was with having no intent or already having made a reduction. This was especially true for hazardous users. Only two beliefs were independently correlated with change among hazardous users: 'Drinking could get me addicted' and 'Drinking makes me more relaxed/less tense' (pseudo-R2 < 0.1). Among moderate users, there was no uniform pattern in the relationships. Conclusions: Unexpectedly, hazardous users with an intent to change rated pro arguments as more important than those with no intent to change. Of the investigated pros and cons, only a few were independently related to intention to change drinking behaviour. These arguments provide interesting topics in consultations. Little support was found for any rational decision making behind the intention to reduce alcohol intake.
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7. |
- Kelfve, Susanne, et al.
(author)
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Alcohol Consumption among the Oldest Old in Sweden – Trends Over Time and Methodological Challenges
- 2012
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In: The Gerontologist. - : Oxford University Press (OUP). - 0016-9013 .- 1758-5341.
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Conference paper (peer-reviewed)abstract
- The overall aim of this study is to describe trends in the frequency of alcohol consumption among the oldest old population in Sweden over the last 20 years. In addition, the methodological challenges involved will be analyzed and discussed. Data from a nationally representative survey of the oldest old population in Sweden (SWEOLD) from 1992, 2002 and 2010/2011 will be used. SWEOLD provides a unique longitudinal database that represents a very high proportion of the population aged 77+ in Sweden. By including institutionalized persons, using proxy interviews and achieving a high response rate, individuals are represented regardless of their health, possible cognitive impairments or place of residence. The prevalence patterns show significant increases in alcohol consumption in all age groups, both in men and women, even when controlling for health status. More individuals are consumers and those who consume drink more often. Less frequent alcohol consumption was associated with high age, women, institutionalized individuals, proxy interviewed persons and those requiring extra effort to recruit. By excluding persons living in institutions or requiring a proxy interview – groups sometimes not represented in surveys – or accepting a lower response rate, the total prevalence of alcohol consumers is likely to be overestimated. A higher percentage of upcoming elderly cohorts in Sweden consume alcohol than previous cohorts. This has been associated with increasing health and financial problems. This emphasizes the importance of including elderly people in research on alcohol consumption and of finding solutions to the methodological challenges posed in surveying the oldest old.
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8. |
- Trygged, Sven, et al.
(author)
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Income and education as predictors of return to working life among younger stroke patients
- 2011
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 11, s. 742-
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Journal article (peer-reviewed)abstract
- Background: Socioeconomic conditions are not only related to poor health outcomes, they also contribute to the chances of recovery from stroke. This study examines whether income and education were predictors of return to work after a first stroke among persons aged 40-59. Methods: All first-stroke survivors aged 40-59 who were discharged from a hospital in 1996-2000 and who had received income from work during the year prior to the stroke were sampled from the Swedish national register of in-patient care (n = 7,081). Income and education variables were included in hazard regressions, modelling the probability of returning to work from one to four years after discharge. Adjustments for age, sex, stroke subtype, and length of in-patient care were included in the models. Results: Both higher income and higher education were associated with higher probability of returning to work. While the association between education and return to work was attenuated by income, individuals with university education were 13 percent more likely to return than those who had completed only compulsory education, and individuals in the highest income quartile were about twice as likely to return as those in the lowest. The association between socioeconomic position and return to work was similar for different stroke subtypes. Income differences between men and women also accounted for women's lower probability of returning to work. Conclusions: The study demonstrates that education and income were independent predictors of returning to work among stroke patients during the first post-stroke years. Taking the relative risk of return to work among those in the higher socioeconomic positions as the benchmark, there may be considerable room for improvement among patients in lower socioeconomic strata.
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