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Heshmati, A., Dunlavy, A., Mussino, E., Fritzell, S. & Juárez, S. P. (2025). Health before pregnancy and eligibility for parental leave benefits: a Swedish total population cohort study. BMC Public Health, 25, Article ID 1045.
Open this publication in new window or tab >>Health before pregnancy and eligibility for parental leave benefits: a Swedish total population cohort study
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2025 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 25, article id 1045Article in journal (Refereed) Published
Abstract [en]

Background  Parental leave generosity is protective for mothers’ mental health in the postpartum period and beyond. Strong work requirements exist for parents in Sweden to receive more generous benefits which might penalise individuals who, due to poor health, have a weak labour market attachment. The aim of the study was to examine whether mothers with poor health prior to pregnancy are less likely to be eligible for more generous benefits in Sweden.

Methods  We used total population registers to study first-time mothers, aged 25–45 years, who were resident in Sweden and gave birth between 1 January 2009 and 30 September 2013 (n = 151,452). We used logistic regression to examine the association between health one and two consecutive years prior to pregnancy (to assess chronicity) and eligibility for earnings-related parental leave benefits.

Results  Mothers who were admitted to hospital or received specialist outpatient care for any health condition in the year prior to pregnancy were less likely to be eligible for earnings-related benefits (OR 0·79, 95%CI 0·76–0·83) compared to healthy mothers, particularly those with chronic health issues (OR 0·64, 95%CI 0·62–0·68). Findings were driven by mothers with mental disorders (OR 0·22, 95%CI 0·20–0·23 for the year before pregnancy), and associations were stronger for those with chronic health issues and for Swedish-born mothers.

Conclusion  Mothers with prior health conditions, particularly mental disorders, are less likely to benefit from the protective health effect of parental leave as they may not meet the eligibility requirements for more generous remunerations. This study highlights how the strong work requirement for accessing generous parental leave benefits could unintentionally exacerbate socioeconomic inequalities between mothers with and without poor mental health. Easing work requirements for eligibility to more generous parental leave remuneration could help reduce these inequalities and thus promote better mental health for all, particularly among more disadvantaged groups. As such, our findings empirically support the need for adopting the Health in All Policies framework when designing parental leave policies in order to minimise health inequalities.

Keywords
Health in All Policies, Health inequalities, Mental health, Parental leave
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:su:diva-241828 (URN)10.1186/s12889-025-22248-8 (DOI)001449530200010 ()40102758 (PubMedID)2-s2.0-105000418649 (Scopus ID)
Available from: 2025-04-09 Created: 2025-04-09 Last updated: 2025-04-29Bibliographically approved
Uggla, C., Mussino, E. & Aradhya, S. (2024). Are women from man-older unions economically disadvantaged following separation? Sweden 1997–2015. Acta Sociologica, 67(1), 98-116
Open this publication in new window or tab >>Are women from man-older unions economically disadvantaged following separation? Sweden 1997–2015
2024 (English)In: Acta Sociologica, ISSN 0001-6993, E-ISSN 1502-3869, Vol. 67, no 1, p. 98-116Article in journal (Refereed) Published
Abstract [en]

Separation often leads to worse economic consequences for women than for men. However, little is known about how economic consequences of separation play out for different groups of women. Women who are younger than their male partner are generally assumed to have lesser agency, but evidence mostly comes from contexts with low gender equality. Here, we examine women's benefit recipiency as a function of the partner age gap of their dissolved union. Using register data from Sweden, we examine whether women from man-older unions suffer greater economic disadvantage after separation, and whether patterns differ for ancestral Swedes and women with migrant background. Results from logistic regression models suggest that, post-separation, the uptake of social and housing benefits increases for nearly all groups of women. However, these data do not show any consistent disadvantages of women from man-older unions. Among ancestral Swedes, patterns differed by benefit type, and among women of African/Middle Eastern origin, benefit recipiency increases were inversely U-shaped to the age gap. Social norms do not appear to explain economic costs of separation, but may explain why the risk of separation itself differed between ancestral Swedish women and women with migrant background.

Keywords
Union dissolution, economic consequences, age gap, gender dynamics, immigration background, benefit recipiency
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Identifiers
urn:nbn:se:su:diva-213106 (URN)10.1177/00016993221136050 (DOI)000893953000001 ()2-s2.0-85143598571 (Scopus ID)
Available from: 2022-12-21 Created: 2022-12-21 Last updated: 2024-02-21Bibliographically approved
Wallace, M., Mussino, E., Aradhya, S., Harber-Aschan, L. & Wilson, B. (2024). Childhood socioeconomic background and elevated mortality among the young adult second generation in Sweden: a population-based cohort study. BMJ Public Health, 2(1), Article ID e000643.
Open this publication in new window or tab >>Childhood socioeconomic background and elevated mortality among the young adult second generation in Sweden: a population-based cohort study
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2024 (English)In: BMJ Public Health, E-ISSN 2753-4294, Vol. 2, no 1, article id e000643Article in journal (Refereed) Published
Abstract [en]

Introduction The native-born children of migrants represent one of the fastest-growing and most diverse young populations in the world today. A growing body of research highlights an elevated young adult mortality risk in this ‘second generation’ (G2) relative to the majority population at the same ages. Previous studies have tried to understand this increased risk by examining its association with inequality in the adult socioeconomic background (SEB) of the G2. Here, we instead analyse the association of second-generation status with childhood SEB.

Methods We use administrative register data from Sweden to fit multistate, competing-risk, flexible parametric survival models on a data set of 13404 deaths in 2.35million young adults. We examine mortality from all causes and specific causes of death at the generational level and by parental region of birth, both before and after having adjusted for childhood SEB.

Results The G2 have higher all-cause mortality hazard rates (HR=1.29 (95% CIs=1.23 to 1.34)) than the majority population before adjusting for childhood SEB. Following adjustment, the size of the hazard rate is smaller, but remains higher than the majority population (aHR=1.16 (95% CIs=1.11 to 1.21)). The G2 additionally experience persistent and higher hazard rates of mortality from suicide (aHR=1.29 (95% CIs=1.20 to 1.39)), substance misuse (aHR=1.41 (95% CIs=1.26 to 1.58)) and assault (aHR=2.54 (95% CIs=2.02 to 3.20)). By parental origins, similar patterns to those described are documented among G2 that have at least one parent born in Finland, the other Nordic countries, former Yugoslavia, the rest of Europe, sub-Saharan Africa, Northern Africa, and Iran and Iraq. However, higher all-cause (aHR=1.42 (95% CIs=1.33 to 1.51)) and external-cause hazard rates of mortality (aHR=1.59 (95% CIs=1.48 to 1.72)) only persist among G2 with parent(s) born in Finland.

Conclusions G2 with various parental origins have higher mortality rates than the majority population do, and this difference is partly explained by their childhood SEB.

National Category
Demography Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:su:diva-235386 (URN)10.1136/bmjph-2023-000643 (DOI)
Funder
Swedish Research Council, 2021-00875Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07115Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-00603EU, Horizon 2020, 948727
Available from: 2024-11-09 Created: 2024-11-09 Last updated: 2025-05-09Bibliographically approved
Juárez, S. P., Debiasi, E., Wallace, M., Drefahl, S., Mussino, E., Cederström, A., . . . Aradhya, S. (2024). COVID-19 mortality among immigrants by duration of residence in Sweden: a population-based cohort study. Scandinavian Journal of Public Health, 52(3), 370-378
Open this publication in new window or tab >>COVID-19 mortality among immigrants by duration of residence in Sweden: a population-based cohort study
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2024 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 52, no 3, p. 370-378Article in journal (Refereed) Published
Abstract [en]

Background: Explanations for the disproportional COVID-19 burden among immigrants relative to host-country natives include differential exposure to the virus and susceptibility due to poor health conditions. Prior to the pandemic, immigrants displayed deteriorating health with duration of residence that may be associated with increased susceptibility over time. The aim of this study was to compare immigrant–native COVID-19 mortality by immigrants’ duration of residence to examine the role of differential susceptibility. Methods: A population-based cohort study was conducted with individuals between 18 and 100 years old registered in Sweden between 1 January 2015 and 15 June 2022. Cox regression models were run to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Inequalities in COVID-19 mortality between immigrants and the Swedish-born population in the working-age group were concentrated among those of non-Western origins and from Finland with more than 15 years in Sweden, while for those of retirement age, these groups showed higher COVID-19 mortality HRs regardless of duration of residence. Both age groups of immigrants from Africa and the Middle East showed consistently higher COVID-19 mortality HRs. For the working-age population: Africa: HR<15: 2.46, 95%CI: 1.78, 3.38; HR≥15: 1.49, 95%CI: 1.01, 2.19; and from the Middle East: HR<15: 1.20, 95%CI: 0.90, 1.60; HR≥15: 1.65, 95%CI: 1.32, 2.05. For the retirement-age population: Africa: HR<15: 3.94, 95%CI: 2.85, 5.44; HR≥15: 1.66, 95%CI: 1.32, 2.09; Middle East: HR<15: 3.27, 95%CI: 2.70, 3.97; HR≥15: 2.12, 95%CI: 1.91, 2.34. Conclusions: Differential exposure, as opposed to differential susceptibility, likely accounted for the higher COVID-19 mortality observed among those origins who were disproportionately affected by the pandemic in Sweden.

Keywords
COVID-19, immigrants, vulnerability, susceptibility, Sweden
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:su:diva-228689 (URN)10.1177/14034948241244560 (DOI)001200551900001 ()38600446 (PubMedID)2-s2.0-85190443529 (Scopus ID)
Available from: 2024-04-29 Created: 2024-04-29 Last updated: 2025-02-20Bibliographically approved
Mussino, E., Drefahl, S., Wallace, M., Billingsley, S., Aradhya, S. & Andersson, G. (2024). Lives saved, lives lost, and under-reported COVID-19 deaths: Excess and non-excess mortality in relation to cause-specific mortality during the first year of the COVID-19 pandemic in Sweden. Demographic Research, 50, Article ID 1.
Open this publication in new window or tab >>Lives saved, lives lost, and under-reported COVID-19 deaths: Excess and non-excess mortality in relation to cause-specific mortality during the first year of the COVID-19 pandemic in Sweden
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2024 (English)In: Demographic Research, ISSN 1435-9871, Vol. 50, article id 1Article in journal (Refereed) Published
Abstract [en]

Background: The number of confirmed COVID-19 deaths differed across countries and across waves of the pandemic. Patterns also differed between groups within a country.

Objective: We combine data on excess mortality with data on cause-of-death-specific mortality in the case of Sweden to identify which groups had excess mortality beyond what can be captured by analyses of COVID-19-specific deaths. We also explore the possibility that some groups may have benefited in terms of reduced all-cause mortality, potentially due to home-centered living conditions during the pandemic.

Methods: We produced and compared three sets of group-specific incidence rates: deaths from (1) any cause in 2020, (2) any cause in 2019, (3) any cause excluding COVID-19 in 2020. We compared rates across different socioeconomic profiles based on combinations of sex, age, marital status, education, and country of birth.

Contribution: We show that many of those who died during 2020 would not have done so in the absence of the pandemic. We find some evidence of COVID-19 mortality underestimation, mainly among individuals with a migration background. We also found groups for which mortality decreased during the pandemic, even when including COVID-19 mortality. Progression across the first and second waves of the pandemic shows that more groups appeared to become protected over time and that there was less underestimation of COVID-19 mortality in the second part of 2020.

National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:su:diva-226532 (URN)10.4054/DemRes.2024.50.1 (DOI)001141079500001 ()2-s2.0-85190449041 (Scopus ID)
Available from: 2024-02-14 Created: 2024-02-14 Last updated: 2025-02-20Bibliographically approved
Callaway, J., Strozza, C., Drefahl, S., Mussino, E. & Kashnitsky, I. (2024). Mortality inequalities at retirement age between migrants and nonmigrants in Denmark and Sweden. Demographic Research, 50, 473-502
Open this publication in new window or tab >>Mortality inequalities at retirement age between migrants and nonmigrants in Denmark and Sweden
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2024 (English)In: Demographic Research, ISSN 1435-9871, Vol. 50, p. 473-502Article in journal (Refereed) Published
Abstract [en]

Background: Denmark and Sweden index their statutory retirement ages to life expectancy. When lifespan increases, so does retirement age. This policy does not consider demographic heterogeneity in life expectancy, e.g., between migrants and non-migrants, posing possible issues for pension policies that index retirement age to life expectancy.

Objective: To understand how mortality inequalities between migrants and non-migrants interact with the indexation of statutory retirement age in Denmark and Sweden.

Methods: We used Danish and Swedish registry data from 1988–2018, and included individuals aged 50+. Migrants were classified as European-born or non-European-born. We calculated the probability of dying before retirement age, remaining life expectancy at retirement age, lifespan inequalities after retirement age, and the likelihood that a non-migrant would outlive a migrant. We also classified the Danish-born population into four income levels and compared them to migrant groups.

Results: Non-European-born migrants had the survival advantage in both countries, but equal or higher lifespan inequality at retirement. Sweden had a proportionally larger migrant population, but Denmark’s was more diverse. The probability that a non-migrant would outsurvive a migrant was 40%–50% in both countries.

Conclusions: The healthy migrant effect was observed in both Denmark and Sweden. Despite mortality advantages, migrants do not contribute to increasing life expectancy in Denmark or Sweden.

Contribution: This study contributes to the literature on mortality differences between migrants and non-migrants in Scandinavia. The novel contributions of this paper are the consideration of the socioeconomic status of non-migrants in Denmark, and the calculation of probabilities that migrants will outsurvive non-migrants, all within the context of pension policy.

National Category
Public Health, Global Health and Social Medicine Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Identifiers
urn:nbn:se:su:diva-228123 (URN)10.4054/DemRes.2024.50.18 (DOI)001188075400001 ()2-s2.0-85192973015 (Scopus ID)
Available from: 2024-04-10 Created: 2024-04-10 Last updated: 2025-02-20Bibliographically approved
Mussino, E. & Cantalini, S. (2024). Multiple Origins and Multiple Destinations: The Fertility of Immigrant Women in Europe. Journal of International Migration and Integration, 25, 911-932
Open this publication in new window or tab >>Multiple Origins and Multiple Destinations: The Fertility of Immigrant Women in Europe
2024 (English)In: Journal of International Migration and Integration, ISSN 1488-3473, E-ISSN 1874-6365, Vol. 25, p. 911-932Article in journal (Refereed) Published
Abstract [en]

Studies on immigrant fertility typically compare immigrants and natives or different migrant groups at the same destination but rarely immigrants of the same origins in different destination countries. In this paper, we look at immigrants from multiple origins in multiple destination countries simultaneously, using the European Union Labour Force Survey to compare female immigrants from ten areas of origin in eight destination countries in Europe. Our results indicate a strong origin effect. However, they also suggest that when women migrate to a context where the fertility norm is different from that in their origin, they adjust their behaviors accordingly, which indicates that policy and normative context play an important role in shaping migrants’ fertility. From a policy perspective, this is important because it suggests that the fertility of immigrant women, who are exposed to different norms and normative contexts, can resemble that of native women at the destination. Our findings contribute to strengthening the role of destination in shaping fertility behavior and highlighting the importance of looking at all the possible combinations of immigrants coming from and going to different fertility regimes. 

Keywords
Multiple origins, Multiple destination, Fertility, Migrants, Europe
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology) International Migration and Ethnic Relations
Identifiers
urn:nbn:se:su:diva-226485 (URN)10.1007/s12134-024-01121-4 (DOI)001148126700001 ()2-s2.0-85182993989 (Scopus ID)
Available from: 2024-02-13 Created: 2024-02-13 Last updated: 2024-09-05Bibliographically approved
Mussino, E., Santos, B., Monti, A., Matechou, E. & Drefahl, S. (2024). Multiple systems estimation for studying over-coverage and its heterogeneity in population registers. Quality and quantity, 58, 5033-5056
Open this publication in new window or tab >>Multiple systems estimation for studying over-coverage and its heterogeneity in population registers
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2024 (English)In: Quality and quantity, ISSN 0033-5177, E-ISSN 1573-7845, Vol. 58, p. 5033-5056Article in journal (Refereed) Published
Abstract [en]

The growing necessity for evidence-based policy built on rigorous research has never been greater. However, the ability of researchers to provide such evidence is invariably tied to the availability of high-quality data. Bias stemming from over-coverage in official population registers, i.e. resident individuals whose death or emigration is not registered, can lead to serious implications for policymaking and research. Using Swedish Population registers and the statistical framework of multiple systems estimation, we estimate the extent of over-coverage among foreign-born individuals’ resident in Sweden for the period 2003–2016. Our study reveals that, although over-coverage is low during this period in Sweden, we observed a distinct heterogeneity in over-coverage across various sub-populations, suggesting significant variations among them. We also evaluated the implications of omitting each of the considered registers on real data and simulated data, and highlight the potential bias introduced when the omitted register interacts with the included registers. Our paper underscores the broad applicability of multiple systems estimation in addressing and mitigating bias from over-coverage in scenarios involving incomplete but overlapping population registers. 

Keywords
Over-coverage, Sweden, Multiple-systems estimation, Population registers, Foreign born
National Category
Human Geography
Identifiers
urn:nbn:se:su:diva-233899 (URN)10.1007/s11135-023-01757-x (DOI)2-s2.0-85173710076 (Scopus ID)
Available from: 2024-09-30 Created: 2024-09-30 Last updated: 2025-02-24Bibliographically approved
Mussino, E. & Duvander, A.-Z. (2024). Parental leave use among newly arrived immigrant mothers in Sweden: Causes and consequences. Journal of European Social Policy, 34(1), 85-100
Open this publication in new window or tab >>Parental leave use among newly arrived immigrant mothers in Sweden: Causes and consequences
2024 (English)In: Journal of European Social Policy, ISSN 0958-9287, E-ISSN 1461-7269, Vol. 34, no 1, p. 85-100Article in journal (Refereed) Published
Abstract [en]

Immigration to Sweden is dominated by women and men of childbearing age, and many arrive with children. The labour-market integration of newly arrived mothers is of concern, and well directed social policy is crucial. Parental leave is based on residence, and until recently it was granted to all parents of foreign-born children of preschool age. This study uses population and social insurance registers to investigate whether newly arrived immigrant mothers use parental leave upon arrival, and whether use is an obstacle to future labour-market activity. Our results indicate that the majority of the newly arrived mothers do not take any parental leave, but also that there are great differences in uptake in relation to country of birth and reason for residence permit. However, there seem to be only marginal associations between parental leave use and subsequent labour-market attachment. Nevertheless, moderate use is associated with labour-market activity rather than being an obstacle to it. Our results contribute to the debate on the unintended effects of social policy on the integration of immigrants.

Keywords
parental leave use, Sweden, immigrants, labour market attachment, reason of migration
National Category
International Migration and Ethnic Relations Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Identifiers
urn:nbn:se:su:diva-225089 (URN)10.1177/09589287231216688 (DOI)001118301100001 ()2-s2.0-85178224300 (Scopus ID)
Available from: 2024-01-08 Created: 2024-01-08 Last updated: 2024-03-08Bibliographically approved
Santos, B., Mussino, E., Drefahl, S. & Matechou, E. (2024). Using population register data and capture-recapture models to estimate over-coverage in Sweden. Scientific Reports, 14(1), Article ID 30551.
Open this publication in new window or tab >>Using population register data and capture-recapture models to estimate over-coverage in Sweden
2024 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 14, no 1, article id 30551Article in journal (Refereed) Published
Abstract [en]

Over-coverage occurs when individuals who reside in a country leave or pass away, and this demographic event is not recorded in population registers, leading to population size overestimation. This problem can have important policy and decision-making consequences. With the increased reliance on incomplete but overlapping official registers for documenting whole populations or subgroups of populations, there is a need for more sophisticated modelling techniques that reliably estimate population size, and hence over-coverage, from such registers. Previous approaches have considered multiple systems estimation (MSE) for monitoring over-coverage, but MSE does not naturally extend to cases where individuals are followed over time. In this paper, motivated by the case study of Sweden, we develop a capture-recapture (CR) modelling framework for population registers that allows us to estimate the population size each year, the probability of presence for each individual in the population, conditional on their records, each year and to quantify the effect of demographic characteristics on the probability of emigration and re-immigration, amongst other parameters. Our results suggest that the CR approach, which accounts for the whole time series for each individual, gives a more realistic estimate of the population size compared to existing, deterministic approaches, especially when considering the subgroup of newly arrived individuals, and that it provides new insights on individual behaviour in terms of migration patterns than existing MSE approaches.

Keywords
Capture-recapture models, Over-coverage, Register data
National Category
Demography
Identifiers
urn:nbn:se:su:diva-240694 (URN)10.1038/s41598-024-82547-9 (DOI)001381004000010 ()39695188 (PubMedID)2-s2.0-85212420167 (Scopus ID)
Available from: 2025-03-14 Created: 2025-03-14 Last updated: 2025-03-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5311-4277

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