Alcohol-related morbidity and mortality by fathers' parental leave: A quasi-experimental study in Sweden

IF 5.2 1区医学 Q1 PSYCHIATRY Addiction Pub Date : 2023-10-05 DOI:10.1111/add.16354

Helena Honkaniemi, Sol Pía Juárez

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Abstract

Background and Aims

Fathers' parental leave has been associated with decreased risks of alcohol-related hospitalizations and mortality. Whether this is attributable to the health protections of parental leave itself (through stress reduction or behavioral changes) or to selection into leave uptake remains unclear, given that fathers are more likely to use leave if they are in better health. Using the quasi-experimental variation of a reform incentivizing fathers' leave uptake (the 1995 Father's quota reform), this study aimed to assess whether fathers' parental leave influences alcohol-related morbidity and mortality.

Design

Quasi-experimental interrupted time series and instrumental variable analyses.

Setting

Sweden.

Participants

Fathers of singleton children born from January 1992 to December 1997 (n = 220 412).

Measurements

Exposure was indicated by the child's birthdate before or after the reform and used to instrument fathers' 2- and 8-year parental leave uptake. Outcomes included fathers' hospitalization rates for acute alcohol-related (intoxication; mental and behavioral disorders) and chronic alcohol-related diagnoses (cardiovascular, stomach and other diseases; liver diseases), as well as alcohol-related mortality, up to 2, 8 and 18 years after the first child's birthdate.

Findings

In interrupted time series analyses, fathers of children born after the reform exhibited immediate decreases in alcohol-related hospitalization rates up to 2 (incidence rate ratio [IRR] = 0.66, 95% confidence interval [CI] = 0.51–0.87), 8 (IRR = 0.74, 95% CI = 0.57–0.96) and 18 years after birth (IRR = 0.72, 95% CI = 0.54–0.96), particularly in acute alcohol-related hospitalization rates, compared with those with children born before. No changes were found for alcohol-related mortality. Instrumental variable results suggest that alcohol-related hospitalization decreases were driven by fathers' parental leave uptake (e.g. 2-year hospitalizations: IRR = 0.16, 95% CI = 0.03–0.84).

Conclusions

In Sweden, a father's parental leave eligibility and uptake may protect against alcohol-related morbidity.

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父亲休育儿假导致的酒精相关发病率和死亡率：瑞典的一项准实验研究。

背景和目的：父亲的育儿假与降低与酒精相关的住院和死亡风险有关。这是由于育儿假本身的健康保护（通过减轻压力或行为改变），还是由于选择休假，目前尚不清楚，因为如果父亲的健康状况更好，他们更有可能休假。本研究利用激励父亲休假的改革（1995年父亲配额改革）的准实验变化，旨在评估父亲的育儿假是否会影响与酒精相关的发病率和死亡率。设计：准实验中断时间序列和仪器变量分析。背景：瑞典。参与者：1992年1月至1997年12月出生的独生子女的父亲（n = 220 412）。测量：暴露量由改革前后孩子的出生日期表示，并用于衡量父亲2年和8年的育儿假。结果包括父亲因急性酒精相关（中毒；精神和行为障碍）和慢性酒精相关诊断（心血管、胃部和其他疾病；肝脏疾病）的住院率，以及酒精相关死亡率，最高可达2、8和18 第一个孩子出生几年后。研究结果：在中断的时间序列分析中，改革后出生的孩子的父亲表现出与酒精相关的住院率立即下降，最高可达2（发病率比[IRR] = 0.66,95%置信区间[CI] = 0.51-0.87），8（IRR = 0.74，95%CI = 0.57-0.96）和18 出生后数年（IRR = 0.72，95%CI = 0.54-0.96），尤其是在与酒精相关的急性住院率方面，与之前出生的孩子相比。与酒精相关的死亡率没有变化。工具变量结果表明，与酒精相关的住院率下降是由父亲休育儿假的情况推动的（例如，2年住院率：IRR = 0.16，95%CI = 0.03-0.84）。结论：在瑞典，父亲的育儿假资格和接受情况可以预防与酒精相关的发病率。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.