OBJECTIVE We evaluated the claim that interventions to improve academic achievement can reduce the risk for alcohol use disorder (AUD). METHOD Using nationwide data for individuals born in Sweden from 1972 to 1981 (n = 930,182), we conducted instrumental variable and co-relative analyses of the association between academic achievement and AUD with a mean 21.4-year follow-up. Our instrument, used in the instrumental variable analyses, was month of birth. Co-relative analyses were conducted in cousins, full siblings, and monozygotic twins discordant for AUD, with observed results fitted to a genetic model. The academic achievement-AUD association was modeled in Cox regression. AUD was assessed using national medical, criminal, or pharmacy registries. RESULTS Later month of birth was significantly associated with poorer academic achievement. Lower standardized academic achievement had a strong relationship with the risk for subsequent AUD registration: hazard ratio (HR) [per SD] = 2.14 [2.11, 2.17]. Instrumental variable analysis produced a substantial but moderately attenuated association: HR = 1.52 [1.28, 1.80]. Controlling for modest associations between month of birth and parental education and AUD risk reduced the association to HR = 1.43 [1.20, 1.69]. Our genetic co-relative model fitted the observed data relatively well and estimated the academic achievement-AUD association in monozygotic twins discordant for academic achievement to equal an HR of 1.44 [1.35, 1.52]. Results were broadly similar when analyzed separately in males and females. CONCLUSIONS Two distinct methods with different assumptions produced results suggesting that the association observed between academic achievement at age 16 and the risk for AUD into middle adulthood is partly causal, thereby providing support for interventions to improve academic achievement as a means to prevent later AUD risk.

中文翻译：

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学业成就与饮酒障碍风险之间因果关系的性质

目的我们评估了以下主张：提高学业成绩的干预措施可以减少饮酒障碍（AUD）的风险。方法我们利用1972年至1981年在瑞典出生的个人的全国性数据（n = 930,182），对平均学历为21.4年的学术成就和AUD之间的关联性进行了工具变量和相关分析。我们用于工具变量分析的工具是出生月份。在表亲，全兄弟姐妹和与AUD不符的单卵双胞胎中进行了相关分析，观察结果与遗传模型相符。学术成就-AUD关联以Cox回归建模。AUD是使用国家医疗，刑事或药房注册机构进行评估的。结果出生后一个月与学习成绩差显着相关。较低的标准化学习成绩与随后进行AUD注册的风险密切相关：危险比（HR）[每SD] = 2.14 [2.11，2.17]。仪器变量分析产生了显着但中等程度的减弱的关联：HR = 1.52 [1.28，1.80]。控制出生月份与父母教育之间的适度关联以及AUD风险可使关联降低至HR = 1.43 [1.20，1.69]。我们的遗传相关模型相对较好地拟合了观察到的数据，并估计与成绩不一致的单卵双胞胎的成绩-AUD关联等于1.44的HR [1.35，1.52]。当分别对男性和女性进行分析时，结果大致相似。