Alcohol consumption, educational level and labour market participation: A prospective cohort study of transitions between work and unemployment

Introduction In Europe alcohol consumption is high. Heavy drinking is associated with adverse consequences on multiple levels and the socioeconomic costs are substantial. Also, alcohol plays a considerable role in the production of health inequalities. Despite a relatively even distribution of the overall alcohol consumption across socioeconomic positions in Denmark, the adverse consequences cluster among people of lower socioeconomic positions; from 2005–2009, alcohol accounted for 15% of socioeconomic differences in mortality among men and 7% among women. The literature refers to this phenomenon as the harm paradox of alcohol. Few have considered the social consequences of alcohol consumption related to labour market participation. In this study, we aim to test the hypothesis that heavy alcohol consumption and problem drinking is associated with a higher risk of unemployment as well as a lower chance of returning to work and whether this effect differs on different educational levels. Methods A sample of 84,671 men and women aged 18–60 years from the Danish National Health Survey 2010 participated in the study. Alcohol consumption was measured by number of drinks per week and problem drinking was measured by six items from the CAGE-C questionnaire (Cut down, Annoyed, Guilty, Eye-opener - Copenhagen). The CAGE-C score was specified based on the number of positive answers and problem drinking was defined as 4–6 positive answers. Information on educational level and labour market participation was obtained from national administrative registers. Data were analysed by use of Cox proportional hazards models and adjusted for age, gender, cohabitation status, geographic location, comorbidity, smoking habits and labour market attachment. Results High weekly alcohol consumption and problem drinking (CAGE-C score of 4–6) were both associated with a higher risk of unemployment as well as a lower chance of returning to the labour market. For example, hazard ratios (HRs) of becoming unemployed and returning to work were 1.48 (95% CI: 1.37–1.60) and 0.85 (95% CI: 0.76–0.94) among individuals drinking 28+ drinks per week as compared to individuals drinking 1–6 drinks per week. Low educational level was associated with higher risks of unemployment and lower chances of returning to work compared to a high educational level. For example, the HR of becoming unemployed was 2.30 (95% CI: 2.20–2.40) among individuals with a low level of education in comparison to individuals with a high educational level. However, at all educational levels, heavy alcohol consumption and problem drinking was associated with a higher risk of unemployment and a lower chance of returning to work. Conclusions Heavy drinking and alcohol problems have adverse consequences on labour market participation and were associated with a higher risk of unemployment and a lower chance of becoming employed. This was consistently observed at all educational levels, which indicates that alcohol problems are of importance for labour market participation across all socioeconomic positions.