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  • 1.
    Ahrén-Moonga, Jennie
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Silverwood, Richard
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Association of Higher Parental and Grandparental Education and Higher School Grades With Risk of Hospitalization for Eating Disorders in Females: The Uppsala Birth Cohort Multigenerational Study2009In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 170, no 5, p. 566-575Article in journal (Refereed)
    Abstract [en]

    Eating disorders are a leading cause of disease burden amongyoung women. This study investigated associations of socialcharacteristics of parents and grandparents, sibling position,and school performance with incidence of eating disorders. Theauthors studied Swedish females born in 1952–1989 (n =13,376), third-generation descendants of a cohort born in Uppsalain 1915–1929. Data on grandparental and parental socialcharacteristics, sibling position, school grades, hospitalizations,emigrations, and deaths were obtained by register linkages.Associations with incidence of hospitalization for eating disorderswere studied with multivariable Cox regression, adjusted forage and study period. Overall incidence of hospitalization foreating disorders was 32.0/100,000 person-years. Women with morehighly educated parents and maternal grandparents were at higherrisk (hazard ratio for maternal grandmother with higher educationrelative to elementary education = 6.5, 95% confidence interval:2.2, 19.3, adjusted for parental education). Independent offamily social characteristics, women with the highest schoolgrades had a higher risk of eating disorders (hazard ratio =7.7, 95% confidence interval: 2.5, 24.1 for high compared withlow grades in Swedish, adjusted for parental education). Thus,higher parental and grandparental education and higher schoolgrades may increase risk of hospitalization for eating disordersin female offspring, possibly because of high internal and externaldemands.

  • 2.
    Bellavia, Andrea
    et al.
    Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Bottai, Matteo
    Wolk, Alicja
    Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol.
    Orsini, Nicola
    Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol.
    Sleep Duration and Survival Percentiles Across Categories of Physical Activity2014In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 179, no 4, p. 484-491Article in journal (Refereed)
    Abstract [en]

    The association between long sleep duration and death is not fully understood. Long sleep is associated with low physical activity, which is a strong predictor of death. Our aim was to investigate the association between sleep duration and death across categories of total physical activity in a large prospective cohort of Swedish men and women. We followed a population-based cohort of 70,973 participants (37,846 men and 33,127 women), aged 45-83 years, from January 1998 to December 2012. Sleep duration and physical activity levels were assessed through a questionnaire. We evaluated the association of interest in terms of mortality rates by estimating hazard ratios with Cox regression and in terms of survival by evaluating 15th survival percentile differences with Laplace regression. During 15 years of follow-up, we recorded 14,575 deaths (8,436 men and 6,139 women). We observed a significant interaction between sleep duration and physical activity in predicting death (P < 0.001). Long sleep duration (>8 hours) was associated with increased mortality risk (hazard ratio = 1.24; 95% confidence interval: 1.11, 1.39) and shorter survival (15th percentile difference = -20 months; 95% confidence interval: -30, -11) among only those with low physical activity. The association between long sleep duration and death might be partly explained by comorbidity with low physical activity.

  • 3.
    Carlson, Elwood
    et al.
    Department of Sociology, University of South Carolina, Columbia, SC..
    Hoem, Jan M.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Low-weight Neonatal Survival Paradox in the Czech Republic1999In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 149, no 5, p. 447-453Article in journal (Refereed)
    Abstract [en]

    Analysis of vital statistics for the Czech Republic between 1986 and 1993, including 3,254 infant deaths from350,978 first births to married and single women who conceived at ages 18-29 years, revealed a neonatalsurvival advantage for low-weight infants born to disadvantaged (single, less educated) women, particularly fordeaths from congenital anomalies. This advantage largely disappeared after the neonatal period. The samepatterns have been observed for low-weight infants born to black women in the United States. Since the CzechRepublic had an ethnically homogenous population, virtually universal prenatal care, and uniform institutionalconditions for delivery, Czech results must be attributed to social rather than to biologic or medicalcircumstances. This strengthens the contention that in the United States, the black neonatal survival paradoxmay be due as much to race-related social stigmatization and consequent disadvantage as to any hypothesizedhereditary influences on birth-weight-specific survival. Am J Epidemiol 1999; 149:447-53.

  • 4. De Stavola, B. L.
    et al.
    Leon, D. A.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Intergenerational correlations in size at birth and the contribution of environmental factors: The Uppsala Birth Cohort Multigenerational Study, Sweden, 1915-20022011In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 174, no 1, p. 52-62Article in journal (Refereed)
    Abstract [en]

    Data indicate an inverse association between dietary calcium and magnesium intakes and blood pressure (BP); however, much less is known about associations between urinary calcium and magnesium excretion and BP in general populations. The authors assessed the relation of BP to 24-hour excretion of calcium and magnesium in 2 cross-sectional studies. The International Study of Macro- and Micro-Nutrients and Blood Pressure (INTERMAP) comprised 4,679 persons aged 40–59 years from 17 population samples in China, Japan, the United Kingdom, and the United States, and the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) comprised 10,067 persons aged 20–59 years from 52 samples around the world. Timed 24-hour urine collections, BP measurements, and nutrient data from four 24-hour dietary recalls (INTERMAP) were collected. In multiple linear regression analyses, urinary calcium excretion was directly associated with BP. After adjustment for multiple confounders (including weight, height, alcohol intake, calcium intake, urinary sodium level, and urinary potassium intake), systolic BP was 1.9 mm Hg higher per each 4.1 mmol per 24 hours (2 standard deviations) of higher urinary calcium excretion (associations were smaller for diastolic BP) in INTERMAP. Qualitatively similar associations were observed in INTERSALT analyses. Associations between magnesium excretion and BP were small and nonsignificant for most of the models examined. The present data suggest that altered calcium homoeostasis, as exhibited by increased calcium excretion, is associated with higher BP levels.

  • 5.
    Dekhtyar, Serhiy
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide Liborio
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Università Cattolica del Sacro Cuore, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico “A. Gemelli”, Italy.
    Marengoni, Alessandra
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Brescia, Italy.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Pan, Kuan-Yu
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Calderón-Larrañaga, Amaia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center.
    Association Between Speed of Multimorbidity Accumulation in Old Age and Life Experiences: A Cohort Study2019In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 188, no 9, p. 1627-1636Article in journal (Refereed)
    Abstract [en]

    Rapidly accumulating multiple chronic conditions (multimorbidity) during aging are associated with many adverse outcomes. We explored the association between 4 experiences throughout life-childhood socioeconomic circumstances, early-adulthood education, midlife occupational stress, and late-life social network-and the speed of chronic disease accumulation. We followed 2,589 individuals aged >= 60 years from the Swedish National Study on Aging and Care in Kungsholmen for 9 years (2001-2013). Information on life experiences was collected from detailed life-history interviews. Speed of disease accumulation was operationalized as the change in the count of chronic conditions obtained from clinical examinations, medical histories, laboratory data, drug use, and register linkages over 9 years. Linear mixed models were used to analyze the data. Speed of disease accumulation was lower in individuals with more than elementary education (for secondary, beta x time = -0.065, 95% CI: -0.126, -0.004; for university, beta x time = -0.118, 95% CI: -0.185, -0.050); for active occupations compared with high-strain jobs (beta x time = -0.078, 95% CI: -0.138, -0.017); and for richer social networks (for moderate tertile, beta x time = -0.102, 95% CI: -0.149, -0.055; for highest tertile, beta x time = -0.135, 95% CI: -0.182, -0.088). The association between childhood circumstances and speed of disease accumulation was attenuated by later-life experiences. Diverse experiences throughout life might decelerate chronic disease accumulation during aging.

  • 6. Einiö, Elina
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Risk of Hospitalization for Cancer, Musculoskeletal Disorders, Injuries, or Poisonings Surrounding Widowhood2019In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 188, no 1, p. 110-118Article in journal (Refereed)
    Abstract [en]

    Psychological distress has been indicated to affect the risk of death from cardiovascular disease, cancer, and external causes. Mortality from these major causes of death is also known to be elevated after widowhood when distress is at a heightened level. Surprisingly little is known about changes in health other than mental and cardiac health shortly before widowhood. We used longitudinal data on widowed (n = 19,185) and continuously married (n = 105,939) individuals in Finland (1996-2002) to assess the risk of hospitalization for cancer and for external and musculoskeletal causes surrounding widowhood or random dates. We fitted population-averaged logit models using longitudinal data of older adults aged 65 years or over. The results show that hospitalization for injuries had already increased prior to widowhood and clearly peaked after it. The increases were largely related to falls. A similar increasing pattern of findings was not found around a random date for a group of continuously married individuals. Hospitalizations for cancer and musculoskeletal disorders appeared to be unrelated to the process of widowhood. Hospitalizations for poisonings increased after widowhood. The results imply that the process of widowhood is multifaceted and that various types of health changes should be studied separately and before the actual loss.

  • 7.
    Fransson, Eleonor I.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Heikkilä, Katriina
    Nyberg, Solja T.
    Zins, Marie
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University College London, United Kingdom.
    Westerholm, Peter
    Väänänen, Ari
    Virtanen, Marianna
    Vahtera, Jussi
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Suominen, Sakari
    Singh-Manoux, Archana
    Siegrist, Johannes
    Sabia, Séverine
    Rugulies, Reiner
    Pentti, Jaana
    Oksanen, Tuula
    Nordin, Maria
    Nielsen, Martin L
    Marmot, Michael G
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Madsen, Ida E. H.
    Lunau, Thorsten
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kumari, Meena
    Kouvonen, Anne
    Koskinen, Aki
    Koskenvuo, Markku
    Knutsson, Anders
    Kittel, France
    Jöckel, Karl-Heinz
    Joensuu, Matti
    Houtman, Irene L.
    Hooftman, Wendela E.
    Goldberg, Marcel
    Geuskens, Goedele A.
    Ferrie, Jane E.
    Erbel, Raimund
    Dragano, Nico
    De Bacquer, Dirk
    Clays, Els
    Casini, Annalisa
    Burr, Hermann
    Borritz, Marianne
    Bonenfant, Sébastien
    Bjorner, Jakob B.
    Alfredsson, Lars
    Hamer, Mark
    Batty, G. David
    Kivimäki, Mika
    Job Strain as a Risk Factor for Leisure-Time Physical Inactivity: An Individual-Participant Meta-Analysis of Up to 170,000 Men and Women The IPD-Work Consortium2012In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 176, no 12, p. 1078-1089Article in journal (Refereed)
    Abstract [en]

    Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 1985-1988 to 2006-2008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50% women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 2-9 years. In cross-sectional analyses, the odds for physical inactivity were 26% higher (odds ratio = 1.26, 95% confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21% higher (odds ratio = 1.21, 95% confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21% and 20% higher for those with high-strain (odds ratio = 1.21, 95% confidence interval: 1.11, 1.32) and passive (odds ratio = 1.20, 95% confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.

  • 8. Goisis, Alice
    et al.
    Remes, Hanna
    Barclay, Kieron
    Stockholm University, Faculty of Social Sciences, Department of Sociology. London School of Economics and Political Science, United Kingdom; Max Planck Institute for Demographic Research, Germany.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Myrskylä, Mikko
    Advanced Maternal Age and the Risk of Low Birth Weight and Preterm Delivery: a Within-Family Analysis Using Finnish Population Registers2017In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 186, no 11, p. 1219-1226Article in journal (Refereed)
    Abstract [en]

    Advanced maternal age at birth is considered a major risk factor for birth outcomes. It is unclear to what extent this association is confounded by maternal characteristics. To test whether advanced maternal age at birth independently increases the risk of low birth weight (< 2,500 g) and preterm birth (< 37 weeks' gestation), we compared between-family models (children born to different mothers at different ages) with within-family models (children born to the same mother at different ages). The latter procedure reduces confounding by unobserved parental characteristics that are shared by siblings. We used Finnish population registers, including 124,098 children born during 1987-2000. When compared with maternal ages 25-29 years in between-family models, maternal ages of 35-39 years and a parts per thousand<yen>40 years were associated with percentage increases of 1.1 points (95% confidence intervals: 0.8, 1.4) and 2.2 points (95% confidence intervals: 1.4, 2.9), respectively, in the probability of low birth weight. The associations are similar for the risk of preterm delivery. In within-family models, the relationship between advanced maternal age and low birth weight or preterm birth is statistically and substantively negligible. In Finland, advanced maternal age is not independently associated with the risk of low birth weight or preterm delivery among mothers who have had at least 2 live births.

  • 9.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of London, England.
    Heshmati, Amy
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Malki, Ninoa
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Associations between birth characteristics and eating disorders across the life course: findings from 2 million males and females born in Sweden, 1975–19982014In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 179, no 7, p. 852-863Article in journal (Refereed)
    Abstract [en]

    Birth characteristics predict a range of major physical and mental disorders, but findings regarding eating disorders are inconsistent and inconclusive. This total-population Swedish cohort study identified 2,015,862 individuals born in 1975–1998 and followed them for anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified until the end of 2010. We examined associations with multiple family and birth characteristics and conducted within-family analyses to test for maternal-level confounding. In total, 1,019 males and 15,395 females received an eating disorder diagnosis. Anorexia nervosa was independently predicted by multiple birth (adjusted hazard ratio = 1.33, 95% confidence interval: 1.15, 1.53) for twins or triplets vs. singletons) and lower gestational age (adjusted hazard ratio = 0.96, 95% confidence interval: 0.95, 0.98) per extra week of gestation, with a clear dose-response pattern. Within-family analyses provided no evidence of residual maternal-level confounding. Higher birth weight for gestational age showed a strong, positive dose-response association with bulimia nervosa (adjusted hazard ratio = 1.15, 95% confidence interval: 1.09, 1.22, per each standard-deviation increase), again with no evidence of residual maternal-level confounding. We conclude that some perinatal characteristics may play causal, disease-specific roles in the development of eating disorders, including via perinatal variation within the normal range. Further research into the underlying mechanisms is warranted. Finally, several large population-based studies of anorexia nervosa have been conducted in twins; it is possible that these studies considerably overestimate prevalence.

  • 10. Hulvej Rod, Naja
    et al.
    Vahtera, Jussi
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University College London, United Kingdom.
    Kivimäki, Mika
    Zins, Marie
    Goldberg, Marcel
    Lange, Theis
    Sleep Disturbances and Cause-Specific Mortality: Results From the GAZEL Cohort Study2011In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 173, no 3, p. 300-309Article in journal (Refereed)
    Abstract [en]

    Poor sleep is an increasing problem in modern society, but most previous studies on the association between sleep and mortality rates have addressed only duration, not quality, of sleep. The authors prospectively examined the effects of sleep disturbances on mortality rates and on important risk factors for mortality, such as body mass index, hypertension, and diabetes. A total of 16,989 participants in the GAZEL cohort study were asked validated questions on sleep disturbances in 1990 and were followed up until 2009, with <1% loss to follow-up. Body mass index, hypertension, and diabetes were measured annually through self-reporting. During follow-up, a total of 1,045 men and women died. Sleep disturbances were associated with a higher overall mortality risk in men (P = 0.005) but not in women (P = 0.33). This effect was most pronounced for men <45 years of age (≥3 symptoms vs. none: hazard ratio = 2.03, 95% confidence interval: 1.24, 3.33). There were no clear associations between sleep disturbances and cardiovascular mortality rates, although men and women with sleep disturbances were more likely to develop hypertension and diabetes (P < 0.001). Compared with people with no sleep disturbances, men who reported ≥3 types of sleep disturbance had an almost 5 times' higher risk of committing suicide (hazard ratio = 4.99, 95% confidence interval: 1.59, 15.7). Future strategies to prevent premature deaths may benefit from assessment of sleep disturbances, especially in younger individuals.

  • 11. Jayasekara, Harindra
    et al.
    English, Dallas R.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University of Melbourne, Australia; Turning Point Alcohol & Drug Centre, Australia.
    MacInnis, Robert J.
    Alcohol Consumption Over Time and Risk of Death: A Systematic Review and Meta-Analysis2014In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 179, no 9, p. 1049-1059Article, review/survey (Refereed)
    Abstract [en]

    The results from the few cohort studies that have measured usual alcohol consumption over time have not been summarized. We therefore conducted a systematic review and meta-analysis to quantify mortality risk. Pertinent studies were identified by searching the Medline, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Scopus databases through August 2012 using broad search criteria. Studies reporting relative mortality risks for quantitatively defined categories of alcohol consumption over time were eligible. Nine cohort studies published during 1991-2010 (comprising 62,950 participants and 10,490 deaths) met the inclusion criteria. For men, there was weak evidence of lower mortality risk with low levels of alcohol intake over time but higher mortality risk for those with intakes over 40 g/day compared with abstainers using a random-effects model (P for nonlinearity = 0.02). The pooled relative risks were 0.90 (95% confidence interval: 0.81, 0.99) for 1-29 g/day, 1.19 (95% confidence interval: 0.89, 1.58) for 30-59 g/day, and 1.52 (95% confidence interval: 0.78, 2.98) for 60 or more g/day compared with abstention. There was moderate between-study heterogeneity but no evidence of publication bias. Studies including women were extremely scarce. Our findings include a curvilinear association between drinking over time and mortality risk for men overall and widespread disparity in methods used to capture exposure and report results.

  • 12. Mehta, Neil K.
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Age at Immigration, Generational Status, and Death Among Children of Immigrant Mothers: A Longitudinal Analysis of Siblings2019In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 188, no 7, p. 1237-1244Article in journal (Refereed)
    Abstract [en]

    Studies have documented that age at immigration and generational status are important predictors of socioeconomic outcomes among children of immigrants. Whether these characteristics are related to long-term risk of death is unknown. Leveraging variation within sibships, we evaluated the association of age at immigration and generational status (i.e., first or second generation) with death among children of immigrant mothers to Sweden. Data included 272,429 individuals (126,701 sibships) aged 15 or more years from the total Swedish population followed between 1990 and 2009. Population-average and sibling fixed-effect regressions were estimated, with the latter controlling for unobserved factors shared by siblings. The foreign-born children of immigrants experienced a 17% higher risk of death than the Swedish-born children of immigrants. This excess risk was evident for external and nonexternal causes of death. In general, a graded association was not detected between age at immigration and death among the foreign-born individuals; however, those arriving during primary school ages appeared especially vulnerable. This study provides robust evidence that among children of immigrants, being foreign born was associated with a long-term death penalty compared with being born in the host country.

  • 13. Melchior, Maria
    et al.
    Ferrie, Jane E
    Alexanderson, Kristina
    Goldberg, Marcel
    Kivimaki, Mika
    Singh-Manoux, Archana
    Vahtera, Jussi
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Zins, Marie
    Head, Jenny
    Does sickness absence due to psychiatric disorder predict cause-specific mortality? A 16-year follow-up of the GAZEL occupational cohort study.2010In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 172, no 6, p. 700-7Article in journal (Refereed)
    Abstract [en]

    Mental disorders are a frequent cause of morbidity and sickness absence in working populations; however, the status of psychiatric sickness absence as a predictor of mortality is not established. The authors tested the hypothesis that psychiatric sickness absence predicts mortality from leading medical causes. Data were derived from the French GAZEL cohort study (n = 19,962). Physician-certified sickness absence records were extracted from administrative files (1990-1992) and were linked to mortality data from France's national registry of mortality (1993-2008, mean follow-up: 15.5 years). Analyses were conducted by using Cox regression models. Compared with workers with no sickness absence, those absent due to psychiatric disorder were at increased risk of cause-specific mortality (hazard ratios (HRs) adjusted for age, gender, occupational grade, other sickness absence-suicide: 6.01, 95% confidence interval (CI): 3.07, 11.75; cardiovascular disease: 1.84, 95% CI: 1.10, 3.08; and smoking-related cancer: 1.65, 95% CI: 1.07, 2.53). After full adjustment, the excess risk of suicide remained significant (HR = 5.13, 95% CI: 2.60, 10.13) but failed to reach statistical significance for fatal cardiovascular disease (HR = 1.59, 95% CI: 0.95, 2.66) and smoking-related cancer (HR = 1.31, 95% CI: 0.85, 2.03). Psychiatric sickness absence records could help identify individuals at risk of premature mortality and serve to monitor workers' health.

  • 14.
    Moustgaard, Heta
    et al.
    University of Helsinki, Finland.
    Avendano, Mauricio
    Department of Social and Behavioral Sciences, Harvard, USA.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Parental Unemployment and Offspring Psychotropic Medication Purchases: A Longitudinal Fixed-Effects Analysis of 138,644 Adolescents2018In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 187, no 9, p. 1880-1888Article in journal (Refereed)
    Abstract [en]

    Parental unemployment is associated with worse adolescent mental health, but prior evidence has primarily been based on cross-sectional studies subject to reverse causality and confounding. We assessed the association between parental unemployment and changes in adolescent psychotropic medication purchases, with longitudinal individual-level fixed-effects models that controlled for time-invariant confounding. We used data from a large, register-based panel of Finnish adolescents aged 13-20 years in 1987-2012 (n = 138,644) that included annual measurements of mothers' and fathers' employment and offspring psychotropic medication purchases. We assessed changes in the probability of adolescent psychotropic medication purchases in the years before, during, and after the first episode of parental unemployment. There was no association between mother's unemployment and offspring psychotropic purchases in the fixed-effects models, suggesting this association is largely driven by unmeasured confounding and selection. By contrast, father's unemployment led to a significant 15%-20% increase in the probability of purchasing psychotropic medication among adolescents even after extensive controls for observed and unobserved confounding. This change takes at least 1 year to emerge, but it is long-lasting; thus, policies are needed that mitigate the harm of father's unemployment on offspring's mental well-being.

  • 15.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, Jan
    Kawachi, Ichiro
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Experience of Sibling Death in Childhood and Risk of Death in Adulthood: A National Cohort Study From Sweden2017In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 185, no 12, p. 1247-1254Article in journal (Refereed)
    Abstract [en]

    Although there is some evidence of an association between loss of a sibling in adulthood and subsequentmortality, there have been no previous studies in which investigators have examined whether the death of a sibling in childhood is associated with adult mortality using total population data. Data on a national cohort born in Sweden in 1973-1982 (n = 717,723) were prospectively collected from the Cause of Death Register until 2013 (i.e., from the ages of 18 years to 31-40 years). Cox proportional hazards models were used to analyze the association between sibling loss during childhood and death in young adulthood. After adjustment for sociodemographic confounders and parental psychosocial covariates, the hazard ratio for all-cause mortality in bereaved siblings versus nonbereaved siblings was 1.39 (95% confidence interval: 1.14, 1.69). Risks were more pronounced for those who lost a noninfant sibling (i.e., > 1 year of age) (hazard ratio = 1.53, 95% confidence interval: 1.18, 1.95) and those who lost a sibling in adolescence (i.e., between the ages of 12 and 18 years) (hazard ratio = 1.71, 95% confidence interval: 1.24, 2.35). Excess mortality risk was found for concordant causes of death (i. e., siblings dying from the same causes) but not for discordant causes.

  • 16.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, Jan
    Invited commentary: Birth order and suicide in a broader context2013In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 177, no 7, p. 645-648Article in journal (Refereed)
    Abstract [en]

    In this issue of the Journal, Bjørngaard et al. give us new insights into the etiology of mental health by studying birth order and suicide risk (Am J Epidemiol. 2013;177(7):638–644). Although the authors provided empirical evidence that each increase in birth order (i.e., from first-born to second-born, second-born to third-born, etc.) is associated with a 46% higher suicide risk, they gave us very little information on the likely explanations. In our commentary, we draw attention to the possible mechanisms underlying a causal relationship between birth order and suicide. Given that Norway is one of the richest countries in the world, the findings of Bjørngaard et al. in a Norwegian cohort also call for a discussion of whether their results are representative of other societies that are similar or dissimilar with respect to economic institutions, social conditions, and political environment. We suggest that there are several plausible mechanisms to explain higher suicide rates among later-born children, but other mechanisms might also operate in the opposite direction, that is, have beneficial outcomes among later-born children. Specifically, there are reasons to expect a different relationship between birth order and psychiatric outcomes in poorer societal contexts.

  • 17.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, Jan
    Kawachi, Ichiro
    Birth Order and Suicide in Adulthood: Evidence From Swedish Population Data2014In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 179, no 12, p. 1450-1457Article in journal (Refereed)
    Abstract [en]

    Each year, almost 1 million people die from suicide, which is among the leading causes of death in young people. We studied how birth order was associated with suicide and other main causes of death. A follow-up study based on the Swedish population register was conducted for sibling groups born from 1932 to 1980 who were observed during the period 1981-2002. Focus was on the within-family variation in suicide risk, meaning that we studied sibling groups that consisted of 2 or more children in which at least 1 died from suicide. These family-fixed effects analyses revealed that each increase in birth order was related to an 18% higher suicide risk (95% confidence interval (CI): 1.14, 1.23, P = 0.000). The association was slightly lower among sibling groups born in 1932-1955 (hazard ratio = 1.13, 95% CI: 1.06, 1.21, P = 0.000) than among those born in 1967-1980 (hazard ratio = 1.24, 95% CI: 0.97, 1.57, P = 0.080). Further analyses suggested that the association between birth order and suicide was only modestly influenced by sex, birth spacing, size of the sibling group, own socioeconomic position, own marital status, and socioeconomic rank within the sibling group. Causes of death other than suicide and other external causes were not associated with birth order.

  • 18.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, Jan
    Kawachi, Ichiro
    The Forgotten Griever: A Nationwide Follow-up Study of Mortality Subsequent to the Death of a Sibling2012In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 176, no 4, p. 338-346Article in journal (Refereed)
    Abstract [en]

    Previous findings have suggested that the loss of a family member is associated with mortality among bereaved family members. The least-studied familial relationship in the bereavement literature is that of siblings, although loss of a sibling may also involve health consequences. The authors conducted a follow-up study based on data from the Swedish total population register, covering the period 1981–2002. Using Cox regression, mortality risk ratios for bereaved and nonbereaved persons aged 18–69 years were estimated. All-cause mortality and cause-specific mortality (unnatural causes, natural causes, cardiovascular disease, cancer, suicide, accidents, and all other causes) were examined. In men, the mortality risk for bereaved persons versus nonbereaved persons was 1.26 (95% confidence interval: 1.22, 1.30), and in women it was 1.33 (95% confidence interval: 1.28, 1.39). An elevated mortality risk associated with a sibling's death was found in all age groups studied, but the association was generally stronger at younger ages and could be observed predominantly after more than 1 year of follow-up. There was also an increased mortality risk if the sibling had died from a discordant main cause, which may strengthen the possibility that the association observed is not due to confounding alone.

  • 19. Törner, Anna
    et al.
    Dickman, Paul
    Duberg, Ann-Sofi
    Kristinsson, Sigurdur
    Landgren, Ola
    Björkholm, Magnus
    Svensson, Åke
    Stockholm University, Faculty of Science, Department of Mathematics.
    A method to visualize and adjust for selection bias in prevalent cohort studies2011In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 174, no 8, p. 969-76Article in journal (Refereed)
    Abstract [en]

    Selection bias and confounding are concerns in cohort studies where the reason for inclusion of subjects in the cohort may be related to the outcome of interest. Selection bias in prevalent cohorts is often corrected by excluding observation time and events during the first time period after inclusion in the cohort. This time period must be chosen carefully-long enough to minimize selection bias but not too long so as to unnecessarily discard observation time and events. A novel method visualizing and estimating selection bias is described and exemplified by using 2 real cohort study examples: a study of hepatitis C virus infection and a study of monoclonal gammopathy of undetermined significance. The method is based on modeling the hazard for the outcome of interest as a function of time since inclusion in the cohort. The events studied were "hospitalizations for kidney-related disease" in the hepatitis C virus cohort and "death" in the monoclonal gammopathy of undetermined significance cohort. Both cohorts show signs of considerable selection bias as evidenced by increased hazard in the time period after inclusion in the cohort. The method was very useful in visualizing selection bias and in determining the initial time period to be excluded from the analyses.

  • 20. Törner, Anna
    et al.
    Duberg, Ann-Sofi
    Dickman, Paul
    Svensson, Åke
    Stockholm University, Faculty of Science, Department of Mathematics.
    A proposed method to adjust for selection bias in cohort studies2010In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 171, no 5, p. 602-608Article in journal (Refereed)
    Abstract [en]

    Selection bias is a concern in cohort studies in which selection into the cohort is related to the studied outcome. An example is chronic infection with hepatitis C virus, where the initial infection may be asymptomatic for decades. This problem leads to selection of more severely ill individuals into registers of such infections. Cohort studies often adjust for this bias by introducing a time window between entry into the cohort and entry into the study. This paper describes and assesses a novel method to improve adjustment for this type of selection bias. The size of the time window is decided by calculating a standardized incidence ratio as a continuous function of the size of the time window. The resulting graph is used to decide on an appropriate window size. The method is evaluated by using the Swedish register of hepatitis C virus infections for 1990-2006. The complications studied were non-Hodgkin lymphoma and liver cancer. Selection bias differed for the studied outcomes, and a time window of a minimum of 2 months and 12 months, respectively, was judged to be appropriate. The novel method may have advantages compared with an interval-based method, especially in cohort studies with small numbers of events.

  • 21.
    Welmer, Anna-Karin
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska University Hospital, Sweden; Stockholm Gerontology Research Center, Sweden.
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Calderón-Larrañaga, Amaia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Aragon Institute for Health Research, Spain; Institute of Health Carlos III, Spain.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Sex Differences in the Association Between Pain and Injurious Falls in Older Adults: A Population-Based Longitudinal Study2017In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 186, no 9, p. 1049-1056Article in journal (Refereed)
    Abstract [en]

    We investigated whether there are sex differences in the association between pain and incident injurious falls. A total of 2,934 people (ages >= 60 years) from the population-based Swedish National Study on Aging and Care in Kungsholmen (2001-2004) participated. Participants were followed up for 3 and 10 years for falls leading to hospitalization or outpatient care. Data were analyzed with flexible parametric survival models that adjusted for potential confounders. During the first 3 years of follow-up, 67 men and 194 women experienced an injurious fall, and over 10 years of follow up, 203 men and 548 women experienced such a fall. In men, the presence of pain, having pain that was at least mild, having pain that affected several daily activities, and having daily pain all significantly increased the likelihood of incurring an injurious fall during the 3-year follow-up period. The multivariate-adjusted hazard ratios ranged from 1.78 (95% confidence interval: 1.00, 3.15) for the presence of pain to 2.89 (95% confidence interval: 1.41, 5.93) for several daily activities' being affected by pain. Results for the 10-year follow-up period were similar. No significant associations were detected in women. Although pain is less prevalent in men than in women, its impact on risk of injurious falls seems to be greater in men.

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