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  • 1.
    Ahrén-Moonga, Jennie
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mothers’ social background and risk of eating disorders in daughters [abstract]2008In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, no suppl. 1, p. 111-112Article in journal (Refereed)
  • 2.
    Almquist B., Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Högnäs, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Only the lonely? All-cause mortality among children without siblings and children without friends2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background: In childhood, relations with siblings and friends lie at the core of social interaction. Lacking either type of relationship may reflect lower levels of social support. While social support is known to be negatively associated with premature death, there are still no long-term follow-ups of mortality risks among children without siblings (‘only-children’) and children without friends (‘lonely-children’). The aim of the present study was therefore to examine and compare all-cause mortality in these two groups.

    Methods: Cox regression analysis was based on a Stockholm cohort born in 1953 (n = 15,117). Individuals were identified as only-children if there were no records of siblings before age 18. Derived from sociometric data collected at age 13, lonely-children were defined as not being nominated by classmates as one of three best friends. The follow-up of all-cause mortality covered ages 20-56.

    Results: Both only-children and lonely-children had increased risks of premature mortality. When adjusted for a wide range of family-related and individual factors, the risk ratio for only-children increased in strength whereas the risk ratio for lonely-children was reduced. The former finding may be explained by suppressor effects: for example, both only-children and those whose parents had alcohol problems had higher mortality risks but only-children were less likely to have parents with alcohol problems. The latter finding was primarily due to adjustment for scholastic ability.

    Conclusions: It is concluded that while only-children and lonely-children have similar risks of all-cause mortality, the processes leading up to premature death appear to be rather different. Yet, interventions targeted at improving social learning experiences may be beneficial for both groups.

    Key messages:

    • Only-children have higher risks of premature mortality but the mechanisms remain unclear.

    • Lonely-children are at risk of premature mortality primarily due to poorer scholastic ability.

  • 3.
    Almquist B., Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Landstedt, Evelina
    Hammarström, Anne
    Associations between social support and depressive symptoms: social causation or social selection – or both?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 84-89Article in journal (Refereed)
    Abstract [en]

    Background: Numerous studies have demonstrated an association between social support and health, almost regardless of how social support and health have been conceptualised or measured. Even so, the issue of causality has not yet been sufficiently addressed. This issue is particularly challenging for mental health problems such as depressive symptoms. The aim of the present study is to longitudinally assess structural and functional aspects of social support in relation to depressive symptoms in men and women, through a series of competing causal models that, in contrast to many other statistical methods, allow for bi-directional effects. Methods: Questionnaire data from the Northern Swedish Cohort (n = 1001) were utilised for the years 1995 (age 30) and 2007 (age 42). Associations were analysed by means of gender-specific structural equation modelling, with structural and functional support modelled separately. Results: Both structural and functional support were associated with depressive symptoms at ages 30 and 42, for men and women alike. A higher level of support, particularly functional support, was associated with a decrease in depressive symptoms over time among men. Among women, there were bi-directional effects of social support and depressive symptoms over time. Conclusion: Concerning social support and health, the social causation hypothesis seems relevant for men whereas, for women, the associations appear to be more complex. We conclude that preventive and health promoting work may need to consider that the presence of depressive symptoms in itself impedes on women’s capability to increase their levels of social support.

  • 4.
    Almquist, Ylva B
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Landstedt, E.
    Jackisch, Josephine
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hammarström, A.
    Growing through asphalt: What counteracts the long-term negative health impact of youth adversity?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Adversity in the family of origin tends to translate into poor health development. Yet, the fact that this is not the always the case has been seen an indicator of resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status.

    Methods

    The study was based on the Northern Swedish Cohort born in 1965 (n = 1,001). Measures of social and material adversity, health, and protective factors related to school, peers, and spare time, were derived from questionnaires distributed to the cohort members and their teachers at age 16. Self-rated health was measured at age 43. The main associations were examined by means of ordinal regression analysis, with the role of the protective factors being assessed through interaction analysis.

    Results

    Social and material adversity in youth was associated with poorer self-rated health in midlife among males and females alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time – particularly in terms of being seen as having good educational and work prospects, as well as a high-quality spare time – appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health.

    Conclusions

    There are several factors outside the context of the family that seemingly have the potential to buffer against the negative health consequences stemming from having experienced a disadvantaged upbringing. Initiatives targeted at increasing academic motivation and commitment as well as social capital and relationships in youth, may here be of particular relevance.

    Key messages:

    • While the experience of disadvantageous living conditions in adolescence tends to translate into poor health development across the life course, this is not always the case.

    • Advantages related to school, peers, and spare time have the potential of counteracting the negative health impact of an adverse family context.

  • 5.
    Almquist, Ylva M.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Childhood friendships and adult health: Findings from the Aberdeen Children of the 1950s Cohort study2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no 3, p. 378-383Article in journal (Refereed)
    Abstract [en]

    Social relations are known to influence morbidity and mortality but few have studied this association from a life-course perspective specifically targeting the importance of social relations in childhood for adult health. In childhood, a key aspect of children’s relationships is the number of friendships a child has in the school class, i.e. friendship quantity. The overall aim of this study was to examine the association between childhood friendships and adult self-rated health. Data from a longitudinal study of children born in Aberdeen, Scotland, between 1950 and 1956 was used. Information on friendship quantity (1964) was derived from sociometric nominations among classmates and defined as mutual choices. The health outcome was based on self-ratings derived from a questionnaire in 2001-2003. The study included various childhood and adult circumstances as possible explanatory factors. The analysis was based on ordinal logistic regression, producing odds ratios (n=5,814). The results demonstrated a gradient in women’s self-rated health according to the number of friendships in the school class. A number of circumstances in childhood and adulthood were partial explanations. For men, only those without friends reported poorer self-rated health in adulthood. This finding was explained by adult socioeconomic status. It is concluded that childhood friendships are linked to health disparities in middle age, underlining the importance of such relationships and the need for a life-course perspective on health that integrates a variety of mechanisms as they interact across life.

  • 6. Benson, Rebecca
    et al.
    Glaser, Karen
    Corna, Laurie M
    Platts, Loretta G
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Di Gessa, Giorgio
    Worts, Diana
    Price, Debora
    McDonough, Peggy
    Sacker, Amanda
    Do work and family care histories predict health in older women?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 6, p. 1010-1015Article in journal (Refereed)
    Abstract [en]

    Background: Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health.

    Methods: We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours.

    Results: Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories.

    Conclusion: Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

  • 7. Björkenstam, Emma
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Adverse childhood experiences and disability pension in early midlife: results from a Swedish National Cohort Study2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 3, p. 472-477Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have examined the association between adverse childhood experiences (ACEs) and disability pension (DP). The current study aimed to investigate the relationship between different ACEs, cumulative ACEs, and DP, and the mediating role of school performance. Methods: We used a Swedish cohort of 522 880 individuals born between 1973 and 1978. ACEs included parental death, parental substance abuse and psychiatric disorder, substantial parental criminality, household public assistance, parental DP and child welfare intervention. Estimates of risk of DP in 2008 were calculated as odds ratios (OR) with 95% confidence intervals (CIs). Results: A total of 2.3% (3.0% females, 1.7% males) received DP in 2008. All studied ACEs increased the odds for DP, particularly child welfare intervention and household public assistance. Cumulative ACEs increased the odds of DP in a graded manner. Females exposed to 4+ ACEs had a 4-fold odds (OR: 4.0, 95% CI 3.5-4.5) and males a 7-fold odds (OR: 7.1, 95% CI: 6.2-8.1). School performance mediated the ACEs-DP association. Conclusion: This study provides evidence that ACEs is associated with increased odds of DP, particularly when accumulated. The effects of ACEs should be taken into account when considering the determinants of DP, and when identifying high-risk populations.

  • 8.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Psychological complaints in adolescence: do they track into young adulthood?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Psychological complaints, such as feeling sad or nervous, are common among adolescents, especially girls. The prevalence also appears to have risen during the last decades in Sweden, in particular among girls. Yet, knowledge about whether there are long-term associations with adverse health outcomes later in life is scarce. The aim of the current study is to assess to what extent psychological complaints in adolescence track into young adulthood, and whether there are gender differences.

    Methods

    The data used were derived from the Swedish Young-LNU, which is a prospective study based on a nationally representative sample with survey information from adolescents aged 10-18 years in 2000 and from the same individuals at ages 20-28 years in 2010 (n = 792). Information on household characteristics at baseline was provided by parents. Psychological complaints in adolescence were measured by self-reported items on feeling sad and down, tense and nervous, and grouchy and irritated. Psychological complaints in young adulthood were measured by self-reported items on anxiety and depression. The statistical method used was binary logistic regression.

    Results

    Psychological complaints in adolescence were associated with an excess risk of psychological complaints in young adulthood (OR = 2.08, p = 0.003) also when adjusting for sex, age group, and family structure and household social class at baseline. Gender-separate analyses revealed that the association was statistically significant for females (OR = 2.22, p = 0.007) but not for males (OR = 1.83, p = 0.148).

    Conclusions

    For females, psychological complaints in adolescence predicted psychological complaints in young adulthood. This underlines the importance that adolescents who suffer from this type of health problems should be identified and provided support, for instance through the school health services.

  • 9.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Bo, Vinnerljung
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Child welfare clients have higher risks for teenage childbirths: which are the major confounders?2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 4, p. 592-597Article in journal (Refereed)
    Abstract [en]

    Background: Aiming to support effective social intervention strategies targeting high-risk groups for teenage motherhood, this study examined to what extent the elevated crude risks of teenage childbirth among child welfare groups were attributable to the uneven distribution of adverse individual and family background factors. Methods: Comprehensive longitudinal register data for more than 700 000 Swedish females born 1973–1989 (including around 29 000 child welfare clients) were analysed by means of binary logistic regression. The Karlson/Holm/Breen-method was used to decompose each confounding factor’s relative contribution to the difference between crude and adjusted odds ratios (ORs). Results: Elevated crude risks for teenage childbirth are to a large extent attributable to selection on observables. Girls’ school failure was the most potent confounder, accounting for 28–35% of the difference between crude and adjusted ORs. Conclusion: As in majority populations, girls’ school failure was a strong risk factor for teenage childbirth among former child welfare children. At least among pre-adolescents, promoting school performance among children in the child welfare system seems to be a viable intervention path.

  • 10.
    Burström, Bo
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Öberg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Smedman, Lars
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Policy measures and the survival of foster infants in Stockholm 1878-19252012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no 1, p. 56-60Article in journal (Refereed)
    Abstract [en]

    Background: At the end of the 19th century, infant mortality was high in urban and rural areas in Sweden. In Stockholm, the mortality rate was particularly high among foster children. This study addresses the importance for health of targeted public policies and their local implementation in the reduction of excess mortality among foster children in Stockholm at the turn of the 19th century. In response to public concern, a law was passed in 1902 on inspections of foster homes. Stockholm city employed a handful of inspectors who visited foster homes and advised parents on child care and feeding. Methods: Analysis of historical records from the City of Stockholm was combined with epidemiological analysis of mortality rates and hazard ratios on individual-level data for 112 746 children aged < 1 year residing in one part of Stockholm between 1878 and 1925. Hazard ratios of mortality were calculated using Cox' regression analysis. Results: Mortality rates of foster infants exceeded 300/1000 before 1903. Ten years later the mortality rates among foster children had declined and were similar to other children born in and out of wedlock. Historical accounts and epidemiological analysis of individual-level data over a longer time period showed similar results. Conclusions: Targeted policy measures to foster children may have potentiated the positive health effects of other universal policies, such as improved living conditions, clean water and sanitation for the whole population in the city, contributing to an equalization of mortality rates between different groups.

  • 11.
    Dunlavy, Andrea
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Migration background characteristics and the association between unemployment and suicide2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Persons of foreign-origin have higher rates of unemployment compared to those of native-origin, yet few studies have assessed relationships between unemployment and mental health in persons of foreign-origin relative to the native-origin. This study aims to examine the extent to which generational status, region of origin, age at arrival, and duration of residence modify the relationship between employment status and suicide risk.

    Methods

    Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993-2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models.

    Results

    Elevated hazard ratios for suicide were observed among the majority of foreign-origin persons exposed to unemployment. Second generation Swedish men exposed to unemployment demonstrated significantly greater (p < 0.05) excess risk of suicide (HR = 3.63, 95% CI: 2.90-4.54) than that observed among native-origin Swedish men exposed to unemployment (HR = 1.67, 95% CI: 1.29-2.16). In unemployed foreign-born men, younger age at arrival and longer duration of residence were associated with increased risk of suicide, whereas unemployed foreign-born men who arrived as adults and had a shorter duration of residence did not demonstrate excess suicide risk.

    Conclusions

    Analyses indicated that the majority of the foreign-origin exposed to unemployment demonstrated excess risk of suicide that was of a similar magnitude to that observed among their native-origin counterparts. Yet there were notable differences in patterns of association by generational status, region of origin, age at arrival, and duration of residence. The high excess risk observed in unemployed second generation men suggests that ensuring employment among this group may be of particular public health importance.

  • 12. Ekeus, Cecilia
    et al.
    Cnattingius, Sven
    Essen, Birgitta
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Stillbirth among foreign-born women in Sweden2011In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 21, no 6, p. 788-792Article in journal (Refereed)
    Abstract [en]

    Background:

    The aims of this study were: (i) to investigate stillbirth risk in offspring to foreign-born

    women by region of birth; (ii) if disparities in risks can be explained by socio-economic factors,

    pregnancy complications or maternal morbidity; and (iii) if the risk varies by time since immigration.

    Methods:

    This was a population-based register study with data from the Swedish Medical Birth Register

    and socio-economic variables from national income and population registers. We studied single births

    from 1992 to 2005, and included 219 832 births to foreign-born women and 1 094 146 births to

    Swedish-born women. Logistic regression analysis was used to calculate odds ratios (ORs), using 95%

    confidence intervals (CIs).

    Results:

    In all, 4104 antepartal and 255 intrapartal stillbirths occurred.

    Compared with births to Swedish women, the OR of stillbirth was 2.27 (95% CI 1.84–2.80) for births

    to women from Africa and 1.41 (95% CI 1.22–1.64) for births to women from Middle East, after

    adjustment for confounding factors. The risk of stillbirth was higher in immigrants who had been in

    Sweden for a short time period (<5 years) compared with those who had been in Sweden for a longer

    period, OR 1.21 (95% CI 1.05–1.40).

    Conclusions:

    The risk of stillbirth in immigrant women varies

    by region of birth and time since immigration, being highest in women from Africa and the Middle

    East, and the recently settled. Further studies are needed to identify the mechanisms behind

    these patterns.

     

  • 13.
    Engdahl, Barbro
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Is the population level link between drinking and harm similar for women and men?: a time series analysis with focus on gender-specific drinking and alcohol-related hospitalizations in Sweden2011In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 21, no 4, p. 432-437Article in journal (Refereed)
    Abstract [en]

    Background: A question that has not been addressed in the literature is whether the population level association between alcohol and harm differs between men and women. The main aim of this article is to fill this gap by analysing recently collected time series data of male and female self-reported drinking in relation to gender-specific harm indicators in Sweden. Methods: Male and female per capita and risk consumption was estimated on the basis of self-reported data from monthly alcohol surveys for the period 2002-07. Overall per capita consumption including recorded sales and estimates of unrecorded consumption were also collected for the same period. Alcohol-related hospitalizations were used as indicators of alcohol-related harm. Data were aggregated into quarterly observations and analysed by means of time series analyses (ARIMA-modelling). Results: Overall per capita consumption was significantly related to both male and female alcohol-related hospitalizations. Male per capita consumption and risk consumption were also significantly related to alcohol-related hospitalizations among men. Female per capita consumption and risk consumption had also a positive association with alcohol-related hospitalizations but statistical significance was only reached for alcohol poisonings where the association was even stronger than for men. Conclusions: Changes in alcohol consumption in Sweden was associated with changes in male and female alcohol-related hospitalizations also in analyses based on gender-specific consumption measures. There was no clear evidence that the population level association between alcohol and harm differed between men and women.

  • 14. Floderus, Birgitta
    et al.
    Hagman, Maud
    Aronsson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Marklund, Staffan
    Wikman, Anders
    Medically certified sickness absence with insurance benefits in women with and without children2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no 1, p. 85-92Article in journal (Refereed)
    Abstract [en]

    Background: Sickness absence in Sweden is high, particularly in young women and the reasons are unclear. Many Swedish women combine parenthood and work and are facing demands that may contribute to impaired health and well-being. We compared mothers and women without children under different conditions, assuming increased sickness absence in mothers, due to time-based stress and psychological strain. Methods: All women born in 1960-79 (1.2 million) were followed from 1993 to 2003. Information on children in the home for each year was related to medically certified sickness absence with insurance benefits the year after. We used age and time-stratified proportional hazard regression models accounting for the individual's changes on study variables over time. Data were retrieved from national administrative registers. Results: Sickness absence was higher in mothers than in women without children, the relative risks decreased by age, with no effect after the age of 35 years. An effect appeared in lonely women irrespective of age, while in cohabiting women only for the ages 20-25 years. Mothers showed increased sickness absence in all subgroups of country of birth, education, income, sector of employment and place of residence. The relation between number of children and sickness absence was nonlinear, with the highest relative risks for mothers of one child. The upward trend of sickness absence at the end of 1990s was steeper for mothers compared to women without children. Conclusion: Despite the well-developed social security system and child care services in Sweden, parenthood predicts increased sickness absence, particularly in young and in lone women.

  • 15.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Health inequalities among older adults in Sweden 1991–20022008In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, no 2, p. 138-143Article in journal (Refereed)
    Abstract [en]

    Current research has shown a decline in health amongolder adults in Sweden. This study examines health inequalitiesamong older adults in Sweden in 1991–1992 and 2000–2002and explores the development of these inequalities during thisperiod.

    Methods: A data set was constructed out of four levelsof living surveys, comprising 4085 individuals aged 55 and above.Multivariate logistic regressions were used to assess the associationbetween social class, sex, age and four different domains ofself-reported health: global self-rated health, impaired mobility,musculoskeletal pain and psychological distress. Adjustmentswere made for period of interview. Interaction terms were alsoused to assess change over time. Levin's attributable risk wasused to assess the magnitude of the health inequalities.

    Results:The results indicate an increase in reports of all specifichealth problems, but not in the global health measure duringthe period. Significant sex differences and a clear social gradientin health were discernible during both periods. Women were morelikely than men to report problems with impaired mobility, painand psychological distress. Manual workers were significantlymore likely than non-manuals to report problems in all fourdomains of health. However, both the sex differences and thesocial gradient seemed to remain constant during the period.

    Conclusion: Although it seems there are significant differencesin health depending on sex and social class among older adultsin Sweden, these inequalities appear to be unaffected by thegeneral increase in ill health that has been observed in thesegroups over the last decade.

  • 16.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Heshmati, Amy Frances
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Malki, N
    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 Swedish males and females born 1975-19982013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no Supplement 1, p. 108-109Article in journal (Refereed)
  • 17.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, United Kingdom.
    Heshmati, Amy
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Family history of education predicts eating disorders across multiple generations: a study of one million Swedish females born 1973-19982013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, p. 108-108Article in journal (Other academic)
  • 18.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rajmil, Luis
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berlin, Marie
    Stockholm University, Faculty of Social Sciences, Department of Sociology. National Board of Health and Welfare .
    Gustafsson, Per A.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Migrant density and well-being - A national school survey of 15-year-olds in Sweden2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 5, p. 823-828Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to investigate the impact of migrant density in school on the well-being of pupils with a migrant origin in first as well as second generation. Methods: Cross-sectional analysis of data from a national classroom survey of 15-year-old Swedish schoolchildren. The study population included 76 229 pupils (86.5% participation) with complete data set from 1352 schools. Six dimensions of well-being from the KIDSCREEN were analysed in two-level linear regression models to assess the influence of migrant origin at individual level and percentage of students with a migrant origin at school level, as well as interaction terms between them. Z-scores were used to equalize scales. Results: A high density (>50%) of pupils with a migrant origin in first or second generation was associated with positive well-being on all six scales for foreign-born pupils originating in Africa or Asia compared with schools with low (<10%) migrant density. The effect sizes were 0.56 for boys and 0.29 for girls on the comprehensive KIDSCREEN 10-index (P<0.001) and 0.61 and 0.34, respectively, for psychological well-being (P<0.001). Of the boys and girls born in Africa or Asia, 31.6% and 34.6%, respectively, reported being bullied during the past week in schools with low (<10%) migrant density. Conclusions: Pupils born in Africa or Asia are at high risk for being bullied and having impaired well-being in schools with few other migrant children. School interventions to improve peer relations and prevent bullying are needed to promote well-being in non-European migrant children.                 

  • 19. Holowko, N.
    et al.
    Mishra, G.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social differences in pre-pregnancy body mass index (BMI) and gestational weight gain: an opportunity to reduce long-lasting inequality in maternal and offspring health2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no suppl 2, p. 43-43Article in journal (Refereed)
  • 20. Jansson, B.
    et al.
    Stenbacka, M.
    Leifman, A.
    Romelsjö, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    A small fraction of patients with repetitive injuries account for a large proportion of medical costs2004In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 14, no 2, p. 161-167Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The phenomenon of repetitive injuries has been judged to be of limited importance in the public health context. A study was therefore initiated in order to analyse all types of single and repetitive injuries using a longitudinal approach.

    METHODS:

    Hospital care, medical costs and risk factors were examined for single and repetitive severe injuries. A cross-sectional survey with a 12-year follow-up was performed. Questionnaire information from a survey of a random sample of the adult population 20-89 years old in 1984 in Stockholm County were linked to the Swedish national inpatient and cause-of-death register up to 1996, inclusive.

    RESULTS:

    During the study period 13% of males and 15% of females were hospitalized or deceased as a result of injuries. Persons with three or more injuries comprise 19% of the injuries, but account for 63% of the total number of days of hospital care and medical costs. Injuries related to falls were most common among patients requiring hospital care. Factors such as high age, living alone, stroke earlier, and use of hypnotics and sedatives were especially associated with repetitive injuries. The risk factors for single and repetitive injuries covariate, but the size of the risk is overrepresented for stroke, drugs, self-reported injuries and living alone for two or more injuries.

    CONCLUSION:

    These results indicate that subjects with repetitive injuries, and with the observed risk factors for such injuries, should be given extra attention, both in policy and prevention, but also in integrated treatment programmes.

  • 21.
    Khanolkar, Amal
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Byberg, Liisa
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Parental influences on cardiovascular risk factors in Swedish children aged 5–14 years2011In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360XArticle in journal (Refereed)
    Abstract [en]

    Background: Precursors of cardiovascular diseases (CVD) originate in childhood. We investigated relationships of children's CVD risk factors with parent's socio-economic position (SEP) and lifestyle and how CVD risk factors correlate within families. Methods: We studied 602 families with 2141 individuals comprising two full sibs; aged 5–14 years, and their biological parents (Uppsala Family Study). Parental SEP (occupational class and education) and lifestyle habits [smoking, physical activity (PA), alcohol consumption] were taken from questionnaires. Associations with cholesterol, ApoB/ApoA1, leptin, adiponectin, blood pressure, body mass index (BMI) and overweight/obesity (OW/OB) were analysed by linear/logistic regression. Results were adjusted for child's age, gender, pubertal stage and family clustering. Results: We observed no consistent associations between parental SEP and children's CVD risk factors. Parental lifestyle had stronger effects, independent of parental SEP. Children of smoking fathers had higher BMI (4%, 95% CI 1–7%) and leptin levels (27%, 95% CI 1.00–61.60%). Children of mothers reporting vigorous PA had lower BMI, cholesterol and decreased odds for OW/OB with a possible dose effect. Compared with mothers reporting no vigorous activity, mothers with ≤75 min and 76–150 min/week of vigorous activity had 43% (OR 0.57, 95% CI 0.22–0.89) and 72% (OR 0.28, 95% CI 0.14–0.60) lower risk of having an OW/OB child, respectively, after adjustment for confounders. Independent, consistently stronger and significant associations were found between all studied parents’ and children's CVD risk factors. Conclusion: Parental behaviours: smoking, alcohol consumption, low PA are associated with higher levels of CVD risk factors (BMI, OW/OB, cholesterol) in children. Strong correlations in CVD risk factors within families not related to parental SEP/lifestyle suggest a role of genetics in influencing children's CVD risk factors. Public health policies should target families with unhealthy lifestyles.

  • 22. Kilpi, Fanny
    et al.
    Silventoinen, Karri
    Konttinen, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Disentangling the relative importance of different socioeconomic resources for myocardial infarction incidence and survival: a longitudinal study of over 300 000 Finnish adults2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 2, p. 260-266Article in journal (Refereed)
    Abstract [en]

    Background: Lower socioeconomic position (SEP) is associated with an increased risk of myocardial infarction (MI) incidence and mortality, but the relative importance of different socioeconomic resources at different stages of the disease remains unclear. Methods: A nationally representative register-based sample of 40- to 60-year-old Finnish men and women in 1995 (n = 302 885) were followed up for MI incidence and mortality in 1996-2007. We compared the effects of education, occupation, income and wealth on first MI incidence, first-day and long-term fatality. Cox's proportional hazards regression and logistic regression models were estimated adjusting for SEP covariates simultaneously to assess independent effects. Results: Fully adjusted models showed greatest relative inequalities of MI incidence by wealth in both sexes, with an increased risk also associated with manual occupations. Education was a significant predictor of incidence in men. Low income was associated with a greater risk of death on the day of MI incidence [odds ratio (OR) = 1.40 in men and 1.95 in women when comparing lowest and highest income quintiles], and in men, with long-term fatality [hazard ratio (HR) = 1.74]. Wealth contributed to inequalities in first-day fatality in men and in long-term fatality in both sexes. Conclusion: The results show that different socioeconomic resources have diverse effects on the disease process and add new evidence on the significant association of wealth with heart disease onset and fatality. Targeting those with the least resources could improve survival in MI patients and help reduce social inequalities in coronary heart disease mortality.

  • 23.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Smith KE, Hill S and Bambra C (eds.). Health inequalities, critical perspectives2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 2, p. 363-363Article, book review (Other academic)
  • 24. Kulhánová, Ivana
    et al.
    Menvielle, Gwenn
    Hoffmann, Rasmus
    Eikemo, Terje A.
    Kulik, Margarete C.
    Toch-Marquardt, Marlen
    Deboosere, Patrick
    Leinsalu, Mall
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Regidor, Enrique
    Looman, Caspar W. N.
    Mackenbach, Johan P.
    The role of three lifestyle risk factors in reducing educational differences in ischaemic heart disease mortality in Europe2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 6, p. 1081-1088Article in journal (Refereed)
    Abstract [en]

    Background: Ischaemic heart disease (IHD) is one of the leading causes of death worldwide with a higher risk of dying among people with a lower socioeconomic status. We investigated the potential for reducing educational differences in IHD mortality in 21 European populations based on two counterfactual scenarios—the upward levelling scenario and the more realistic best practice country scenario. Methods: We used a method based on the population attributable fraction to estimate the impact of a modified educational distribution of smoking, overweight/obesity, and physical inactivity on educational inequalities in IHD mortality among people aged 30–79. Risk factor prevalence was collected around the year 2000 and mortality data covered the early 2000s. Results: The potential reduction of educational inequalities in IHD mortality differed by country, sex, risk factor and scenario. Smoking was the most important risk factor among men in Nordic and eastern European populations, whereas overweight and obesity was the most important risk factor among women in the South of Europe. The effect of physical inactivity on the reduction of inequalities in IHD mortality was smaller compared with smoking and overweight/obesity. Although the reduction in inequalities in IHD mortality may seem modest, substantial reduction in IHD mortality among the least educated can be achieved under the scenarios investigated. Conclusion: Population wide strategies to reduce the prevalence of risk factors such as smoking, and overweight/obesity targeted at the lower socioeconomic groups are likely to substantially contribute to the reduction of IHD mortality and inequalities in IHD mortality in Europe.

  • 25. Lahelma, E.
    et al.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Health inequalities in European welfare states2009In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 19, no 5, p. 445-446Article in journal (Refereed)
  • 26.
    Leineweber, Constanze
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Baltzer, Maria
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Work-family conflict and health in Swedish working women and men: a 2-year prospective analysis (the SLOSH study)2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 4, p. 710-716Article in journal (Refereed)
    Abstract [en]

    Background: Research has suggested that gender is related to perceptions of work-family conflict (WFC) and an underlying assumption is that interference of paid work with family life will burden women more than men. There is, however, mixed evidence as to whether men and women report different levels of WFC. Even less studies investigate gender differences in health outcomes of WFC. Also the number of longitudinal studies in this field is low. METHODS: Based on the Swedish Longitudinal Occupational Survey of Health, we prospectively examined the effects of WFC on three different health measures representing a wide spectrum off ill health (i.e. self-rated health, emotional exhaustion and problem drinking). Logistic regression analyses were used to analyse multivariate associations between WFC in 2008 and health 2 years later. RESULTS: The results show that WFC was associated with an increased risk of emotional exhaustion among both men and women. Gender differences are suggested as WFC was related to an increased risk for poor self-rated health among women and problem drinking among men. Interaction analyses revealed that the risk of poor self-rated health was substantially more influenced by WFC among women than among men. CONCLUSIONS: We conclude that, despite the fact that women experience conflict between work and family life slightly more often than men, both men's and women's health is negatively affected by this phenomenon.

  • 27.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bacchus Hertzman, Jennie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergqvist, Kersti
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ferranini, Tommy
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Nelson, Kenneth
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Rehnberg, Johan
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    The effect of social protection and income maintenance policies on health and health inequalities2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no Suppl. 1Article in journal (Refereed)
    Abstract [en]

    Background

    As a starting point we review the existing evidence on welfare states, health and health inequalities, from 2005 onwards. Three different approaches emerge in these previous studies – the welfare regime approach, the welfare institutions approach and the social spending approach. While no clear picture emerges for the welfare regime approach, summarising findings regarding the institutional and expenditure approach suggest that a higher degree of generosity and social spending benefits public health. These are therefore approaches we follow to arrive at a better understanding of what type of policies are linked to smaller inequalities in health across the life-course.

    Methods

    A starting point in the analyses is the relation between income, poverty and mortality. The cross-national variation in poverty rates, both absolute (poverty threshold) and relative (60 per cent of median income) measure, and mortality rates in European 26 countries will be considered.

    The second step in the analysis focuses on the relationship between social rights and subjective health in Europe, with a focus on national variations and changes in social rights to levels and changes in subjective health outcomes across several countries. The data holds information regarding social rights and social expenditure, including individual data from EU-SILC.

    Results

    Preliminary results indicate that it is the totality of social protection that is important rather than individual policies. A sub-study regarding social rights and health among youth highlight also the importance of active and passive labour market policy in the 16 included countries.

    Conclusions

    In sum our diverse approach to analysing welfare state efforts and their links to health inequalities suggest that there is a clear relationship between more ambitious policies and smaller inequalities in health. These results are discussed in relation to previous findings.

  • 28.
    Miyakawa, Michiko
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Hosei University, Japan.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Subjective social status: its determinants and association with health in the Swedish working population (the SLOSH study)2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no 4, p. 593-597Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study aims to confirm associations between subjective social status (SSS) and health in the Swedish working population, to investigate if SSS is related to health over and above conventional measures of socio-economic status and to identify factors related to perception of SSS.

    METHODS: The study includes 2358 men and 2665 women in the age group of 19-68 years who participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH). SSS was measured using the MacArthur scale, a 10-rung ladder on which individuals indicate where they think they stand in the social hierarchy. Health, health behaviors and social situation were also measured in 2006, while more objective measures of socio-economic position were derived from registry data and interviews in 2003.

    RESULTS: Perception of SSS was cross-sectionally related to age-adjusted prevalence of suboptimal perceived general health, sleep disturbances, musculoskeletal symptoms, depressive symptoms and emotional exhaustion. Relative Indices of Inequalities (RII) showed significant relationships between SSS and health, which were attenuated by adjustment for general life satisfaction. Adjustment for occupational grade, education and income further attenuated the relationship. The main predictors of SSS in 2006 were occupational grade, personal income and education in 2003; household financial situation, general life satisfaction and job control in 2006. When ranking their SSS, women put more weight on household financial situation and men on their personal income.

    CONCLUSION: SSS is associated with prevalence of several health complaints in the Swedish working population over and above conventional SES, indicating that SSS is a valid measure of social inequality in health.

  • 29.
    Modin, Bitte
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bullying in context – an analysis of health complaints among adolescents in greater Stockholm2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no supplement 2, p. 221-221Article in journal (Refereed)
  • 30. Moustgaard, Heta
    et al.
    Joutsenniemi, Kaisla
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    A longitudinal study of educational differences in antidepressant use before and after hospital care for depression2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 6, p. 1034-1039Article in journal (Refereed)
    Abstract [en]

    Background: Despite social inequalities in depression various studies report small or even reversed social gradients for antidepressant treatment, suggesting unmet need for treatment among those with low social position. However, few studies assess need for treatment or compare longitudinal antidepressant use patterns between socioeconomic groups. Methods: We used a nationally representative register cohort of Finnish adults with hospital care for depression in 1998–2007 (n = 7249). We compared the prevalence of any use and daily use of antidepressants across educational groups in consecutive 3-month periods up to 5 years before admission and 5 years after discharge, adjusting for important confounders. Results: We found no educational differences in any antidepressant use in the 5 years leading to hospital care for depression but a 3–4 percentage-point higher prevalence among those with high education in the 3-month periods immediately preceding and following hospital care for depression. Furthermore, decline in the prevalence of antidepressant use after discharge was more rapid in low education resulting in a significant 4–6 percentage-point higher prevalence among the highly educated lasting until 2.5 years after discharge. Daily use was significantly more common among the highly educated for a year before admission, immediately after discharge and for 2.5 years thereafter, the excess being 3–8 percentage-points. Conclusion: Our results suggest rather equitable access to antidepressant treatment at the time of evident need, i.e. immediately after discharge from hospital care for depression. However, early discontinuation of treatment as well as below guideline use of antidepressants were more common among the low educated.

  • 31. Mäki, Netta E.
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Premature mortality after suicide attempt in relationto living arrangements. A register-based study in Finland in 1988-20072017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 73-79Article in journal (Refereed)
    Abstract [en]

    Background: Several studies have shown that individuals with a history of suicide attempt form a high-risk mortality group. Completed suicide is the main cause of death among them, but excess mortality for other causes of death is much less studied. Furthermore, little is known whether living with others modifies the excess risk of mortality among suicide attempters. Methods: We evaluated an 11% sample from the population registration data of Finns aged 15 years and older in the period 1988-2007 with an 80% oversample of death records and a linkage with information on causes of hospitalisation. We estimate standardised mortality rates and Poisson regression models separately for the general population and those treated in hospital for suicide attempt. Results: Compared with the general population, all-cause mortality risk was similar to 10-fold among women and well over 10-fold among men during the first 3 months following suicide attempt. The risk for suicide was even greater, but in addition to external causes of death, mortality from smoking-and alcohol-related diseases was elevated. Instead, the proportion of alcohol-associated suicides was smaller among the suicide attempters. Among suicide attempters, the association between living arrangements and mortality was much weaker than in the general population. Conclusion: Premature mortality is extremely high after suicide attempt, especially in the first year. Our results do not support the idea that the resources provided by living with others ameliorate the effects of suicide attempt on subsequent mortality. Suicide prevention should focus on designing adequate aftercare following the attempt, especially for those with alcohol problems.

  • 32. Möller, Sanne P.
    et al.
    Andersen, A-M N.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Nörredam, M.
    Uptake of vaccinations and health examinations among refugee children compared to Danish-born children - a register based cohort study2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no S2, p. 165-166Article in journal (Refereed)
    Abstract [en]

    Background

    In Denmark, vaccinations recommended for children include among others vaccinations against diphteria, tetanus, pertussis and polio (DTwP) and measles, mumps and rubella (MMR). Children are also offered seven child health examinations (CHE). Both are important to prevent illness and to ensure early detection of developmental progblems. It is crucial that both services are utilized by all families regardless of their socioeconomic position, ethnic background or migrant status. However, there is a paucity of studies on uptake among the potentially vulnerable group of refugees.

    Methods

    The study population consisted of all refugee children arriving to Denmark between 1993 and 2010, and Danish-born children matched 1:6 on age and sex to the refugee children. Those included in the study had to be eligible for vaccination or CHE, i.e. have the recommended age for an investigated outcome during the observation period, which was January 1993 - May 2012. These criteria were met by 17,701 refugees and 106,206 Danish-born children. Information on vaccinations and CHE's from the Danish National Health Service Register was used to compare uptake among the two groups. Information on refugee status, duration of residence, region of origin and equivalised family income was used to examine predictors of uptake among refugee children. Analyses were made using a Cox regression model.

    Results

    For all unadjusted vaccination outcomes refugee children had lower uptake than Danish-born children. However, after adjusting for income only the DTwP remained significant (HR = 0.61; 95%CI: 0.58-0.63). All results for the CHE's remained significant after adjustment for income, with the biggest difference observed for the last CHE at age 5 (HR = 0.48; 95%CI:0.47-0.50). Both refugee status, duration of residence, region of origin and equivalised family income were identified as predictors of uptake among refugee children.

    Conclusion

    The findings that refugee children do not have the same uptake of the investigated services as Danish-born children, suggest that refugees face barriers in the Danish health care system, and that newly arrived families are especially vulnerable. This indicates a need for improvements in the information on health services for newly arrived families.

  • 33.
    Nilsen, Charlotta
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Andel, Ross
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Work-related stress in midlife and all-cause mortality: can sense of coherence modify this association?2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 6, p. 1055-1061Article in journal (Refereed)
    Abstract [en]

    Background: Survival reflects the accumulation of multiple influences experienced over the life course. Given the amount of time usually spent at work, the influence of work may be particularly important. We examined the association between work-related stress in midlife and subsequent mortality, investigating whether sense of coherence modified the association. Methods: Self-reported work-related stress was assessed in 1393 Swedish workers aged 42-65 who participated in the nationally representative Level of Living Survey in 1991. An established psychosocial job exposure matrix was applied to measure occupation-based stress. Sense of coherence was measured as meaningfulness, manageability and comprehensibility. Mortality data were collected from the Swedish National Cause of Death Register. Data were analyzed with hazard regression with Gompertz distributed baseline intensity. Results: After adjustment for socioeconomic position, occupation-based high job strain was associated with higher mortality in the presence of a weak sense of coherence (HR, 3.15; 1.62-6.13), a result that was stronger in women (HR, 4.48; 1.64-12.26) than in men (HR, 2.90; 1.12-7.49). Self-reported passive jobs were associated with higher mortality in the presence of a weak sense of coherence in men (HR, 2.76; 1.16-6.59). The link between work stress and mortality was not significant in the presence of a strong sense of coherence, indicating that a strong sense of coherence buffered the negative effects of work-related stress on mortality. Conclusions: Modifications to work environments that reduce work-related stress may contribute to better health and longer lives, especially in combination with promoting a sense of coherence among workers.

  • 34.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Razvodovsky, Yury
    Per capita alcohol consumption and alcohol-related harm in Belarus, 1970-20052010In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 20, no 5, p. 564-568Article in journal (Refereed)
    Abstract [en]

    Background: Although alcohol seems to be an important determinant of the mortality crisis in the former Soviet Republic of Belarus, little systematic research has been done on the relationship between alcohol consumption and harm at the aggregate level. The aims of the present study were to estimate the effect of per capita alcohol consumption on all-cause mortality, mortality from alcohol poisoning and hospital admissions for alcohol psychosis in Belarus. Methods: Annual data on the three outcomes and alcohol sale per capita for the period 1970–2005 were analysed using the Box–Jenkins technique. Female mortality was included as a control variable and regarded as a proxy for other causal factors. To incorporate the lag structure, a weighted input was used in which a geometrical lag-scheme was applied. Results: The outcomes suggest that a 1 l increase in consumption was associated with an increase in male all-cause mortality of ∼2.3%. The corresponding figures for alcohol poisoning mortality and alcohol psychosis admissions are 12 and 25%. Conclusions: The present study strengthens the notion of alcohol consumption as an important determinant of population health in this part of the world, and thus the notion that alcohol control must be a key priority for Belorussian public health policy.

  • 35.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Stickley, Andrew
    Alcohol tax, consumption and mortality in tsarist Russia: is a public health perspective applicable?2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 2, no 23, p. 340-344Article in journal (Refereed)
    Abstract [en]

    Background: The public health perspective on alcohol comprises two main tenets: (i) population drinking impacts on alcohol-related harm and (ii) population drinking is affected by the physical and economic availability of alcohol, where alcohol taxes are the most efficient measure for regulating consumption. This perspective has received considerable empirical support from analyses of contemporary data mainly from Europe and North America. However, as yet, it has been little examined in a historical context. The aims of the present article are to use data from tsarist Russia to explore (i) the relation between changes in the tax on alcohol and per capita alcohol consumption and (ii) the relation between per capita alcohol consumption and alcohol mortality. Methods: The material comprised annual data on alcohol taxes, alcohol consumption and alcohol mortality. The tax and alcohol consumption series spanned the period 1864–1907 and the mortality data covered the period 1870–94. The data were analysed by estimating autoregressive integrated moving average models on differenced data. Results: Changes in alcohol taxes were significantly associated with alcohol consumption in the expected direction. Increases in alcohol consumption, in turn, were significantly related to increases in alcohol mortality. Conclusion: This study provides support for the utility of the public health perspective on alcohol in explaining changes in consumption and alcohol-related harm in a historical context. We discuss our findings from tsarist Russia in the light of experiences from more recent alcohol policy changes in Russia.

  • 36.
    Pimouguet, Clement
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lagergren, Mårten
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Living alone and unplanned hospitalizations among older adults: a population-based longitudinal study2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 2, p. 251-256Article in journal (Refereed)
    Abstract [en]

    Background: The association of living alone with hospitalization among the general elderly population has been rarely investigated, and the influence of common disorders on this association remains unknown. Methods: We used data on participants in the Swedish National study on Aging and Care in Kungsholmen (n = 3130). Risk and number of unplanned hospitalizations and length of hospital stays were studied over a period of 2 years. We used Cox proportional hazard models to estimate hazard ratios (HRs) of incident hospitalization and zero-inflated negative binomial regression models adjusted for potential confounders to estimate incident rate ratios (IRR) of the number of hospitalizations and total length of stay associated with living alone. Results: A total of 1768 participants (56.5%) lived alone. Five hundred and sixty-one (31.7%) of those who lived alone had at least one unplanned hospitalization. In the multivariate analyses, living alone was significantly associated with the risk of unplanned hospitalization (HR = 1.21, 95% confidence interval [CI] 1.01-1.45) and the number of hospitalizations (IRR = 1.35, 95% CI 1.04-1.76) but not with the length of hospital stays. In stratified analyses, the association between living alone and unplanned hospitalizations remained statistically significant only among men (HR = 1.52, 95% CI 1.17-1.99). Conclusions: Living alone is associated with higher risks of unplanned hospitalization in elderly, especially for men.

  • 37.
    Pimouguet, Clement
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). INSERM, ISPED, Centre INSERM, France; University of Bordeaux, France.
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Schön, Pär
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Shakersain, Behnaz
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Angleman, Sara
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lagergren, Marten
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Impact of living alone on institutionalization and mortality: a population-based longitudinal study2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1, p. 182-187Article in journal (Refereed)
    Abstract [en]

    Background: Living alone is common among elderly people in Western countries, and studies on its relationship with institutionalization and all-cause mortality have shown inconsistent results. We investigated that the impact of living alone on institutionalization and mortality in a population-based cohort of elderly people. Methods: Data originate from the Swedish National study on Aging and Care-Kungsholmen. Participants aged >= 66 years and living at home (n = 2404) at baseline underwent interviews and clinical examination. Data on living arrangements were collected in interviews. All participants were followed for 6 years; survival status and admission into institutions were tracked continuously through administrative registers from 2001 to 2007. Data were analysed using Cox proportional hazard models, competing risk regressions and Laplace regressions with adjustment for potential confounders. Results: Of the 2404 participants, 1464 (60.9%) lived alone at baseline. During the follow-up, 711 (29.6%) participants died, and 185 (15.0%) were institutionalized. In the multi-adjusted Cox model, the hazard ratio (HR) of mortality in those living alone was 1.35 (95% confidence interval [CI] 1.18 to 1.54), especially among men (HR = 1.44, 95% CI 1.18 to 1.76). Living alone shortened survival by 0.6 years and was associated with the risk of institutionalization (HR = 1.74, 95% CI 1.10 to 2.77) after taking death into account as a competing risk. Conclusions: Living alone is associated with elevated mortality, especially among men and an increased risk of institutionalization. Over a 6-year period, living alone was related to a half year reduction in survival among elderly people in Sweden.

  • 38.
    Platts, Loretta G.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Gerry, Christopher J.
    Social inequalities in self-rated health in Ukraine in 2007: the role of psychosocial, material and behavioural factors2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 2, p. 211-217Article in journal (Refereed)
    Abstract [en]

    Background: Despite Ukraine's large population, few studies have examined social inequalities in health. This study describes Ukrainian educational inequalities in self-rated health and assesses how far psychosocial, material and behavioural factors account for the education gradient in health. Methods: Data were analyzed from the 2007 wave of the Ukrainian Longitudinal Monitoring Survey. Education was categorized as: lower secondary or less, upper secondary and tertiary. In logistic regressions of 5451 complete cases, stratified by gender, declaring less than average health was regressed on education, before and after adjusting for psychosocial, material and behavioural factors. Results: In analyses adjusted for socio-demographic characteristics, compared with those educated up to lower secondary level, tertiary education was associated with lower risk of less than average health for both men and women. Including material factors (income quintiles, housing assets, labour market status) reduced the association between education and health by 55-64% in men and 35-47% in women. Inclusion of health behaviours (physical activity, smoking, alcohol consumption and body mass index) reduced the associations by 27-30% in men and 19-27% in women; in most cases including psychosocial factors (marital status, living alone, trust in family and friends) did not reduce the size of the associations. Including all potential explanatory factors reduced the associations by 68-84% in men and 43-60% in women. Conclusions: The education gradient in self-rated health in Ukraine was partly accounted for by material and behavioural factors. In addition to health behaviours, policymakers should consider upstream determinants of health inequalities, such as joblessness and poverty

  • 39.
    Rajaleid, Kristiina
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nummi, Tapio
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Virtanen, Pekka
    Gustafsson, Per E.
    Hammarström, Anne
    Social adversities in adolescence predict unfavourable trajectories of internalized mental health symptoms until middle age: results from the Northern Swedish Cohort2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1, p. 23-29Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experiencing adversities during upbringing has short-term and long-term effects on mental health. This study aims to explore how social adversities in adolescence predict trajectories of internalized mental health symptoms (IMHS), from adolescence and onward until middle age.

    METHODS: Based on 1040 individuals from the Northern Swedish Cohort Study, a community-based cohort with 27 years of follow-up. We applied latent class growth analysis to extract trajectories of IMHS between ages 16 and 43. Multinomial logistic regression was used to study the association of social adversities (residential mobility, residential crowding, parental loss, unemployment of a parent, physical illness of a parent, mental illness or alcohol problems of a parent) in adolescence with IMHS trajectories.

    RESULTS: Five trajectory classes were identified: 'very low stable' (26% of the sample), 'low stable' (58%), 'moderate stable' (5%), 'increasing' (8%) and 'high decreasing' (3%). Both in men and women, reporting social adversities at the age of 16 increased the risk of belonging to the classes with less favourable development of IMHS. Reporting adversities was positively associated with the initial level of the IMHS trajectories. Thus it seems that the influence of adversities is more pronounced during the early years of follow-up and is attenuated over time.

    CONCLUSION: Experiencing social adversities in adolescence increases the risk of entering unfavourable developmental trajectories of mental health until middle age.

  • 40.
    Romelsjö, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenbacka, Marlene
    Lundberg, Michael
    Upmark, Marianne
    A population study of the association between hospitalisation for alcoholism among employed in different socio-economic classes and the risk of mobility out of or within the working force2004In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 14, no 1, p. 53-57Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Alcohol problems can increase the risk of downward mobility within, or mobility out of, the workforce. The magnitude of this risk has been unclear, as has also been the question whether the risk is different for men and women, for different socio-economic classes, and for single-living compared with co-habiting people. METHODS: The study period was 1970-1980, when unemployment was low in Sweden. Information about socio-economic status from censuses was linked to hospitalization for alcoholism, alcohol psychosis and alcohol intoxication (AAA) over the period 1970-1975 in Stockholm County in persons aged 20-49 years in 1970 and gainfully employed in the same socio-economic category in both 1970 and 1975, and to general population data. The standardized rate ratio for mobility out of the workforce and for downward socio-economic mobility was calculated for those hospitalized with AAA. RESULTS: There was a statistically significant risk of mobility out of the workforce over the period 1976-1980 in both sexes and in all socio-economic groups. The relative risk was 6.63 for male skilled and semi-skilled manual workers and 9.52 for non-manual employees at medium and high level, while the corresponding figures were lower for women. The absolute risk of leaving the workforce was lowest in non-manual employees at medium and high level. The relative risk was reduced in persons who were co-habiting. CONCLUSIONS: Severe alcohol problems are powerful determinants of downward mobility within, or mobility out of, the workforce in both sexes and in all socio-economic categories.

  • 41.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Heroin maintenance and attraction to treatment: [Commentary]2002In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 12, no 3, p. 234-235Article in journal (Refereed)
  • 42.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, J.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Sibling death in childhood predicts mortality in young adults – a Swedish national cohort study2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no Suppl. 3, p. 53-53Article in journal (Refereed)
    Abstract [en]

    Background

    Previous studies have found that the loss of a family member increases mortality among bereaved family members. Although, some previous evidence have found associations between loss of a sibling in adulthood and subsequent mortality few studies have studied whether sibling deaths in childhood is associated with all-cause and cause-specific mortality in young adulthood.

    Methods

    A national cohort born during 1973–1982 (N= 871 402) was followed prospectively in the Swedish Cause of Death Register from age 18 to 30–35. Multivariate Cox analyses of proportional hazards with adjustment for socio-demographic confounders were used to test the association between sibling loss and all-cause and cause-specific mortality in young adulthood. Sibling deaths were divided into deaths caused by external causes and natural causes and we studied mortality from CVD, cancer, other diseases, suicides and accidents among bereaved siblings.

    Results

    In men, the mortality risk for bereaved persons versus non bereaved persons during childhood/adolescence was 1.48 (95% CI: 1.17, 1.86), and in women it was 1.45 (95% CI: 1.01, 2.09) after adjustment for socio-demographic confounders. Losing anon-infant sibling (>1 years) was most detrimental for both men (HR: 1.65, 95% CI: 1.23, 2.23) and women (HR: 1.54,95% CI: 0.95, 2.50) while bereaved men (HR: 1.86, 95% CI:1.28, 2.72) and women (HR: 1.75, 95% CI: 0.97, 3.18) were most vulnerable when exposed to loss of a sibling inadolescence (12-18 years). Further, preliminary analyses showed that external causes of death were most detrimental for mortality among bereaved siblings.

    Conclusions

    Sibling death during childhood predicts mortality in young adulthood, particularly when persons are exposed in adolescence. Men and women are about equally vulnerable to sibling deaths at different stages of childhood.

  • 43.
    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
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Experience of sibling death in childhood and risk of psychiatric care in adulthood2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Sibling loss has received scant attention in the bereavement literature. A previous study suggested an overall increased risk of mortality in siblings bereaved during childhood. However, the underlying disease pattern behind increased mortality is unclear. We studied the influence of sibling loss during childhood on in and outpatient care with an underlying psychiatric diagnosis in adulthood.

    Methods

    A national cohort born in Sweden in 1973-1982 (N = 717,723) was followed prospectively in the Cause of Death Register until 2013, i.e. from ages 18 years to 31-40 years of age. Cox proportional hazards models were used to analyse the association between sibling loss during childhood and psychiatric in- and outpatient care during follow-up.

    Results

    After adjustment for socio-demographic confounders and parental psychosocial covariates, HR for psychiatric inpatient-and outpatient care in bereaved siblings versus non- bereaved siblings was fairly small and non-significant in women. Bereaved men had increased HR for both psychiatric inpatient- (HR 1.17, 95% CI 1.00-1.36) and outpatient care (HR 1.21, 95% CI 1.10-1.33). Risks were however more pronounced when exposed to loss of a sibling in adolescence (i.e. in the ages 12-18 years) in both men and women.

    Conclusions

    The death of a sibling in childhood was associated with slightly increased risk of psychiatric in and out-patient care in surviving siblings in adulthood in men but not in women. Individuals experiencing the loss of a sibling in childhood may need particular attention from health care services.

  • 44.
    Rydwik, Elisabeth
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm City Council .
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University.
    Angleman, Sara
    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).
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Adherence to physical exercise recommendations in people over 65 - The SNAC-Kungsholmen study2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 5, p. 799-804Article in journal (Refereed)
    Abstract [en]

    Background: There is limited knowledge regarding to what extent the older population meet the recommendations of physical exercise, especially fitness-enhancing exercise. This study assessed participation in health- and fitness-enhancing exercises in people aged >65, and explored to what extent the possible differences in meeting current recommendations differs by age, gender and education. Methods: The study population was derived from the Swedish National study on Aging and Care, and consisted of a random sample of 2593 subjects, aged 65+ years. Participation in health- and fitness-enhancing exercise according to the WHO and the American College of Sports Medicine's recommendations in relation to age, gender and education was evaluated using multinomial logistic regression adjusted for health indicators and physical performance. Results: According to the recommendations, 46% of the participants fulfilled the criteria for health-enhancing and 16% for fitness-enhancing exercises. Independent of health indicators and physical performance, women <80 years of age were less likely than men to participate in fitness-enhancing exercise, but they participated more in health-enhancing exercise. In the advanced age group (80+ years), women were less likely to participate both in fitness- and health-enhancing exercise. Advanced age and low education were negatively related to participation in both health- and fitness-enhancing exercise independent of health indicators, but the association was not observed among people with fast walking speed. Conclusion: Promoting physical exercise and encouraging participation among older adults with lower education, especially among those with initial functional decline, may help to reduce adverse health outcomes.

  • 45. Sidorchuk, A
    et al.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, United Kingdom .
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Social class, social mobility and alcohol-related disorders in four generations of Swedish families2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl. 1, p. 117-117Article in journal (Refereed)
  • 46. Sovio, U.
    et al.
    Dibden, A.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    ‘‘Low birth weight paradox’’ revisited: Persisting social inequalities early in life and evolving role of maternal smoking2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no Suppl. 2, p. 42-43Article in journal (Refereed)
  • 47. Stubbe Østergaard, Liv
    et al.
    Norredam, Marie
    Mock-Munoz de Luna, Claire
    Blair, Mitch
    Goldfeld, Sharon
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Restricted health care entitlements for child migrants in Europe and Australia2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 5, p. 869-873Article in journal (Refereed)
    Abstract [en]

    Background

    More than 300 000 asylum seeking children were registered in Europe alone during 2015. In this study, we examined entitlements for health care for these and other migrant children in Europe and Australia in a framework based on United Nations Convention of the Rights of the Child (UNCRC).

    Methods

    Survey to child health professionals, NGO's and European Ombudspersons for Children in 30 EU/EEA countries and Australia, supplemented by desktop research of official documents. Migrant children were categorised as asylum seekers and irregular/undocumented migrants.

    Results

    Five countries (France, Italy, Norway, Portugal and Spain) explicitly entitle all migrant children, irrespective of legal status, to receive equal health care to that of its nationals. Sweden and Belgium entitle equal care to asylum seekers and irregular non-EU migrants, while entitlements for EU migrants are unclear. Twelve European countries have limited entitlements to health care for asylum seeking children, including Germany that stands out as the country with the most restrictive health care policy for migrant children. In Australia entitlements for health care are restricted for asylum seeking children in detention and for irregular migrants. The needs of irregular migrants from other EU countries are often overlooked in European health care policy.

    Conclusion

    Putting pressure on governments to honour the obligations of the UNCRC and explicitly entitle all children equal rights to health care can be an important way of advocating for better access to primary and preventive care for asylum seeking and undocumented children in Australia and the EU.

  • 48.
    Sundberg, Louise
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Agahi, Neda
    Fritzell, Johan
    Fors, Stefan
    Trends in health expectancies among the oldest old in Sweden, 1992-20112016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 6, p. 1069-1074Article in journal (Refereed)
    Abstract [en]

    Background: Information on the extent to which older people's increasing life expectancy is characterized by good or poor health is important for policy and fiscal planning. This study explores trends in health expectancies among the oldest old in Sweden from 1992 to 2011. Methods: Cross-sectional health expectancy estimates at age 77 were obtained for 1992, 2002, 2004 and 2011 by Sullivan's method. Health expectancy was assessed by severe disability, mild disability and mobility problems. Changes in health expectancies were decomposed into the contributions attributed to changes of mortality rates, and changes in disability and mobility prevalence. Mortality data were obtained from Statistics Sweden and prevalence data from two nationally representative surveys, the Swedish Panel Study of Living Conditions of the Oldest Old and the Survey of Health, Ageing and Retirement in Europe. Results: Years free from severe disability, mild disability and mobility problems increased in both men and women. Decomposition analysis indicates that the increase was mainly driven by the change in health status rather than change in mortality. In relation to total life expectancy, the general patterns suggest that women had a compression of health problems and men an expansion. Conclusion: Men's life expectancy increased more than women's; however, the increased life expectancy among men was mainly characterized by disability and mobility problems. The results suggest that the gender gap in health expectancy is decreasing.

  • 49. Svedberg, Pia
    et al.
    Mather, L.
    Bergström, G.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Blom, V.
    Are time pressure and sleep problems due to thoughts about work risk factors for future sick leave?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no S3, p. 252-252, article id ckx187.667Article in journal (Refereed)
    Abstract [en]

    Background: Previous research indicates that long working hours, time pressure and overtime work relate to a range of adverse outcomes including poor recovery and health complaints. But, findings are inconclusive and limited, especially regarding the associations to sick leave. The aim was to study if time pressure or sleep problems due to thoughts about work were associated with future sick leave, when adjusting for confounders including familial factors, and stratifying by occupational sector. Methods: The study sample included 23,777 twin individuals (54.5% women), aged 19-47 years who participated in a survey in 2005 including questions on time pressure, sleep, work and health. Register data on sick-leave spells lasting >14 days were obtained from the National Social Insurance Agency. Individuals were followed from date of survey response until 12/31/2013. Associations between time pressure, sleep problems due to thoughts about work and future sick leave were investigated using logistic regression analyses to assess Odds Ratios (OR) with 95% Confidence Intervals (CI). Results: Thirty-five percent of the individuals had an incident sick leave spell during the 8-years of follow-up. Sleep problems due to thoughts about work once a month or more often were associated with sick leave in the fully adjusted model (OR 1.22, CI 1.10-1.36). Stratified by sector, the highest estimate was shown for state employees (OR 1.54, CI 1.11-2.13). Familial factors did not seem to influence the associations. We found no statistically significant associations between time pressure and sick leave. No sex differences were found. Conclusions: Results indicate that sleep problems due to thoughts about work is a risk factor for future sick leave. This follows previous research showing that sleep length and disturbances, regardless of their reasons, are associated with sick leave. But, experiences of work-related time pressure seem not to be associated with sick leave.

  • 50.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Jood, Katarina
    Slunga Järvholm, Lisbeth
    Vingård, Eva
    Perk, Joep
    Östergren, Per Olov
    Hall, Charlotte
    A systematic review of studies in the contributions of the work environment to ischaemic heart disease development2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 3, p. 470-477Article in journal (Refereed)
    Abstract [en]

    Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system. Methods: Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed. Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence. Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.

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