Triangulation of evidence on immigration and rates of alcohol use disorder in Sweden: Evidence of acculturation effects

• Published in: Alcohol, clinical & experimental research Vol. 47; no. 1; pp. 104 - 115
• Main Authors: Chartier, Karen G., Kendler, Kenneth S., Ohlsson, Henrik, Sundquist, Kristina, Sundquist, Jan
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2023
• Subjects: Acculturation; Alcohol use; alcohol use disorder; Alcoholism; Beroendelära; Child; co-sibling analysis; Emigrants and Immigrants; Emigration and Immigration; Female; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Health Sciences; Humans; Hälsovetenskap; Immigrants; Immigration; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Public Health, Global Health, Social Medicine and Epidemiology; Regions; Registries; Regression analysis; Risk; Risk Factors; Siblings; socio-cultural influences; Substance Abuse; Sweden - epidemiology; Sweden; alcohol use disorder; immigration; co-sibling analysis; acculturation; socio-cultural influences
• ISSN: 0145-6008; 1530-0277; 2993-7175
• DOI: 10.1111/acer.14969

Background This study aimed to determine the robustness of the impact of immigration on risk for alcohol use disorder (AUD) using different measures, designs, and immigrant regional cohorts. Methods The analytic sample included all individuals born between 1950 and 1990 and registered in Sweden from 1973 to 2017. Using Cox regression models, we examined the risk for AUD from Swedish nationwide registries in immigrants to Sweden from seven geographical regions: Africa, Asia and Oceania, Eastern Europe, Finland, Latin America and the Caribbean, Middle East/North Africa, and Western countries. We assessed greater exposure to Swedish culture, which we interpreted as increasing acculturation, by (i) comparing first‐generation immigrants and their children with no and one native Swedish parent and (ii) examining age at immigration. The baseline comparison group was the native Swedish population. We also examined AUD risk in first‐generation sibling pairs discordant for their age at immigration. Results In nearly all immigrant cohorts in Sweden, increasing degrees of acculturation, as assessed by both our variables, were associated with rates of AUD that approached those of the Swedish population. These findings occurred in both men and women and both regional cohorts whose first‐generation immigrants had lower and higher levels of AUD than native‐born Swedes. For most cohorts, the rates of change with acculturation were greater in women than in men. In sibling pairs from most regions, the sibling who was younger at immigration had a higher rate of AUD. Conclusions An examination of both sexes and two different proxies for acculturation provides consistent support for socio‐cultural influences on AUD risk. Our co‐sibling analyses suggest that a meaningful proportion of this effect is likely to be causal in nature. This study evaluated the robustness of the impact of immigration and acculturation effects on risk for alcohol use disorder (AUD) using different measures, designs, and seven distinct immigrant cohorts. Results showed that increasing acculturation was associated with rates of AUD that increasingly approached those of the population. This was seen in men and women (with a greater rate of change in women) and in regional cohorts whose first‐generation immigrants had lower and higher AUD rates compared to the population.