The impact of parenthood on risk of registration for alcohol use disorder in married individuals: a Swedish population-based analysis

Abstract

Background: Although being married with children is associated with a reduced rate of alcohol use disorder (AUD), is this finding independent of a marital effect, different in mothers and fathers and potentially causal in effect.

Methods: Using Cox proportional hazards, we examined, in 1 252 237 married individuals, the association between a resident younger and older child and risk for AUD registration in national medical, criminal, and pharmacy registers. Using logistic regression, we analyzed, in 600 219 parents, within-person models comparing risk for AUD prior to first pregnancy v. with young children. We examined whether risk for AUD in 1302 parents after a first spousal AUD registration was reduced by having a young resident child.

Results: Compared with childless married individuals, resident younger children were associated with a reduced risk for AUD in mothers [hazard ratio (HR) 0.36, 95% confidence interval 0.31-0.41] and fathers (HR 0.66, 0.60-0.73). The reduced risk was attenuated but still significant for older children. Within-person models confirmed the protective effect of young children in mothers [odds ratio (OR) 0.49, 0.30-0.80] but yielded inconclusive results in fathers (OR 0.85, 0.58-1.25). After a first spousal registration for AUD, a resident young child was associated with a substantial reduction in risk for mothers and a weaker marginal effect in fathers.

Conclusion: In married individuals, resident children are associated with a reduction in basal risk for AUD which is stronger in mothers than fathers and with younger v. older children. This effect is also evident during high-risk periods. In mothers, our results are consistent with a largely causal effect.

Keywords: Alcohol use disorder; children; epidemiology; marriage.

Fig. 1.

(a) First registration for AUD in husbands when the wives had a first AUD registration – a non-parametric estimate of the hazard function (and 95% CIs) of first AUD registration in husbands as a function of whether there was a resident child in the home (in dotted line) or there were no children (solid line). Estimates are presented in solid lines and 95% Cis in dotted lines. The x-axis is time from registration in the wife in years. The y-axis is rate of AUD registration. (b) First registration for AUD in wives when the husband had a first AUD registration – a non-parametric estimate of the hazard function (and 95% Cis) of first AUD registration in wives as a function of whether there was a resident child in the home (dotted line) or there were no children (solid line). Estimates are presented in solid lines and 95% Cis in dotted lines. The x-axis is time from first registration in the husband in years. The y-axis is rate of AUD registration.

Fig. 2.

Risk ratio for first registration for AUD in men (solid line) and women (dotted line) who had been exposed to a first onset of AUD in their spouse when there was v. was not a resident child in the home. The two curves represent the ratio between the curves seen, respectively, in Figs 1a and b.