Risk and protective factors for mortality in a 35 year follow-up of 50,000 young men in Sweden

Introduction

Several studies indicate that social factors and alcohol and drug use are determinants of health and ill-health. Fewer studies address the issue of the duration of the impact at young age of the social, behavioural and personality factors and alcohol and drug use on mortality. This is a 35 year follow up of the 50,000 mandatory military conscripts in Sweden 1969/70, a cohort which earlier has been followed-up during shorter periods in several scientific papers.

Purpose: To analyse social and behavioural risk and protective factors for mortality.

Material and methods: The cohort of men aged 18-20 years went through a health examination, confidentially completed two questionnaires about social background, behaviour, social network, alcohol, narcotics and tobacco use, with very little attrition. Information about mortality (2,704 deaths) up 2004, with almost complete coverage was linked to the individual questionnaire data. Cox regression analyses were conducted.

Results: Statistically significant social risk and protective factors were identified in multivariate analyses with mortality for all-causes, alcohol, narcotics or ischemic heart disease respectively. Good social maturity (RH=0.79, 95% CI 0.71-0.88), good emotional control and talk with parents about leisure time reduced the risk for all-cause mortality while increased risk was associated with divorced parents, contact with juvenile authorities, medication for nervous problems, alcohol consumption over 30 grams 100 ethanol/day and  use of narcotics. Alcohol-related death was predicted by contact with juvenile authorities (RH. 2.54, 95% C.I. 1.83-3.54), while good social maturity had a RH of 0.65 (95% C.I.0.46-0.93). The results were similar if mortality 20-35 years after conscription was studied.

Conclusion: Some social factors, use of drugs and hazardous use of alcohol, although not a persisting phenomenon in many, are nevertheless predictors of increased risk of mortality.

To counterbalance, the protective factors should be strengthened in the family or by the environment.