Non-employment histories of middle-aged men and women who died from alcohol-related causes: a longitudinal retrospective study

Abstract

Background: Long-term patterning of non-employment among problem drinkers is poorly understood. We determined the level and timing of non-employment, and the relative contribution of various types of non-employment among middle-aged persons who died of alcohol-related causes.

Methods: We conducted a longitudinal retrospective register-based study of Finnish men and women aged 45-64 years who died of alcohol-related causes (n = 15,552) or other causes (n = 39,166) in the period 2000-07, or who survived (n = 204,422) until the end of 2007. We traced back the number of days in employment and non-employment for up to 17 years before death or before the end of the study period for the survivors.

Results: The majority (≥56%) of persons who died of alcohol-related causes were in employment up to ten years before death. Over the 17-year period before death, those who died of alcohol-related causes were in employment on average two years less (mean 6.3 years, 95%CI 6.2-6.4) than those dying of other causes (8.2, 8.1-8.3), and five years less than survivors (11.6, 11.5-11.7), when sex and age were adjusted for. The relative role of various types of non-employment differed markedly across the two mortality groups. Among those who died of alcohol-related causes, unemployment accounted for 54% of the total burden of non-employment, in comparison with 29% among those who died of other causes. In contrast, disability pension accounted for 41% of the total burden of non-employment among those who died of alcohol-related causes, but 65% among those who died of other causes.

Conclusions: The results indicate the feasibility of preventing movement out of employment among middle-aged men and women with severe alcohol-related harm, provided that they are identified early on during their working careers and offered effective interventions.

Figure 1. Flow chart of the study population.

Figure 2. Proportion of men and women in employment at a given year before death/end of study period.

Figure 3. Average annual number of days of employment and non-employment.

Sex and age adjusted average annual number of days of A) employment, B) total non-employment, C) unemployment, D) medically certified sick leave, and E) disability pension in the preceding 17 years before death/end of study period for those who died of alcohol-related causes, other causes, and for those who survived the 17-year period.

Figure 4. Average annual number of days of non-employment by cause of death.

Sex and age adjusted average annual number of days of unemployment, disability pension, and sick leave over the 17-year study period separately by major cause-of-death groups. Error bars represent 95% confidence intervals.