Abstract
BACKGROUND: In Republic of Korea, household debt has increased recently among young adults, especially during the COVID-19 pandemic. Household debt may potentially lead to numerous outcomes including alcohol use disorder (AUD). The aim of this study was to investigate the relationship between a change in indebtedness and the risk of developing AUD. METHODS: A total of 5,091 participants (2,720 men and 2,371 women) were included during a 4-year study period. Indebtedness was divided into four groups: no debt a year ago and at present (group 1), paying off a year's debt (group 2), newly incurred current debt after a year when there was no debt (group 3), and indebtedness a year ago and at present (group 4). Groups 2, 3, and 4 were also divided into subgroups based on debt characteristics. AUD risk was evaluated by the CAGE scale, and a score of 2 or higher was defined as AUD high risk. Several time-varying socioeconomic and health-related characteristics were adjusted. RESULTS: Participants who indicated indebtedness at present (groups 3 and 4) were more likely to be AUD high-risk compared to group 1 in both genders (men: adjusted relative risk [aRR] = 1.031, 95% CI [1.014-1.049] in group 3, aRR = 1.028, 95% CI [1.007-1.050] in group 4; women: aRR = 1.039, 95% CI [1.016-1.163] in group 3, aRR = 1.028, 95% CI [1.007-1.050] in group 4). Even paid-off debt affected the risk of AUD among female participants (aRR = 1.018, 95% CI [1.001-1.034] in group 2). Women whose amount of debt increased for 1 year were more likely to be AUD high-risk compared to group 1. Women showed higher aRR than men for increasing CAGE scores by one unit in all debt subgroups. CONCLUSION: Our research demonstrated a possible link between indebtedness and a heightened risk of AUD. These results underscore the importance of implementing targeted screening and interventions for AUD, particularly among young women who are facing mounting levels of debt.