Anders Leifman

Association between alcohol consumption and mortality, myocardial infarction, and stroke in 25 year follow up of 49 618 young Swedish men

Several epidemiological studies have shown that moderate alcohol consumption is associated with reduced mortality from cardiovascular diseases in middle aged and elderly subjects,1 but its effect in younger people is unknown. High alcohol consumption is associated with increased total mortality, but the findings for stroke have varied.1 2 We analysed the association between alcohol consumption and the incidence of myocardial infarction, stroke, and mortality in a 25 year follow up of military conscripts. This study is based on 49 618 Swedish men conscripted between 1 July 1969 and 30 June 1970 and born between 1949 and 1952.2 At conscription, all men were given two questionnaires with questions covering social background, behaviour, and use of alcohol and tobacco, and all met with a psychologist for assessment. The percentage of non-responders was between 1% and 2%. From questions about quantity and frequency …

Association between use of sedatives or hypnotics, alcohol consumption, or other risk factors and a single injurious fall or multiple injurious falls: a longitudinal general population study

In this study, we investigated the association between risk factors, including use of sedatives or hypnotics or alcohol consumption, and injurious falls leading to hospitalization or death among 4023 subjects (1828 men and 2195 women) aged 20-89 years in Stockholm County, Sweden. Questionnaire data obtained from the 1984-1985 Stockholm Health of the Population Study (SHPS) were linked to official data registers on hospitalization and mortality. Of the 4023 subjects, 330 (121 men and 209 women) had been treated for or died of injurious falls during the 12-year follow-up period. High age was significantly associated with injurious falls among both men and women. Multivariate analyses showed that women who had used sedatives or hypnotics during the 2 weeks before an injurious fall were at increased risk [relative risk of 1.83 (95% confidence interval, 1.10-3.06)] for two or more injurious falls, but not for a single fall accident. High alcohol consumption and earlier self-reported injurious falls were significantly associated with injurious falls for women younger than 60 years of age and with earlier self-reported falls and living alone for men in the same age category. Among older women (>60 years of age), high alcohol consumption and use of sedatives or hypnotics were significantly associated with injurious falls, whereas living alone and earlier self-reported accidents were significant predictors for men in the same age category. These results support a cautious prescribing policy for sedatives and hypnotics, as well as an awareness of high alcohol consumption and its association with injurious falls.

Mortality and cause of death among 1705 illicit drug users: A 37 year follow up

INTRODUCTION AND AIMS To examine the overall mortality and causes of deaths of a large cohort of users of illicit drugs in Stockholm over 37 years. DESIGN AND METHODS People with substance abuse were identified through records collected by different institutions in Stockholm in 1967. Subjects were followed in registers recording mortality and cause of death and in-patient care stays until 2003. RESULTS More than half (n = 860) of the 1705 identified substance abusers died at an average age of 47 years, 25-30 years younger than the general population. The standardised rate ratio (SRR) for mortality was 3.3 among men and 3.5 among women. Incidence of mortality per 1000 person-years was also increased, but somewhat lower for women. The difference between these two measures is mainly explained by a lower mortality among women in general. In-patient care stays with both alcohol and drug-related diagnoses were associated with higher risk of dying among women than men: SRR = 14.5 and SRR = 4.0, respectively. Accidents and suicide were the most common cause of death among the youngest subjects (15-24 years) and cardiovascular diseases and tumours among the oldest (> or =55 years). DISCUSSION AND CONCLUSIONS Accidents and suicide, especially at a young age, are two common causes of death that might be prevented by increased awareness in medical personnel, along with better treatment and supportive measures.

An 18-Year Follow-Up of Patients Admitted to Methadone Treatment for the First Time

ABSTRACT An 18-year addiction career, 1985-2003, for 157 heroin dependent subjects (73% men; 49% human immunodeficiency virus seropositive) admitted for the first time to Stockholms Methadone Maintenance Treatment program during 1989 to 1991 was analyzed with data from seven official registers and patient records. Regression analyses and incidence rates for various outcomes were calculated for subjects in first methadone maintenance treatment at the end of the observation period, discharged from first methadone maintenance treatment, in second methadone maintenance treatment, and discharged from second methadone maintenance treatment. Being human immunodeficiency virus positive (HR = 3.8), lodging (HR = 1.9) and prison sentence (HR = 1.7) predicted mortality for the 45% deceased. Approximately 70% of living subjects participated in methadone maintenance treatment at some period each year. Subjects in first or second methadone maintenance treatment had less criminality and had spent more time in methadone maintenance treatment (70% to 100%) than those discharged from first or from second methadone maintenance treatment (50%). Efforts and interventions should be intensified to increase time in treatment also for those with high problem severity.

College Students’ Drinking Patterns: Trajectories of AUDIT Scores during the First Four Years at University

Aims: Changes in AUDIT score trajectories were examined in a student population during their first 4 years at a university, including high-risk consumers and a subsample of low-risk consumers. Method: 359 students were selected for the present study, comprising all high-risk consumers (the 27% with highest scores, i.e. 11 for males and 7 for females) and a randomized sample of low-risk consumers (n = 177 and 182, respectively). The Alcohol Use Disorder Identification Test (AUDIT) was used as screening instrument. Trajectory analyses were made using a semiparametric group-based model. Results: In the low-AUDIT group, five distinct trajectories were identified: three stable non-risky consumption groups (83%) and two increasing groups (17%; from non-risky to risky). In the high-AUDIT group, three groups were identified: two stable high groups (58%) and one decreasing group (from risky to non-risky consumption; 41%). In the integrated model, stable risky consumption comprised 16% of the total sample, decreasing consumption 11%, increasing consumption comprised 13% and stable non-risky consumption 60% of the sample. Gender influenced the trajectories. Conclusion: The pattern of changes in risk consumption is similar to that found in corresponding US studies.

The impact of methadone treatment on registered convictions and arrests in HIV-positive and HIV-negative men and women with one or more treatment periods.

This study investigates criminality among 331 opiate abusers admitted to Stockholms methadone maintenance programme (SMMP) between 1988 and 1992, and a comparison group of 1483 untreated opiate abusers. Information on arrests, criminal convictions, and intravenous drug abuse was obtained from official records. For both genders the annual rate of convictions decreased from 2.2 convictions per year during the 4 years prior to the first treatment, to 0.5 convictions during treatment, compared to 2.0 convictions for the comparison group. There was an even greater decrease in the rate of arrests for patients on methadone treatment. The decline was observed for both genders and in both HIV-positive and HIV-negative patients. Rates of convictions among patients who had more than one treatment period were clearly reduced during each treatment period, and while the rate increased after they were expelled from treatment it remained at a lower level than during the 4 years prior to treatment. Thus, the methadone treatment is shown to have a profound positive effect on arrests and convictions, not only for patients remaining in treatment but also for those patients who were expelled from treatment involuntarily.

Self-reported drug use and mortality among a nationwide sample of Swedish conscripts - a 35-year follow-up.

BACKGROUND Drug users in clinical samples have elevated mortality compared with the general population, but little is known about mortality among users of drugs within the general population. AIM To determine whether self-reported use of illicit drugs and non-prescribed sedatives/hypnotics among young men in the general population is related to mortality. METHODS A 35-year follow-up of 48024 Swedish men, born 1949-1951 and conscripted in 1969/1970, among whom drug use was reported by 8767 subjects. Cross-record linkage was effected between individual data from the Swedish conscription and other national registers. Deaths and causes of death/1000 person-years were calculated. Cox PH regression was used to estimate hazard ratios (HRs) for death with 95% confidence intervals (95% CIs). An HR was calculated for users of different dominant drugs at conscription compared with non-users by age interval, after adjusting for confounders and hospitalisation with a drug-related diagnosis. RESULTS Drug users showed elevated mortality (HR 1.61, p<0.05) compared with non-users. After adjusting for risk factors, users of stimulants (HR 4.41, p<0.05), cannabis (HR 4.27, p<0.05), opioids (HR 2.83, p>0.05), hallucinogens (HR 3.88, p<0.05) and unspecified drugs (HR 4.62, p<0.05) at conscription with a drug-related diagnosis during follow-up showed an HR approaching the standard mortality ratios in clinical samples. Among other drug users (95.5%), only stimulant users showed statistically significantly increased mortality (HR 1.96, p<0.05). CONCLUSIONS In a life-time perspective, drug use among young men in the general population was a marker of premature death, even a long time after exposure.

Can individual competence factors prevent adult substance and alcohol abuse in low- and high-income areas?

This study investigates the role of individual competence factors as modifiers of the risk for adult substance and alcohol abuse in relation to living in high- or low-income areas. The study group consisted of 7,577 18-year-old Swedish conscripts followed for substance and alcohol abuse until the age of 45 ears. Records of alcohol and substance abuse were obtained from official registers. In the 25-year follow-up period, 166 (2.2%) persons were identified as substance abusers and 286 (3.8%) as alcohol abusers. Subjects with many (from five to nine) behavioral risk factors and many (from four to five) competence factors had significantly less adult alcohol and substance abuse in low-income areas compared with those who had few competencies. This finding was also true for alcohol abuse in high-income areas. Experimentation with drugs and alcohol use before conscription was the most powerful risk factor for adult alcohol abuse and substance abuse in both income areas. The results of this study indicate that knowledge of competence factors is important in preventing abuse, especially among high-risk persons coming from low-income areas.

Alcohol Trajectories over Three Years in a Swedish Residence Hall Student Population

Although it is known that college students have a high alcohol consumption, less is known about the long-term drinking trajectories amongst college students and, in particular, students living in residence halls, known to be high-risk drinkers. Over four consecutive years, the drinking habits of 556 Swedish residence hall students were analyzed. The main instruments for measuring outcome were AUDIT (Alcohol Use Identification Disorders Test), SIP (Short Index of Problems) and eBAC (estimated Blood Alcohol Concentration). The drinking trajectories among Swedish residence hall students showed stable and decreasing drinking patterns, with age and gender being predictors of group membership.

Predictors of a favourable socio-economic situation in middle age for Swedish conscripts with self-reported drug use

BACKGROUND Risk and protective factors for adverse outcomes among drug users in the general population have been identified. This study considers whether some of these factors predict favourable socio-economic situations in middle age. METHODS A 37-year follow-up of 49,411 Swedish male conscripts 1969/70, born 1949-1951. Based on self-reports at conscription, 36,191 living subjects in 2006 were divided into users of certain dominant drugs (n=3946) and non-users (n=32,245). Individual data from conscription and national registers were linked. Using logistic bivariate and multivariate regression, odds ratios (ORs) for the categories of dominant-drug users, compared with non-users, were computed for outcomes in 1990 and in 2006: education ≥12 years, being in work, and having a disposable income above the median. The ORs were calculated after considering familial, social and individual risk and protective factors, with separate analyses being performed for drug-use categories. RESULTS Small changes were observed in the ORs for the outcomes in 1990 and 2006. After adjustment for protective and risk factors, users of the various dominant drugs had increased ORs with an education ≥12 years but lower or non-significantly different from non-users for the other outcomes. The ORs decreased with severity of drug use. Among drug users, high intellectual ability, having a father from highest SES group, and communication with parents were among the factors that increased the probability of favourable socio-economic outcomes, especially when several protective factors were involved. CONCLUSIONS Protective factors increase the probability of favourable outcomes, but least among individuals with severe drug use.