O-251 The role of working conditions in the relationship between education and alcohol-related morbidity among Swedish workers

Introduction

Associations between social class and alcohol-related morbidity are well established, but less is known about the explanatory mechanisms. This study aims to investigate the role of working conditions in explaining associations between education and alcohol-related harm.

Material and Methods

This register-based cohort includes around three million individuals aged 30–60 years registered in Sweden in 2005. Highest attained education (in five categories ranging from compulsory to at least three years of tertiary education) and diagnosed alcohol-related morbidity between 2006 and 2016 were obtained from national registers. Physical workload and job control were measured using job exposure matrices, where mean levels of these exposures were linked to index persons through their registered occupation in 2005. Cox proportional hazards regression was used to measure associations between education and alcohol-related morbidity among men and women separately. Models were adjusted for early life factors, followed by job control and physical workload. The percent of attenuation in the hazard ratios were calculated using the formula ((HRcrude-HRadjusted)/HRcrude-1)*100). This research was approved by the Regional Ethics Review Board in Stockholm (dnr 2017/1224–31 and 2018/1675–32).

Results and Conclusions

Having lower education was associated with an increased risk of alcohol-related morbidity. Associations were similar among men and women and showed a dose-response pattern (HR 2.43 95%CI 2.33–2.51 and HR 2.48 95% CI 2.36–2.61 for men and women respectively when comparing the highest and lowest level of education). Models were relatively unchanged when adjusting for birth year, birth country, childhood socioeconomic position, and own and parents’ previous psychiatric diagnoses. Job control attenuated estimates by about 11% for men and women, while physical workload explained around 30% of the association for men and around 19% for women. These results indicate that low job control, and especially heavy physical workload are important factors in explaining associations between lower education and alcohol-related morbidity.