Importance Although spouses strongly resemble one another in their risk for alcohol use disorder (AUD), the causes of this association remain unclear.

Objectives To examine longitudinally, in first marriages, the association of a first registration for AUD in one spouse with risk of registration in his or her partner and to explore changes in the risk for AUD registration in individuals with multiple marriages as they transition from a spouse with AUD to one without or vice versa.

Design, Setting, and Participants Population-wide Swedish registries were used to identify individuals born in Sweden between 1960 and 1990 who were married before the end of study follow-up on December 31, 2013. The study included 8562 marital pairs with no history of AUD registration prior to their first marriage and an AUD registration in 1 spouse during marriage and 4891 individuals with multiple marriages whose first spouse had no AUD registration and second spouse did or vice versa. Final statistical analyses were conducted from August 15 to September 1, 2017.

Exposures A spousal onset or history of AUD registration.

Main Outcomes and Measures Alcohol use disorder registration in national medical, criminal, or pharmacy registries.

Results Among the 8562 marital pairs (5883 female probands and 2679 male probands; mean [SD] age at marriage, 29.2 [5.7] years) in first marriages, the hazard ratio of AUD registration in wives immediately after the first AUD registration in their husbands was 13.82, which decreased 2 years later to 3.75. The hazard ratio of AUD registration in husbands after the first AUD registration in their wives was 9.21, which decreased 2 years later to 3.09. Among the 4891 individuals with multiple marriages (1439 women and 3452 men; mean [SD] age at first marriage, 25.5 [4.2] years), when individuals transitioned from a first marriage to a spouse with AUD to a second marriage to a spouse without AUD, the hazard ratio for AUD registration was 0.50 (95% CI, 0.42-0.59) in women and 0.51 (95% CI, 0.44-0.59) in men. After a first marriage to a spouse without AUD, the hazard ratio for AUD with a second marriage to a spouse with AUD was 7.02 (95% CI, 5.34-9.23) in women and 9.06 (95% CI, 7.55-10.86) in men. These patterns were modestly attenuated when moving from second to third marriages. Controlling for AUD registration prior to first marriage or between first and second marriages produced minimal changes in risk.

Conclusions and Relevance The increase in risk for AUD registration in a married individual following a first AUD registration in the spouse is large and rapid. When an individual with serial spouses is married, in either order, to partners with vs without an AUD registration, the risk for AUD registration is substantially increased when the partner has an AUD registration and decreased when the partner does not have an AUD registration. These results suggest that a married individual’s risk for AUD is directly and causally affected by the presence of AUD in his or her spouse.

重要性 尽管配偶在酒精使用障碍（AUD）的风险上非常相似，但这种关联的原因仍不清楚。

目的 为了纵向研究初婚中配偶的首次注册澳币与在其伴侣中有注册风险的关联，并探讨多婚个人从配偶过渡后澳币注册的风险的变化澳元兑一元，反之亦然。

设计，地点和参加者 瑞典的整个人口登记系统用于确定1960年至1990年之间在瑞典出生的人，这些人在2013年12月31日研究结束之前未婚。该研究包括8562对婚姻，没有婚姻史。首次婚前进行AUD注册，婚内一名配偶进行AUD注册，多婚的4891个人，其第一任配偶没有AUD登记，而第二任配偶则进行了AUD登记，反之亦然。最终统计分析于2017年8月15日至9月1日进行。

暴露 AUD配偶的病历或病史。

主要成果和措施 在国家医疗，刑事或药房注册中对酒精滥用障碍进行注册。

结果 在初婚中的8562对婚姻中（5883个女性先证者和2679个男性先证者；结婚时的平均[SD]年龄，29.2 [5.7]岁），在其丈夫首次进行AUD注册后，妻子中AUD注册的危害比为13.82，两年后下降到3.75。丈夫在妻子中首次进行AUD注册后，AUD注册的危险比为9.21，两年后降至3.09。在多婚的4891个人中（1439名女性和3452名男性；第一次结婚的平均[SD]年龄为25.5 [4.2]岁），当时个人从第一笔婚姻过渡到有澳元的配偶，再到第二笔婚姻过渡到没有婚姻的配偶。 AUD，女性注册AUD的风险比为0.50（95％CI，0.42-0.59），男性为0.51（95％CI，0.44-0.59）。与没有澳元的配偶初婚后，女性第二次婚配AUD的风险比为7.02（95％CI，5.34-9.23），男性为9.06（95％CI，7.55-10.86）。从第二次婚姻移到第三次婚姻时，这些模式略有减弱。在第一次结婚之前或第一次和第二次结婚之间控制澳元的注册，对风险的影响很小。

结论和相关性 在配偶中首次进行AUD注册后，已婚个人进行AUD注册的风险增加很大。如果有连续配偶的个人以两种顺序与有或没有AUD登记的伴侣结婚，则当伴侣进行AUD登记时，AUD登记的风险会大大增加，而在没有AUD登记的情况下，AUD登记的风险会大大降低。这些结果表明，已婚人士的AUD风险直接或因其配偶中AUD的存在而受到因果关系的影响。