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Role of hospitalisation for substance misuse in marital status transitions: a 47-year follow-up of a Swedish birth cohort
  1. Lauren Bishop1,2,3,4,
  2. Robin S Högnäs5
  1. 1 Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
  2. 2 International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, Rostock, Germany
  3. 3 Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
  4. 4 Max Planck–University of Helsinki Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
  5. 5 Epidemiology Unit, Stress Research Institute, Stockholm University, Stockholm, Sweden
  1. Correspondence to Dr Lauren Bishop, Population Research Unit, Faculty of Social Sciences, University of Helsinki, PL 42 (Unioninkatu 33), FIN-00014 Helsinki, Finland; lauren.bishop{at}helsinki.fi

Abstract

Background Substantial research suggests that the risk of substance misuse is higher among individuals who remain unmarried or experience marital dissolution, whereas marriage tends to be protective. However, few studies have considered the role of substance misuse for transitions between discrete marital status categories. The current study aims to estimate associations between substance misuse and marital status transitions from ages 20–66.

Methods Our study population was a national Swedish cohort born in 1953 (n=71 901), followed from 1973 to 2019. Annual marital status and hospitalisation records for substance misuse were derived from the Total Population and National Patient registers, respectively. We used a five-state multistate model to estimate associations between substance misuse and marital status transitions—the state space included never married, married, divorced and widowed with death as the absorbing state. We further used fixed-effect models to estimate the effects of substance misuse on transitions out of marriage.

Results Findings suggested that individuals’ substance misuse was associated with an increased risk of transitioning from married to divorced (HR=3.54, 95% CI 3.40 to 3.69) or widowed (HR=1.71, 95% CI 1.46 to 2.01), and transitioning to death from all states. Substance misuse was also negatively associated with transitioning from never married to married (HR=0.59, 95% CI 0.57 to 0.61), and into remarriage after divorce (HR=0.86, 95% CI 0.80 to 0.92). The fixed-effect results suggested that substance misuse increased the risk of transitioning to divorce and widowhood, net of sociodemographic characteristics.

Conclusion Substance misuse is associated with an increased risk of marital dissolution and death when accounting for nearly 50 years of marital biographies.

  • substance abuse
  • marital status
  • longitudinal studies
  • demography
  • public health

Data availability statement

Data may be obtained from a third party and are not publicly available. Owing to ethical regulations regarding the Stockholm Birth Cohort Multigenerational Study (SBC Multigen), access to the data is restricted. If there is interest in the unpublished data from this research article, readers may contact the Principal Investigator of the SBC Multigen (ylva.almquist@su.se), who will forward the request to the steering committee.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Owing to ethical regulations regarding the Stockholm Birth Cohort Multigenerational Study (SBC Multigen), access to the data is restricted. If there is interest in the unpublished data from this research article, readers may contact the Principal Investigator of the SBC Multigen (ylva.almquist@su.se), who will forward the request to the steering committee.

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Footnotes

  • Contributors Both authors designed the study. LB prepared the dataset and conducted the statistical analysis. LB wrote the first draft of the manuscript. Both authors interpreted the results and critically revised the manuscript.

    LB is responsible for the overall content as guarantor. Both authors contributed to and approved the final manuscript.

  • Funding This study was financially supported by the Swedish Research Council for Health, Working Life and Welfare (Forte), grant number 2016–07148. RSH was supported also supported by Forte, grant number 2019-01321.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.