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  • 1.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Shaw, Benjamin A.
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Social and economic conditions in childhood and the progression of functional health problems from midlife into old age2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 8, p. 734-740Article in journal (Refereed)
    Abstract [en]

    Background Childhood living conditions have been found to predict health and mortality in midlife and in old age. This study examines the associations between social and economic childhood conditions and the onset and progression of functional health problems from midlife into old age, and the extent to which potential associations are mediated by educational attainment and smoking. Methods Data from the Level of Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old were merged to create a longitudinal data set with five repeated measures from 1968 to 2004 (n=1765, aged 30-50 years and free from functional health problems at baseline). Multilevel regression models were used to analyse retrospective reports of social and economic conditions in childhood (eg, conflicts or economic problems in the family) in relation to the progression of functional health problems over the 36-year period. Results Results showed that social and economic disadvantages in childhood were associated with an earlier onset and a faster progression of functional health problems from midlife into old age. Subsequent models showed that differences in educational attainment, but not smoking, explained much of the association between childhood disadvantages and trajectories of functional health problems. Conclusions According to these results, adverse social and economic conditions in childhood affect the development of functional health problems from midlife into old age indirectly through less favourable life careers, including lower education. Creating equal opportunities for educational attainment may help reduce the long-term effects of disadvantaged childhood conditions and postpone functional health problems.

  • 2. Alexanderson, K.
    et al.
    Kivimäki, M.
    Ferrie, J. E.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Vahtera, J.
    Singh-Manoux, A.
    Melchior, M.
    Zins, M.
    Goldberg, M.
    Head, J.
    Diagnosis-specific sick leave as a long-term predictor of disability pension: a 13-year follow-up of the GAZEL cohort study2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 2, p. 155-159Article in journal (Refereed)
    Abstract [en]

    Background Factors that increase the risk of labour market exclusion are poorly understood. In this study, we examined the extent to which all-cause and diagnosis-specific sick leave predict subsequent disability pension (DP).

    Methods Prospective cohort study of 20 434 persons employed by the French national gas and electric company (the GAZEL study). New sick-leave spells >7 days in 1990–1992 were obtained from company records. Follow-up for DP was from 1994 to 2007.

    Results The HR, adjusted for age and occupational position, for DP was 3.5 (95% CI 2.7 to 4.5) in men and 2.6 (95% CI 1.9 to 3.5) in women with one or more sick-leave spells >7 days compared with those with no sick leave. The strongest predictor of DP was sick leave with a psychiatric diagnosis, HR 7.6 (95% CI 5.2 to 10.9) for men and 4.1 (95% CI 2.9 to 5.9) for women. Corresponding HRs for sick leave due to circulatory diagnoses in men and women were 5.6 (95% CI 3.7 to 8.6) and 3.1 (95% CI 1.8 to 5.3), for respiratory diagnoses 3.9 (95% CI 2.6 to 5.8) and 2.6 (95% CI 1.7 to 4.0), and musculoskeletal diagnoses 4.6 (95% CI 3.4 to 6.4) and 3.3 (95% CI 2.2 to 4.8), respectively.

    Conclusions Sick leave with a psychiatric diagnosis is a major risk factor for subsequent DP, especially among men. Sick leave due to musculoskeletal or circulatory disorders was also a strong predictor of DP. Diagnosis-specific sick leave should be recognised as an early risk marker for future exclusion from the labour market.

  • 3.
    Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Peer status in school and adult disease risk: A 30-year follow-up study of disease-specific morbidity in a Stockholm cohort2009In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 63, no 12, p. 1028-1034Article in journal (Refereed)
    Abstract [en]

    Background: Children have a social status position of their own, apart from that of the family, that may have an impact on short-term and long-term health. The aim of the present study was to analyse the associations between childhood social status in school (ie, peer status) and disease-specific morbidity in adulthood.

    Methods: Data were derived from a longitudinal study using a 1953 cohort born in Stockholm, Sweden: The Stockholm Birth Cohort Study (1953–2003). Peer status was sociometrically assessed in sixth grade (1966). Hazard ratios for adult disease-specific morbidity based on information on inpatient care (1973–2003) were calculated by peer status category for men and women separately, using Cox regression.

    Results: The results indicate that the lower the childhood peer status, the higher the overall adult disease risk. There were, however, differences in the degree and magnitude to which disease-specific inpatient care varied with peer status. Some of the steepest gradients were found for mental and behavioural disorders (eg, alcohol abuse and drug dependence), external causes (eg, suicide) and various lifestyle-related diseases (eg, ischaemic heart disease and diabetes). The results were not explained by childhood social class.

    Conclusion: The present study underlines the importance of recognising children’s social position, apart from that of their family, for later health. Not only psychologically related diseases but also those related to behavioural risk factors demonstrate some of the largest relative differences by peer status, suggesting that health-related behaviour may be one important mechanism in the association between peer status and morbidity.

  • 4.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jackisch, Josephine
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Forsman, Hilma
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    A decade lost: does educational success mitigate the increased risks of premature death among children with experience of out-of-home care?2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738Article in journal (Refereed)
    Abstract [en]

    Background: Past research has consistently identified children with experience of out-of-home care (OHC) as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, the empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success for the association between OHC experience and premature mortality.

    Methods: Drawing on a Stockholm cohort born in 1953 (n=15,117), we analysed the associations between placement in OHC (ages 0-12), school performance (ages 13, 16, and 19), and premature all-cause mortality (ages 20-56) by means of Cox and Laplace regression analysis.

    Results: The Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that these children died more than a decade, based on median survival time, before their majority population peers. However, among individuals who performed well at school, i.e. scored above-average marks at age 16 (grade 9) and age 19 (grade 12), respectively, the risks of premature mortality did not significantly differ between the two groups.

    Conclusion: Educational success seems to mitigate the increased risks of premature death among children with experience of OHC.

  • 5.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    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).
    Berlin, Marie
    Stockholm University, Faculty of Social Sciences, Department of Sociology. National Board of Health and Welfare, Sweden.
    Gustafsson, Per A.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 8, p. 769-774Article in journal (Refereed)
    Abstract [en]

    Background: In many Western countries, an increasing number of children with separated parents have joint physical custody, that is, live equally much in their parent's respective homes. In Sweden, joint physical custody is particularly common and concerns between 30% and 40% of the children with separated parents. It has been hypothesised that the frequent moves and lack of stability in parenting may be stressful for these children.

    Methods: We used data from a national classroom survey of all sixth and ninth grade students in Sweden (N=147839) to investigate the association between children's psychosomatic problems and living arrangements. Children in joint physical custody were compared with those living only or mostly with one parent and in nuclear families. We conducted sex-specific linear regression analyses for z-transformed sum scores of psychosomatic problems and adjusted for age, country of origin as well as children's satisfaction with material resources and relationships to parents. Clustering by school was accounted for by using a two-level random intercept model.

    Results: Children in joint physical custody suffered from less psychosomatic problems than those living mostly or only with one parent but reported more symptoms than those in nuclear families. Satisfaction with their material resources and parent–child relationships was associated with children's psychosomatic health but could not explain the differences between children in the different living arrangements.

    Conclusions: Children with non-cohabitant parents experience more psychosomatic problems than those in nuclear families. Those in joint physical custody do however report better psychosomatic health than children living mostly or only with one parent. Longitudinal studies with information on family factors before and after the separation are needed to inform policy of children's postseparation living arrangements.

  • 6. Björkenstam, C.
    et al.
    Weitoft, G.R.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Nordstrom, P.
    Hallqvist, J.
    Ljung, R.
    School grades, parental education and suicide: a national register-based cohort study2010In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738Article in journal (Refereed)
    Abstract [en]

    Background To investigate whether school performance is a risk factor for suicide death later in life and, if so, to what extent this is explained by intergenerational effects of parental education.

    Methods This population-based cohort study comprises national birth cohorts between 1972 and 1981 in Sweden. We followed 898 342 students, graduating between 1988 and 1997 from the 9 years of compulsory school, equivalent to junior high school, until 31 December 2006, generating 11 148 758 person-years and 1490 suicides. Final school grades, in six categories, and risk of suicide were analysed with Poisson regression.

    Results The incidence rate ratio (RR) for suicide death for students with the lowest grades was 4.57 (95% CI 2.82 to 7.40) for men and 2.67 (1.42 to 5.01) for women compared to those with highest grades after adjustment for a number of sociodemographic and parental morbidity variables, such as year of graduation, parental education, lone parenthood, household receiving social welfare or disability pension, place of schooling, adoption, maternal age and parent's mental illness. Students with grades in the middle categories had RRs in between. These relationships were not modified by parental education.

    Conclusions The strong association between low school grades and suicide in youth and young adulthood emphasises the importance of both primary and secondary prevention in schools.

  • 7.
    Björkenstam, Charlotte
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Karolinska Institutet, Sweden; University of California, USA.
    Kosidou, Kyriaki
    Björkenstam, Emma
    Dalman, Christina
    Andersson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Cochran, Susan
    Self-reported suicide ideation and attempts, and medical care for intentional self-harm in lesbians, gays and bisexuals in Sweden2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 9, p. 895-901Article in journal (Refereed)
    Abstract [en]

    Background Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for intentional self-harm between 1969 and 2010, including age at initial treatment and recurrence. Methods We used data from the Stockholm Public Health Cohort, a population-based sample of 874 lesbians/gays, 841 bisexuals and 67980 heterosexuals, whose self-administered surveys have been linked to nationwide registers. Estimates of risk for medical care were calculated as incidence rate ratios (IRR) with 95% CIs. Results Both suicidal ideation and attempts were more commonly reported by lesbian/gay and bisexual (LGB) individuals. Adjusting for risk-time and confounding, lesbians (IRR 3.8, 95% CI 2.7 to 5.4) and bisexual women (IRR 5.4, 95% CI 4.4 to 6.6) experienced elevated risk for medical care for intentional self-harm, as compared to heterosexual women. Gay men evidenced higher risk (IRR 2.1, 95% CI 1.3 to 3.4) as compared to heterosexual men. Recurrent medical care was more frequent in LGB individuals, especially in bisexual women and gay men. Lesbian and bisexual women were also younger than heterosexual women when they first received medical care for intentional self-harm. Conclusions Positive histories of suicidal ideation, attempts and medical care for intentional self-harm, including higher levels of recurrence, are more prevalent among LGB individuals in contrast to heterosexuals. Lesbian/bisexual women evidence an earlier age of onset of treatment. Tailored prevention efforts are urgently needed.

  • 8. Björkenstam, Emma
    et al.
    Cheng, Siwei
    Burström, Bo
    Pebley, Anne R.
    Björkenstam, Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Sociology. University of California, USA; Karolinska Institutet, Sweden.
    Kosidou, Kyriaki
    Association between income trajectories in childhood and psychiatric disorder: a Swedish population-based study2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 7, p. 648-654Article in journal (Refereed)
    Abstract [en]

    Background Childhood family income variation is an understudied aspect of households' economic context that may have distinct consequences for children. We identified trajectories of childhood family income over a 12-year period, and examined associations between these trajectories and later psychiatric disorders, among individuals born in Sweden between 1987 and 1991 (n=534 294).

    Methods We used annual income data between the ages of 3-14 years and identified 5 trajectories (2 high-income upward, 1 downward and 2 low-income upward trajectories). Psychiatric disorders in the follow-up period after age 15 were defined from International Classification of Disease (ICD)-codes in a nationwide patient register. Multiadjusted risks for all psychiatric disorders, as well as for specific psychiatric diagnoses, were calculated as HRs with 95% CIs.

    Results Of the 5 identified income trajectories, the constant low and the downward trajectories were particularly associated with later psychiatric disorder. Children with these trajectories had increased risks for psychiatric disorder, including mood, anxiety, psychotic disorders and attention deficit/hyperactivity disorder. The association remained, even after adjusting for important variables including parental psychiatric disorder. In contrast, the relationship was reversed for eating disorders, for which children in higher income trajectories had elevated risks.

    Conclusions Findings show that children growing up in a household characterised by low or decreasing family income have an increased risk for psychiatric disorder. Continued work is needed to reduce socioeconomic inequalities in psychiatric disorders. Policies and interventions for psychiatric disorders should consider the socioeconomic background of the family as an important risk or protective factor.

  • 9. Björkenstam, Emma
    et al.
    Dalman, Christina
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Ringbäck Weitoft, Gunilla
    Walder, Deborah J.
    Burström, Bo
    Childhood household dysfunction, school performance and psychiatric care utilisation in young adults: a register study of 96 399 individuals in Stockholm County2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 5, p. 473-480Article in journal (Refereed)
    Abstract [en]

    Background Exposure to childhood household dysfunction increases the risk of psychiatric morbidity. Although school performance also has been linked with psychiatric morbidity, limited research has considered school performance as a mediating factor. To address this gap in the literature, the current register study examined whether school performance mediates the association between childhood household dysfunction (experienced between birth and age 14 years) and psychiatric care utilisation in young adulthood.

    Methods We used a Swedish cohort of 96 399 individuals born during 1987–1991. Indicators of childhood household dysfunction were familial death, parental substance abuse and psychiatric morbidity, parental somatic disease, parental criminality, parental separation/single-parent household, public assistance recipiency and residential instability. Final school grades from the 9th year of compulsory school were used to create five categories. Estimates of risk of psychiatric care utilisation (measured as inpatient, outpatient and primary care) after the age of 18 years were calculated as HRs with 95% CIs. Mediation was tested with the bootstrap approach.

    Results Cumulative exposure to childhood household dysfunction was positively associated with psychiatric care utilisation. Specifically, individuals exposed to three or more indicators with incomplete school grades had the highest risk (HR=3.7 (95% CI 3.3 to 4.1) after adjusting for demographics), compared to individuals exposed to no indicators with highest grades. School performance was found to mediate the relationship.

    Conclusions Our findings suggest that future efforts to prevent or mitigate the negative effects of childhood household dysfunction on psychiatric morbidity may benefit from integration of strategies that improve school performance among vulnerable youth.

  • 10.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Trolldal, Björn
    Menke, Martin
    Stockholm University, Faculty of Social Sciences, Department of Human Geography.
    Spatial spillover effects of a community action programme targeting on-licensed premises on violent assaults: evidence from a natural experiment2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 3, p. 226-230Article in journal (Refereed)
    Abstract [en]

    Background Spatial dependencies may influence the success of community action strategies to prevent and reduce harmful alcohol use. This study examined the effectiveness of a multicomponent Responsible Beverage Service (RBS) programme targeting on-licensed premises on police-recorded assaults in Swedish municipalities. It was expected that the implementation of the programme within any given municipality had an indirect effect by reducing violent assaults in adjacent municipalities.

    Methods This study was a natural experiment exploiting the temporal and spatial variation in the implementation of the RBS programme to predict change in the rate of violent assaults in all Swedish municipalities during 1996–2009 (n=288; T=14; N=4 032). Yearly police-recorded violent assaults per 100 000 inhabitants aged 15 and above committed on weekend nights were used as a dependent variable. Programme fidelity was identified by means of survey data. A semilogarithmic fixed-effects spatial panel regression model was used to estimate the direct, indirect and total effects of the programme.

    Results The direct, indirect and total effects were −1.8% (95% CI −4.4% to 0.8%), −5.8% (95% CI −11.5% to −0.1%) and −7.6% (95% CI −13.2% to −2.2%), respectively. Averaged over time and across all municipalities, implementing one additional programme component in all municipalities will thus reduce violent assaults in one typical municipality by nearly 8%.

    Conclusions The indirect effect of the programme was three times larger than its direct effect. Failing to account for such local spillover effects can result in a considerable underestimation of the programme's total impact and may lead to erroneous policy recommendations.

  • 11.
    Bränstrom, Richard
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Yale University, USA.
    Minority stress factors as mediators of sexual orientation disparities in mental health treatment: a longitudinal population-based study2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 5, p. 446-452Article in journal (Refereed)
    Abstract [en]

    Background Substantial mental health disparities between lesbian, gay and bisexual (LGB) individuals compared with heterosexuals have been identified. The aim was to examine potential sexual orientation-based disparities in mental health treatment in a prospectively analysed population-based sample in Sweden and to explore potential moderators and mediators. Method 30 730 individuals from the Stockholm Public Health Cohort were followed up with questionnaires and registry-based health record data on psychiatric healthcare visits and prescription drug use between 1 January 2011 and 31 December 2011. Results In adjusted analyses, gay and lesbian individuals were more likely to receive treatment for anxiety disorders (adjusted ORs (AOR) = 3.80; 95% CI 2.54 to 5.69) and to use antidepressant medication (AOR= 2.13; 95% CI 1.62 to 2.79); and bisexuals were more likely to receive treatment for mood disorders (AOR = 1.58; 95% CI 1.00 to 2.48), anxiety disorders (AOR = 3.23; 95% CI 2.22 to 4.72) and substance use disorders (AOR = 1.91; 95% CI 1.12 to 3.25), and to use antidepressant medication (AOR = 1.91; 95% CI 1.12 to 3.25) when compared with heterosexuals. The largest mental health treatment disparities based on sexual orientation were found among bisexual women, gay men and younger lesbian women. More frequent experiences of victimisation/threat of violence and lack of social support could partially explain these disparities. Conclusions This study shows a substantially elevated risk of poor mental health among LGB individuals as compared with heterosexuals. Findings support several factors outlined in the minority stress theory in explaining the mechanisms behind these disparities.

  • 12.
    Chaparro, M. Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden; UCLA Fielding School of Public Health, USA.
    Whaley, Shannon E.
    Crespi, Catherine M.
    Koleilat, Maria
    Nobari, Tabashir Z.
    Seto, Edmund
    Wang, May C.
    Influences of the neighbourhood food environment on adiposity of low-income preschool-aged children in Los Angeles County: a longitudinal study2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 11, p. 1027-1033Article in journal (Refereed)
    Abstract [en]

    Background Few studies have examined the association between the food environment and adiposity in early childhood, a critical time for obesity prevention. The objective of this study was to examine the longitudinal association between neighbourhood food environment and adiposity among low-income preschool-aged children in a major metropolitan region in the USA. Methods The study sample was 32 172 low-income preschool-aged children in Los Angeles County who had repeated weight and height measurements collected between ages 2 and 5 years through a federal nutrition assistance programme. We conducted multilevel longitudinal analyses to examine how spatial densities of healthy and unhealthy retail food outlets in the children's neighbourhoods were related to adiposity, as measured by weight-for-height z-score (WHZ), while controlling for neighbourhood-level income and education, family income, maternal education, and child's gender and race/ethnicity. Results Density of healthy food outlets was associated with mean WHZ at age 3 in a non-linear fashion, with mean WHZ being lowest for those exposed to approximately 0.7 healthy food outlets per square mile and higher for lesser and greater densities. Density of unhealthy food outlets was not associated with child WHZ. Conclusions We found a non-linear relationship between WHZ and density of healthy food outlets. Research aiming to understand the sociobehavioural mechanisms by which the retail food environment influences early childhood obesity development is complex and must consider contextual settings.

  • 13.
    Chaparro, M. Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Whaley, Shannon E.
    Crespi, Catherine M.
    Koleilat, Maria
    Nobari, Tabashir Z.
    Seto, Edmund
    Wang, May C.
    Response to Letter to the Editor by Joe Brew, Department of Epidemiology, University of Florida2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 8, p. 817-817Article in journal (Refereed)
  • 14.
    Dadgar, Iman
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Norström, Thor
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Short-term and long-term effects of GDP on traffic deaths in 18 OECD countries, 1960-20112017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 2, p. 146-153Article in journal (Refereed)
    Abstract [en]

    Background Research suggests that increases in gross domestic product (GDP) lead to increases in traffic deaths plausibly due to the increased road traffic induced by an expanding economy. However, there also seems to exist a long-term effect of economic growth that is manifested in improved traffic safety and reduced rates of traffic deaths. Previous studies focus on either the short-term, procyclical effect, or the long-term, protective effect. The aim of the present study is to estimate the short-term and long-term effects jointly in order to assess the net impact of GDP on traffic mortality. Methods We extracted traffic death rates for the period 1960-2011 from the WHO Mortality Database for 18 OECD countries. Data on GDP/capita were obtained from the Maddison Project. We performed error correction modelling to estimate the short-term and long-term effects of GDP on the traffic death rates. Results The estimates from the error correction modelling for the entire study period suggested that a one-unit increase (US$1000) in GDP/capita yields an instantaneous short-term increase in the traffic death rate by 0.58 (p<0.001), and a long-term decrease equal to -1.59 (p<0.001). However, period-specific analyses revealed a structural break implying that the procyclical effect outweighs the protective effect in the period prior to 1976, whereas the reverse is true for the period 1976-2011. Conclusions An increase in GDP leads to an immediate increase in traffic deaths. However, after the mid-1970s this short-term effect is more than outweighed by a markedly stronger protective long-term effect, whereas the reverse is true for the period before the mid-1970s.

  • 15. Di Gessa, Giorgio
    et al.
    Corna, Laurie M.
    Platts, Loretta G.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Worts, Diana
    McDonough, Peggy
    Sacker, Amanda
    Price, Debora
    Glaser, Karen
    Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 5, p. 431-438Article in journal (Refereed)
    Abstract [en]

    Background Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early. Methods Our data come from waves 2-4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65-74 and women aged 60-69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood. Results Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant. Conclusions Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with.

  • 16. Einiö, Elina
    et al.
    Moustgaard, Heta
    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.
    Leinonen, Taina
    Does the risk of hospitalisation for ischaemic heart disease rise already before widowhood?2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 6, p. 599-605Article in journal (Refereed)
    Abstract [en]

    Background The death of a spouse has been shown to increase mortality from various causes, including ischaemic heart disease. It is unclear, however, whether cardiac problems are already on the rise before widowhood.

    Methods Using longitudinal register data of Finnish widows-to-be aged 65 and over at baseline (N=19 185), we assessed the risk of hospitalisation for ischaemic heart disease 18 months before and after widowhood. Hospital admissions were derived from national hospital discharge registers between 1996 and 2002. Analyses used population-averaged and fixed-effects logistic models, the latter of which controlled for unobserved time-invariant characteristics, such as genetic susceptibility, personality and behavioural and medical history.

    Results For men, fixed-effects model revealed that hospitalisation for ischaemic heart disease increased twofold already 0–3 months prior to the death of a spouse (OR=2.09, 95% CI 1.22 to 3.60), relative to the period of 15–18 months before widowhood. It stayed at a heightened level up to 6 months following bereavement (OR=2.15, 95% CI 1.07 to 4.30). Among women, the fixed-effects analysis detected no statistically significant increase in hospitalisation for ischaemic heart disease before or after widowhood.

    Conclusions These findings indicate that men are already vulnerable to cardiac problems before the death of a wife. Medical interventions and health counselling could be targeted to the husbands of terminally ill patients, in order to improve their cardiovascular health over the transition to widowhood.

  • 17.
    Ferrarini, Tommy
    et al.
    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).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Unemployment insurance and deteriorating self-rated health in 23 European countries2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 7, p. 657-662Article in journal (Refereed)
    Abstract [en]

    Background

    The global financial crisis of 2008 is likely to have repercussions on public health in Europe, not least through escalating mass unemployment, fiscal austerity measures and inadequate social protection systems. The purpose of this study is to analyse the role of unemployment insurance for deteriorating self-rated health in the working age population at the onset of the fiscal crisis in Europe.

    Methods

    Multilevel logistic conditional change models linking institutional-level data on coverage and income replacement in unemployment insurance to individuallevel panel data on self-rated health in 23 European countries at two repeated occasions, 2006 and 2009.

    Results

    Unemployment insurance significantly reduces transitions into self-rated ill-health and, particularly, programme coverage is important in this respect. Unemployment insurance is also of relevance for the socioeconomic gradients of health at individual level, where programme coverage significantly reduces health risks attached to educational attainment.

    Conclusions

    Unemployment insurance mitigated adverse health effects both at individual and country-level during the financial crisis. Due to the centrality of programme coverage, reforms to unemployment insurance should focus on extending the number of insured people in the labour force.

  • 18.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Modin, Bitte
    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).
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Socioeconomic inequalities in circulatory and all-cause mortality after retirement: the impact of mid-life income and old-age pension. Evidence from the Uppsala Birth Cohort Study2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 7, p. e16-Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore the impact of mid-life income and old-age pensions on the risk of mortality in later life. Furthermore, the study explored whether income inequalities in old-age mortality can be explained by differences in early childhood development, social class during childhood, education or marital status.

    Methods: The study sample comprises all individuals born at Uppsala Academic Hospital during the period 1915–1924 who had retired but not died or emigrated by 1991 (n=4156). Information on social and biological conditions was retrieved from national registries.

    Results: The results show that income during mid-life and income during retirement were associated with old-age mortality. However, mutually adjusted models showed that income in mid-life was more important for women's late-life mortality and that income during retirement was more important for men's late-life mortality. Furthermore, differences in education and marital status seemed to explain a substantial part of income inequalities in late-life mortality.

    Conclusions: It is unlikely that egalitarian social policies aimed at older populations can eradicate health inequalities accumulated over the life course. However, retirement income appears to have an effect on late-life mortality that is independent of the effect of income in mid-life, suggesting that egalitarian pension schemes could affect health inequalities in later life or, at the very least, slow down further accumulation of inequalities.

  • 19.
    Gauffin, Karl
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet.
    The effect of childhood socioeconomic position on alcohol-related disorders later in life: a Swedish national cohort study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 11, p. 932-938Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol use is the third most important global-health risk factor and a main contributor to health inequalities. Previous research on social determinants of alcohol-related disorders has delivered inconsistent results. We aimed to investigate whether socioeconomic position (SEP) in childhood predicts alcohol-related disorders in young adulthood in a Swedish national cohort.

    Methods: We studied a register-based national cohort of Swedish citizens born during 1973–1984 (N=948 518) and followed them up to 2009 from age 15. Childhood SEP was defined by a six-category socioeconomic index from the Censuses of 1985 and 1990. Rs of alcohol-related disorders, as indicated by register entries on alcohol-related death and alcohol-related medical care, were analysed in Cox regression models with adjustment for sociodemographic variables and indicators of parental morbidity and criminality.

    Results: Low childhood SEP was associated with alcohol-related disorders later in life among both men and women in a stepwise manner. Growing up in a household with the lowest SEP was associated with risk for alcohol-related disorders of HR: 2.24 (95% CI 2.08 to 2.42) after adjustment for sociodemographic variables, compared with the highest SEP group. Adjusting the analysis for parental psychosocial problems attenuated the association to HR 1.87 (95% CI 1.73 to 2.01).

    Conclusions: The study demonstrates that low SEP in childhood predicts alcohol-related disorders in young adulthood. Alcohol abuse needs to be addressed in policies to bridge the gap of health inequalities.                                                                                 

  • 20.
    Gisselmann, Marit
    et al.
    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).
    De Stavola, B. L.
    The combined influence of parental education and preterm birth on school performance2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, no 9, p. 764-769Article in journal (Refereed)
    Abstract [en]

    Background Social background and birth characteristics are generally found to be independently associated with school achievements but the underlying mechanisms are not fully understood. This study aimed to explore how parental education and shorter gestational age jointly influence school performance in a cohort of Swedish children.

    Methods 10 835 children born between 1973 and 1981 were studied, the third generation of the register-based Uppsala Multigenerational Birth Cohort. Ordinal logistic regression models were fitted to estimate OR of achieving middle and high grades in Swedish language at age 16 years, relative to low grade, by parental education and own gestational age, adjusting for potential confounders.

    Results In children from families with lower parental education, the adjusted OR of receiving a higher grade was 0.54 (95% CI 0.41 to 0.71) for preterm (<37 completed weeks) compared with full-term births. This estimate did not change when adjusted for several potential confounders (0.59; CI 0.44 to 0.79). When different cut-points were selected to define preterm birth, the estimated OR for those with low parental education decreased linearly from 0.83 (CI 0.72 to 0.96) using less than 39 weeks as the cut-point, to 0.52 (CI 0.30 to 0.90) using less than 35 weeks. There was no evidence of significant effects of shorter gestational age for children with parents from other educational groups.

    Conclusions The disadvantage of shorter gestational age on the chance of achieving higher grades in Swedish language was confined to children from families in which none of the parents had higher education. This suggests that the detrimental influence of shorter gestational age on school performance in language may be avoidable.

  • 21. Goodman, Anna
    et al.
    Gisselmann, Marit
    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).
    Birth characteristics and early-life social characteristics predict unequal educational outcomes: consistency across Swedish cohorts born 1915-1929 and 1973-1981 (abstract)2010In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 64, no Suppl 1, p. Abstract ref 027-Article in journal (Refereed)
  • 22.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine.
    Heshmati, Amy
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Malki, Ninoa
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    PL03 Associations between Birth Characteristics and Eating Disorders Across the Life Course: findings from two Million Males and Females Born in Sweden 1975-19982013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no S 1, p. A46-Article in journal (Refereed)
    Abstract [en]

    Background: Recent years have seen considerable interest in the developmental origins of eating disorders (ED) but results have been conflicting, perhaps reflecting low power in many studies. Limited power has also prevented robust comparisons of associations with ED subtypes or the use of within-family designs to address the potential for confounding.

    Methods: We used total population data to create a cohort of 2,011,908 males and females, born 1975-1998 in Sweden to Swedish-born mothers. Birth characteristics included twin/triplet status; gestational age; birthweight; birth length; premature rupture of the membranes; delivery method; Apgar score at 5 minutes; birth traumas; mother’s smoking during pregnancy; and mother’s weight gain during pregnancy. We adjusted for multiple family and social characteristics, and conducted within-family analyses to test for confounding at the maternal/family level. Our outcomes were hospitalisation for anorexia, bulimia or eating disorder not-otherwise-specified (EDNOS)’ after age 12, with follow-up period until end 2010.

    Results: Anorexia was independently predicted by multiple birth (AOR 1.33 [95% CI 1.15, 1.53] for twin/triplet vs. singleton) and lower gestational age (HR 0.96 [0.95, 0.98] per extra week of gestation). Gestational age showed a clear dose-response pattern. These associations were largely specific to anorexia, and were only seen in the cohort members affected; within-family analyses revealed that the maternal siblings of twins or preterm individuals showed no increased risk, and provided no evidence of residual maternal-level confounding. Higher birthweight for gestational age showed a strong, positive dose-response association with bulimia (HR 1.15 [1.09, 1.22]) per sex-standardised standard deviation increase). Again, this association was specific to bulimia and within-family analyses provided no evidence of residual confounding. By contrast, although mother’s smoking predicted anorexia, this did seem likely to reflect maternal-level confounding. Other birth characteristics showed little or no association with any ED outcome, except a trend towards increased bulimia and EDNOS among mothers who gained excessive weight during pregnancy.

    Conclusion: These findings are consistent with a causal role of earlier gestational age upon anorexia and higher birthweight upon bulimia. Further research is needed to elucidate the mechanisms, but the dose-response nature of these associations indicates that they do not simply reflect pathological responses at the extremes of the distribution. The strong association with multiple births is noteworthy as many of the largest population-based studies of ED prevalence have been conducted in twins: our findings suggest the possibility that such studies substantially overestimate ED prevalence.

  • 23. Goodman, Anna
    et al.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social and biological determinants of reproductive success in Swedish males and females2009In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 63(SupplI), p. A2-A3Article in journal (Refereed)
  • 24. Gustafsson, Per E
    et al.
    Janlert, Urban
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Socioeconomic status over the life course and allostatic load in adulthood: results from the Northern Swedish Cohort.2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, no 11, p. 986-92Article in journal (Refereed)
    Abstract [en]

    Background Although several studies have reported rather consistent associations between socioeconomic status (SES) and allostatic load (AL), so far no study has examined the influence of SES over the life course on AL. The aim of the present study was to investigate the association between SES over the life course and AL in mid-adulthood, guided by the conceptual models of cumulative risk, critical period and social chain of risk. Methods The sample comprises a 27-year prospective cohort (n=1071) from northern Sweden. Participants (n=855, 79.8%) completed questionnaires at the ages of 16, 21, 30 and 43&emsp14;years. A health examination was performed at age 43&emsp14;years after an overnight fast, including physical examination and blood sampling, and participants completed 1-day salivary cortisol sampling (four samples). SES was based on parental occupation at age 16&emsp14;years and participants' own occupation at ages 21, 30 and 43&emsp14;years. Information on daily smoking, snuff use, high alcohol consumption and physical inactivity was reported by the participants. An AL index was constructed from tertiles of 12 biological parameters. Results Cumulative socioeconomic disadvantage was related to AL in both women and men. The association was largely explained by health behaviours in men, but was independent of health behaviours in women. In women, an association was observed between AL and SES in adolescence, whereas in men only current SES was related to AL, independently of current health behaviours. Conclusions SES over the life course influences the level of multi-systemic dysregulation in mid-adulthood, with the strongest support for the cumulative risk model.

  • 25.
    Hasson, Dan
    et al.
    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.
    Canlon, Barbara
    Prevalence and characteristics of hearing problems in a working and non-working Swedish population2010In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 64, no 5, p. 453-60Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hearing problems are among the top 10 most common burdens of disease and are projected to be become even more common by the year 2030. The aim of the present study was to give a current assessment of the prevalence of communication difficulties because of hearing loss and tinnitus, in the general Swedish working and non-working populations in relation to sex, age, socioeconomic status (SES) and noise exposure. How prevalence is affected by SES has not been previously established. METHODS: A total of 18 734 individuals were invited to participate in the study, of which 11 441 (61%) enrolled. Of the participants, 9756 answered the questionnaire for those who work and 1685 answered the version for non-workers. FINDINGS: The most important findings are that 31% in the working population and 36% in the non-working population report either hearing loss or tinnitus or both. The prevalence of hearing problems increases with age, is higher among men and persons with low self-rated SES, and covaries with exposure to noise at work. Severe hearing problems are already present in men and women under 40 years of age who are exposed to work-related noise. INTERPRETATION: Prevalence of hearing problems is far more common than previously estimated and is associated with SES and noise exposure history. Hearing problems have a gradual onset that can take years to become recognised. In order to proactively intervene and prevent this deleterious, yet avoidable handicap, statistics need to be regularly updated.

  • 26. Herttua, Kimmo
    et al.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    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.
    Influence of affordability of alcohol on educational disparities in alcohol-related mortality in Finland and Sweden: a time series analysis2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 12, p. 1168-1176Article in journal (Refereed)
    Abstract [en]

    Background: Prices of alcohol and income tend to influence how much people buy and consume alcohol. Price and income may be combined into one measure, affordability of alcohol. Research on the association between affordability of alcohol and alcohol-related harm is scarce. Furthermore, no research exists on how this association varies across different subpopulations. We estimated the effects of affordability of alcohol on alcohol-related mortality according to gender and education in Finland and Sweden.

    Methods: Vector-autoregressive time series modelling was applied to the quarter-annual aggregations of alcohol-related deaths and affordability of alcohol in Finland in 1988–2007 and in Sweden in 1991–2008. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. We calculated affordability of alcohol index using information on personal taxable income and prices of various types of alcohol.

    Results: Among Finnish men with secondary education,an increase of 1% in the affordability of total alcohol was associated with an increase of 0.028% (95% CI 0.004 to 0.053) in alcohol-related mortality. Similar associations were also found for affordability for various types of alcohol and for beer only in the lowest education group. We found few other significant positive associations for other subpopulations in Finland or Sweden. However, reverse associations were found among secondary-educated Swedish women.

    Conclusions: Overall, the associations between affordability of alcohol and alcohol-related mortality were relatively weak. Increased affordability of total alcoholic beverages was associated with higher rates of alcohol-related mortality only among Finnish men with secondary education.

  • 27.
    Heshmati, Amy Frances
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mishra, Gita
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). 2School of Population Health, University of Queensland.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Childhood and adulthood socio-economic position and hypertensive disorders in pregnancy: the Uppsala Birth Cohort Multigenerational Study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 11, p. 939-946Article in journal (Refereed)
    Abstract [en]

    Background Childhood and adulthood socio-economic position (SEP) is associated with cardiovascular disease in later life, but associations with hypertensive disorders in pregnancy are not well established.                                 

    Objective The aim of this study was to investigate the association of childhood and adulthood SEP with hypertensive disorders in pregnancy (chronic hypertension, gestational hypertension and pre-eclampsia/eclampsia).                                 

    Method Study participants were Swedish women (n=9507) from generation 3 of the Uppsala Birth Cohort Multigenerational Study (UBCoS Multigen) who delivered a live singleton offspring between 1982 and 2008. Social and health data were obtained from routine Swedish registers. Associations of own education (adulthood SEP), and parental education and social class (childhood SEP) with hypertensive disorders were studied using logistic regression with adjustments for age, calendar period, parity, smoking and body mass index.                                 

    Results Low own education was associated with chronic hypertension, but not with gestational hypertension or pre-eclampsia/eclampsia. Increased risk of chronic hypertension was seen in women whose mothers had medium education compared with women whose mothers had high education (OR 2.18, 95% CI 1.03 to 4.62). Women from a manual social class during childhood had twice the risk of chronic hypertension compared with those from non-manual backgrounds (OR 2.19, 95% CI 1.28 to 3.75). Childhood SEP was not associated with gestational hypertension or pre-eclampsia/eclampsia.                                 

    Conclusions Childhood and adulthood SEP was associated with chronic hypertension in pregnancy. In contrast, no association with childhood or adulthood SEP was seen for gestational hypertension or pre-eclampsia/eclampsia.

  • 28. Holowko, Natalie
    et al.
    Chaparro, M. Pia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Nilsson, Katarina
    Ivarsson, Anneli
    Mishra, Gita
    Koupil, Illona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, UK .
    Social inequality in pre-pregnancy BMI and gestational weight gain in the first and second pregnancy among women in Sweden.2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 12, p. 1154-1161Article in journal (Refereed)
    Abstract [en]

    Background High pre-pregnancy body mass index (BMI) and inappropriate gestational weight gain (GWG) are associated with adverse short and long-term maternal and neonatal outcomes and may act as modifiable risk factors on the path to overweight/obesity, but their social patterning is not well established. This study investigates the association of education with BMI and GWG across two consecutive pregnancies. Methods The study includes 163 352 Swedish women, having their first and second singleton birth in 1982-2010. In both pregnancies, we investigated the association of women's education with (1) pre-pregnancy weight status and (2) adequacy of GWG. We used multinomial logistic regression, adjusting for child's birth year, mother's age and smoking status. Results Overall, the odds of starting either pregnancy at an unhealthy BMI were higher among women with a low education compared to more highly-educated women. Lower education also predicted a greater increase in BMI between pregnancies, with this effect greatest among women with excessive GWG in the first pregnancy (p<0.0001 for interaction). Education was also inversely associated with odds of excessive GWG in both pregnancies among healthy weight status women, but this association was absent or even weakly reversed among overweight and obese women. Conclusions Lower educated women had the largest BMI increase between pregnancies, and these inequalities were greatest among women with excessive GWG in the first pregnancy. The importance of a healthy pre-pregnancy BMI, appropriate GWG and a healthy postpartum weight should be communicated to all women, which may assist in reducing existing social inequalities in body weight.

  • 29.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Lund University, Sweden .
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of London, UK .
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden .
    From cradle to grave: tracking socioeconomic inequalities in mortality in a cohort of 11 868 men and women born in Uppsala, Sweden, 1915-19292016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 6, p. 569-575Article in journal (Refereed)
    Abstract [en]

    Background: Ample evidence has shown that early-life social conditions are associated with mortality later in life. However, little attention has been given to the strength of these effects across specific age intervals from birth to old age. In this paper, we study the effect of the family's socioeconomic position and mother's marital status at birth on all-cause mortality at different age intervals in a Swedish cohort of 11 868 individuals followed across their lifespan.

    Methods: Using the Uppsala Birth Cohort Multigenerational Study, we fitted Cox regression models to estimate age-varying HRs of all-cause mortality according to mother's marital status and family's socioeconomic position.

    Results: Mother's marital status and family's socioeconomic position at birth were associated with higher mortality rates throughout life (HR 1.18 (95% CI 1.12 to 1.26) for unmarried mothers; 1.19 (95% CI 1.12 to 1.25) for low socioeconomic position). While the effect of family's socioeconomic position showed little variation across different age groups, the effect of marital status was stronger for infant mortality (HR 1.47 (95% CI 1.23 to 1.76); p=0.04 for heterogeneity). The results remained robust when early life and adult mediator variables were included.

    Conclusions: Family's socioeconomic position and mother's marital status involve different dimensions of social stratification with independent effects on mortality throughout life. Our findings support the importance of improving early-life conditions in order to enhance healthy ageing.

  • 30.
    Keller Celeste, Roger
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Federal University of Rio Grande do Sul, Brazil.
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Do socioeconomic inequalities in pain, psychological distress and oral health increase or decrease over the life course? Evidence from Sweden over 43 years of follow-up2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 2, p. 160-167Article in journal (Refereed)
    Abstract [en]

    Background Inequalities over the life course may increase due to accumulation of disadvantage or may decrease because ageing can work as a leveller. We report how absolute and relative socioeconomic inequalities in musculoskeletal pain, oral health and psychological distress evolve with ageing. Methods Data were combined from two nationally representative Swedish panel studies: the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Individuals were followed up to 43 years in six waves (1968, 1974, 1981, 1991/1992, 2000/2002, 2010/2011) from five cohorts: 1906-1915 (n=899), 1925-1934 (n=906), 1944-1953 (n=1154), 1957-1966 (n=923) and 1970-1981 (n=1199). The participants were 15-62 years at baseline. Three self-reported outcomes were measured as dichotomous variables: teeth not in good conditions, psychological distress and musculoskeletal pain. The fixed-income groups were: (A) never poor and (B) poor at least once in life. The relationship between ageing and the outcomes was smoothed with locally weighted ordinary least squares, and the relative and absolute gaps were calculated with Poisson regression using generalised estimating equations. Results All outcomes were associated with ageing, birth cohort, sex and being poor at least once in live. Absolute inequalities increased up to the age of 45-64 years, and then they decreased. Relative inequalities were large already in individuals aged 15-25years, showing a declining trend over the life course. Selective mortality did not change the results. The socioeconomic gap was larger for current poverty than for being poor at least once in life. Conclusion Inequalities persist into very old age, though they are more salient in midlife for all three outcomes observed.

  • 31. Kondo, N.
    et al.
    Rostila, Mikael
    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).
    Rising inequality in mortality among working-age men and women in Sweden: a national registry-based repeated cohort study, 1990-20072014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 12, p. 1145-1150Article in journal (Refereed)
  • 32.
    Leineweber, Constanze
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kivimäki, M.
    Westerholm, P.
    Alfredsson, L.
    Covert coping with unfair treatment at work and risk of incident myocardial infarction and cardiac death among men: prospective cohort study2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, no 5, p. 420-425Article in journal (Refereed)
    Abstract [en]

    Background: Covert coping with unfair treatment at work-occurring when an employee does not show the "aggressor" that he/she feels unfairly treated-has been found to be associated with cardiovascular risk factors. This study examined whether covert coping also predicts incident coronary heart disease.

    Methods: A prospective cohort study (the WOLF Stockholm study) of workplaces in the Stockholm area, Sweden. The participants were 2755 men with no history of myocardial infarction at baseline screening in 1992-1995. The main outcome measure was hospitalisation due to myocardial infarction or death from ischaemic heart disease until 2003 obtained from national registers (mean follow-up 9.8±0.9 years).

    Results: Forty-seven participants had myocardial infarction or died from ischaemic heart disease during follow-up. After adjustment for age, socioeconomic factors, risk behaviours, job strain and biological risk factors at baseline, there was a dose-response relationship between covert coping and risk of incident myocardial infarction or cardiac death (p for trend=0.10). Men who frequently used covert coping had a 2.29 (95% CI 1.00 to 5.29) times higher risk than those who did not use coping. Restricting the analysis to direct coping behaviours only strengthened this association (p for trend=0.02).

    Conclusions: In this study, covert coping is strongly related to increased risk of hard-endpoint cardiovascular disease.

  • 33.
    Leinsalu, Mall
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Vågerö, Denny
    Kunst, Anton E
    Increasing ethnic differences in mortality in Estonia after the collapse of the Soviet Union.2004In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 58, no 7, p. 583-589Article in journal (Refereed)
    Abstract [en]

    Study objective: This study examined the change in ethnic differences in mortality in Estonia 1989–2000.

    Design: Two unlinked cross sectional census based analyses were compared. Total and cause specific mortality was analysed for ethnic Estonians and Russians. The absolute differences in mortality were evaluated through life expectancy at birth and age standardised mortality rates. Relative differences were assessed by mortality rate ratios with 95% confidence intervals, calculated using Poisson regression.

    Setting: Estonia before and after the fall of the Soviet Union.

    Participants: Individual cause specific death data for 1987–1990 (69 549 deaths) and for 1999–2000 (33 809 deaths) came from the national mortality database. Population denominators came from the population censuses of 1989 and 2000.

    Main results: In the period 1989–2000, ethnic differences in life expectancy increased from 0.4 years to 6.1 years among men and from 0.6 years to 3.5 years among women. In 2000, Russians had a higher mortality than Estonians in all age groups and for almost all selected causes of death. The largest differences were found for some alcohol related causes of death especially in 2000.

    Conclusions: Political and economic upheaval, increasing poverty, and alcohol consumption can be considered the main underlying causes of the widening ethnic mortality gap.

  • 34. Lu, Wentian
    et al.
    Benson, Rebecca
    Glaser, Karen
    Platts, Loretta G.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Corna, Laurie M.
    Worts, Diana
    McDonough, Peggy
    Di Gessa, Giorgio
    Price, Debora
    Sacker, Amanda
    Relationship between employment histories and frailty trajectories in later life: evidence from the English Longitudinal Study of Ageing2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 5, p. 439-445Article in journal (Refereed)
    Abstract [en]

    Background Given the acceleration of population ageing and policy changes to extend working lives, evidence is needed on the ability of older adults to work for longer. To understand more about the health impacts of work, this study examined the relationship between employment histories before retirement and trajectories of frailty thereafter. Methods The sample comprised 2765 women and 1621 men from the English Longitudinal Study of Ageing. We used gendered typologies of life-time employment and a frailty index (FI). Multilevel growth curve models were used to predict frailty trajectories by employment histories. Results Women who had a short break for family care, then did part-time work till 59 years had a lower FI after 60 years than those who undertook full-time work until 59 years. Women who were largely family carers or non-employed throughout adulthood, had higher levels of frailty at 60 years but experienced a slower decline with age. Men who worked full-time but early exited at either 49 or 60 years had a higher FI at 65 years than those who worked full-time up to 65 years. Interaction between employment histories and age indicated that men in full-time work who experienced an early exit at 49 tended to report slower declines. Conclusions For women, experiencing distinct periods throughout the lifecourse of either work or family care may be advantageous for lessening frailty risk in later life. For men, leaving paid employment before 65 years seems to be beneficial for decelerating increases in frailty thereafter. Continuous full-time work until retirement age conferred no long-term health benefits.

  • 35. Mackenbach, J. P.
    et al.
    Kulhánová, I.
    Menvielle, G.
    Bopp, M.
    Borrell, C.
    Costa, G.
    Deboosere, P.
    Esnaola, S.
    Kalediene, R.
    Kovacs, K.
    Leinsalu, M.
    Martikainen, P.
    Regidor, E.
    Rodriguez-Sanz, M.
    Strand, B. H.
    Hoffmann, R.
    Eikemo, T. A.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Mid-Sweden University , Sweden.
    Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 3, p. 207-217Article in journal (Refereed)
    Abstract [en]

    Background Over the last decades of the 20th century, a widening of the gap in death rates between upper and lower socioeconomic groups has been reported for many European countries. For most countries, it is unknown whether this widening has continued into the first decade of the 21st century. Methods We collected and harmonised data on mortality by educational level among men and women aged 30-74 years in all countries with available data: Finland, Sweden, Norway, Denmark, England and Wales, Belgium, France, Switzerland, Spain, Italy, Hungary, Lithuania and Estonia. Results Relative inequalities in premature mortality increased in most populations in the North, West and East of Europe, but not in the South. This was mostly due to smaller proportional reductions in mortality among the lower than the higher educated, but in the case of Lithuania and Estonia, mortality rose among the lower and declined among the higher educated. Mortality among the lower educated rose in many countries for conditions linked to smoking (lung cancer, women only) and excessive alcohol consumption (liver cirrhosis and external causes). In absolute terms, however, reductions in premature mortality were larger among the lower educated in many countries, mainly due to larger absolute reductions in mortality from cardiovascular disease and cancer (men only). Despite rising levels of education, population-attributable fractions of lower education for mortality rose in many countries. Conclusions Relative inequalities in premature mortality have continued to rise in most European countries, and since the 1990s, the contrast between the South (with smaller inequalities) and the East (with larger inequalities) has become stronger. While the population impact of these inequalities has further increased, there are also some encouraging signs of larger absolute reductions in mortality among the lower educated in many countries. Reducing inequalities in mortality critically depends upon speeding up mortality declines among the lower educated, and countering mortality increases from conditions linked to smoking and excessive alcohol consumption such as lung cancer, liver cirrhosis and external causes.

  • 36.
    Magnusson Hanson, Linda. L.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Chungkham, Holendro Singh
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Indian Statistical Institute, India.
    Ferrie, Jane
    Sverke, Magnus
    Stockholm University, Faculty of Social Sciences, Department of Psychology. North-West University, South Africa.
    Threats of dismissal and symptoms of major depression: a study using repeat measures in the Swedish working population2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 10, p. 963-969Article in journal (Refereed)
    Abstract [en]

    Background Job insecurity is considered a profound work stressor. While previous research has indicated that job insecurity represents a substantial mental health burden, few studies have examined its relationship with symptoms of major depression. The aim of this study was to assess whether episodic and repeated self-reported threats of dismissal increase the risk of subsequent symptoms of major depression and whether symptoms of major depression are related to subsequent experience of threats of dismissal. Methods The study is based on the Swedish Longitudinal Occupational Survey of Health (SLOSH) study, a cohort study with multiple repeated measurements. The sample consisted of 6275 participants who were in regular paid employment and who provided data in 2008, 2010 and 2012. Severity of depression was assessed with a brief Symptom Checklist scale and categorised according to symptoms of major depression or not. Results Results based on generalised estimating equations logit models showed that prior threats of dismissal predicted symptoms of major depression OR 1.37; 95% CI 1.04 to 1.81) after adjustment for prior depression and major confounders. Especially related threats increased the risk of major depression symptoms (OR 1.74 CI 1.09 to 2.78). Major depression symptoms also increased the odds of subsequent threats of dismissal (OR 1.52, CI 1.17 to 1.98). Conclusions These findings support a prospective association between threats of dismissal and symptoms of major depression, in particular repeated exposure to threats of dismissal. The results also indicate that threats of dismissal are more likely to be reported by workers with symptoms of major depression.

  • 37. Modig, K.
    et al.
    Talbäck, M.
    Torssander, Jenny
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Ahlbom, A.
    Payback time? Influence of having children on mortality in old age2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 5, p. 424-430Article in journal (Refereed)
    Abstract [en]

    Background It is known that parents have lower mortality than childless individuals. Support from adult children to ageing parents may be of importance for parental health and longevity. The aim of this study was to estimate the association between having a child and the risk of death, and to examine whether the association increased at older ages when health starts to deteriorate and the need of support from a family member increases.

    Methods In this nationwide study, all men and women (born between 1911 and 1925 and residing in Sweden), as well as their children, were identified in population registers and followed over time. Age-specific death risks were calculated for each calendar year for individuals having at least one child and for individuals without children. Adjusted risk differences and risk ratios were estimated.

    Results Men and women having at least one child experienced lower death risks than childless men and women. At 60 years of age, the difference in life expectancy was 2 years for men and 1.5 years for women. The absolute differences in death risks increased with parents' age and were somewhat larger for men than for women. The association persisted when the potential confounding effect of having a partner was taken into account. The gender of the child did not matter for the association between parenthood and mortality.

    Conclusions Having children is associated with increased longevity, particularly in an absolute sense in old age. That the association increased with parents' age and was somewhat stronger for the non-married may suggest that social support is a possible explanation.

  • 38. Mäki, Netta E.
    et al.
    Martikainen, Pekka T.
    Eikemo, Terje
    Menvielle, Gwenn
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Mid Sweden University, Sweden.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mackenbach, Johan P.
    The potential for reducing differences in life expectancy between educational groups in five European countries: the effects of obesity, physical inactivity and smoking2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 7, p. 653-640Article in journal (Refereed)
    Abstract [en]

    Introduction This study assesses the effects of obesity, physical inactivity and smoking on life expectancy (LE) differences between educational groups in five European countries in the early 2000s. Methods We estimate the contribution of risk factors on LE differences between educational groups using the observed risk factor distributions and under a hypothetically more optimal risk factor distribution. Data on risk factor prevalence were obtained from the Survey of Health, Ageing and Retirement in Europe study, and data on mortality from census-linked data sets for the age between 50 and 79 according to sex and education. Results Substantial differences in LE of up to 2.8 years emerged between men with a low and a high level of education in Denmark, Austria and France, and smaller differences among men in Italy and Spain. The educational differences in LE were not as large among women. The largest potential for reducing educational differences was in Denmark (25% among men and 41% among women) and Italy (14% among men). Conclusions The magnitude of the effect of unhealthy behaviours on educational differences in LE varied between countries. LE among those with a low or medium level of education could increase in some European countries if the behavioural risk factor distributions were similar to those observed among the highly educated.

  • 39.
    Nilsen, Charlotta
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Shaw, Benjamin A.
    Does the association between leisure activities and survival in old age differ by living arrangement?2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 1, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Background Government policies to promote ageing in place have led to a growing frail population living at home in advanced old age, many of whom live alone. Living alone in old age is associated with adverse health outcomes, but we know little about whether it moderates the health impact of other risk and protective factors. Engagement in leisure activities is considered critical to successful ageing. We investigated whether the association between different types of leisure activities and survival in non-institutionalised older adults (aged 76 and above) differs by living arrangement and gender. Methods We used the Swedish Panel Study of Living Conditions of the Oldest Old study from 2011 and the Swedish Cause of Death Register (until 30 June 2014) to conduct Cox regression analyses (n=669). Incident mortality was 30.2% during the follow-up period. Results Overall level of leisure activity was not significantly associated with survival in either living arrangement, but some specific leisure activities, and associations, were different across gender and living arrangement. More specifically, certain social activities (participation in organisations and having relatives visit) were associated with longer survival, but only in men living alone. In women, most results were statistically non-significant, with the exception of solving crosswords being associated with longer survival in women living with someone. Conclusion In order to facilitate engagement with life, interventions focusing on leisure activities in the oldest age groups should take gender and living arrangement into consideration when determining the type of activity most needed.

  • 40.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Grönqvist, Hans
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    The Great Recession, unemployment and suicide2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 2, p. 110-116Article in journal (Refereed)
    Abstract [en]

    Background: How have suicide rates responded to the marked increase in unemployment spurred by the Great Recession? Our paper puts this issue into a wider perspective by assessing (1) whether the unemployment-suicide link is modified by the degree of unemployment protection, and (2) whether the effect on suicide of the present crisis differs from the effects of previous economic downturns.

    Methods: We analysed the unemployment-suicide link using time-series data for 30 countries spanning the period 1960-2012. Separate fixed-effects models were estimated for each of five welfare state regimes with different levels of unemployment protection (Eastern, Southern, Anglo-Saxon, Bismarckian and Scandinavian). We included an interaction term to capture the possible excess effect of unemployment during the Great Recession.

    Results: The largest unemployment increases occurred in the welfare state regimes with the least generous unemployment protection. The unemployment effect on male suicides was statistically significant in all welfare regimes, except the Scandinavian one. The effect on female suicides was significant only in the eastern European country group. There was a significant gradient in the effects, being stronger the less generous the unemployment protection. The interaction term capturing the possible excess effect of unemployment during the financial crisis was not significant.

    Conclusions: Our findings suggest that the more generous the unemployment protection the weaker the detrimental impact on suicide of the increasing unemployment during the Great Recession.

  • 41. Pega, Frank
    et al.
    Carter, Kristie
    Kawachi, Ichiro
    Davis, Peter
    Gunasekara, Fiona Imlach
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet.
    Blakely, Tony
    The impact of in-work tax credit for families on self-rated health in adults: a cohort study of 6900 New Zealanders2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 8, p. 682-688Article in journal (Refereed)
    Abstract [en]

    Background In-work tax credit (IWTC) for families, a welfare-to-work policy intervention, may impact health status by improving income and employment. Most studies estimate that IWTCs in the USA and the UK have no effect on self-rated health (SRH) and several other health outcomes, but these estimates may be biased by confounding. The current study estimates the impact of one such IWTC intervention (called In-Work Tax Credit) on SRH in adults in New Zealand, controlling more fully for confounding. Methods We used data from seven waves (2002-2009) of the Survey of Family, Income and Employment, restricted to a balanced panel of adults in families. The exposures, eligibility for IWTC and the amount of IWTC a family was eligible for, were derived for each wave by applying government eligibility and entitlement criteria. The outcome, SRH, was collected annually. We used fixed effects regression analyses to eliminate time-invariant confounding and adjusted for measured time-varying confounders. Results Becoming eligible for IWTC was associated with no detectable change in SRH over the past year (=0.001, 95% CI -0.022 to 0.023). A $1000 increase in the IWTC amount a family was eligible for increased SRH by 0.003 units (95% CI -0.005 to 0.011). Conclusions This study found that becoming eligible for IWTC or a substantial increase in the IWTC amount was not associated with any detectable difference in SRH over the short term. Future research should investigate the impact of IWTC on health over the longer term.

  • 42. Pivodic, Lara
    et al.
    Pardon, Koen
    Morin, Lucas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). French National Observatory on End-of-Life Care, Paris, France.
    Addington-Hall, Julia
    Miccinesi, Guido
    Cardenas-Turanzas, Marylou
    Onwuteaka-Philipsen, Bregje
    Naylor, Wayne
    Ramos, Miguel Ruiz
    Van den Block, Lieve
    Wilson, Donna M.
    Loucka, Martin
    Csikos, Agnes
    Rhee, Yong Joo
    Teno, Joan
    Deliens, Luc
    Houttekier, Dirk
    Cohen, Joachim
    Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 1, p. 17-24Article in journal (Refereed)
    Abstract [en]

    Background Studying where people die across countries can serve as an evidence base for health policy on end-of-life care. This study describes the place of death of people who died from diseases indicative of palliative care need in 14 countries, the association of place of death with cause of death, sociodemographic and healthcare availability characteristics in each country and the extent to which these characteristics explain country differences in the place of death. Methods Death certificate data for all deaths in 2008 (age >= 1 year) in Belgium, Canada, the Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (Andalusia), the USA and Wales caused by cancer, heart/renal/liver failure, chronic obstructive pulmonary disease, diseases of the nervous system or HIV/AIDS were linked with national or regional healthcare statistics (N=2 220 997). Results 13% (Canada) to 53% (Mexico) of people died at home and 25% (the Netherlands) to 85% (South Korea) died in hospital. The strength and direction of associations between home death and cause of death, sociodemographic and healthcare availability factors differed between countries. Differences between countries in home versus hospital death were only partly explained by differences in these factors. Conclusions The large differences between countries in and beyond Europe in the place of death of people in potential need of palliative care are not entirely attributable to sociodemographic characteristics, cause of death or availability of healthcare resources, which suggests that countries' palliative and end-of-life care policies may influence where people die.

  • 43.
    Rajaleid, K.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Manor, O.
    Koupil, I.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Does the strength of the association between foetal growth rate and ischaemic heart disease mortality differ by social circumstances in early or later life?2008In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 62, no 5, p. e6-Article in journal (Refereed)
    Abstract [en]

    Objective: To study whether the effect of size at birth on the risk of ischaemic heart disease (IHD) death is modified by social circumstances in childhood or in adulthood.

    Design: A cohort study. Data on circumstances at birth were retrieved from archived obstetric records, social characteristics in adulthood and mortality follow-up through routine registers.

    Participants: 6159 men and 5663 women who were born in Uppsala University Hospital, Sweden (the Uppsala Birth Cohort) during 1915–1929, were singleton births with more than 30 weeks of gestational age and were alive in 1961. Follow-up time 1961–2002 (from age 31–46 to 73–88 years).

    Main outcome measure: Death from IHD. Multivariate Cox regression with age as the time scale, controlling for year of birth and stratified by gender.

    Results: The risk of IHD death was lower among men and women with higher weight for gestational age. Lower social class in adulthood was associated with a higher risk of IHD death. The effect of size at birth on IHD mortality did not appear to be modified by social class at birth but was only present in men of higher social class in adulthood (hazard ratio per 1 SD weight for gestational age 0.84, 95% CI 0.75 to 0.93).

    Conclusions: Weight for gestational age was inversely associated with the risk of IHD death in men and women; this effect was present in men of non-manual adult social class only but did not appear to be modified by adult social class in women or by social class at birth in either men or women.

  • 44.
    Rojas, Yerko
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Stenberg, Sten-Åke
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Evictions and suicide: a follow up study of almost 22,000 Swedish households in the wake of the global financial crisis2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 4, p. 409-413Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Millions of families across the world are evicted every year. However, very little is known about the impact that eviction has on their lives. This lack of knowledge is also starting to be noticed within the suicidological literature, and prominent scholars are arguing that there is an urgent need to explore the extent to which suicides may be considered a plausible consequence of being faced with eviction.

    METHOD: The present study's sample consists of all persons served with an application for execution of an eviction order during 2009-2012. This group is compared to a random 10% sample of the general Swedish population, ages 16 years and over. The analysis is based on penalised maximum likelihood logistic regressions.

    RESULTS: Those who had lost their legal right to their dwellings and for whom the landlord had applied for the eviction to be executed were approximately four times more likely to commit suicide than those who had not been exposed to this experience (OR=4.42), controlling for several demographic, socioeconomic and mental health conditions prior to the date of the judicial decision.

    CONCLUSIONS: Home evictions have a significant and detrimental impact on individuals' risk of committing suicide, even when several other well-known suicidogenic risk factors are controlled for. Our results reinforce the importance of ongoing attempts to remove the issue of evictions from its status as a hidden and neglected social problem.

  • 45.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, J.
    Kawachi, I.
    Mortality in parents following the death of a child: A nationwide follow-up study from Sweden2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738Article in journal (Refereed)
  • 46.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, Jan
    Kawachi, Ichiro
    Mortality in parents following the death of a child: a nationwide follow-up study from Sweden2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 10, p. 927-933Article in journal (Refereed)
    Abstract [en]

    Background: The death of a young child is so devastating that it can increase the risk of mortality in the grieving parent. Little is known about the impact of an adult child's death on the health of parents. Methods: The authors conducted a follow-up study between 1980 and 2002 based on a linked-registers database that contains the total Swedish population. The authors examined mortality from all causes, natural causes and unnatural causes among parents following the death of children aged 10-49 years. Results: An increased mortality risk (RR 1.31, 95% CI 1.02 to 1.68) in mothers following the death of a minor child (10-17 years) was found and especially following unnatural deaths (primarily accidents and suicides). Mothers also experienced elevated mortality following the death of an adult child aged 18-25 years (RR 1.15, 95% CI 1.03 to 1.29). Bereavement effects among fathers were more attenuated and chiefly found after >8 years of follow-up. From a short-term perspective (1-3 years), the death of an adult child (>25 years) was somewhat protective for parents. However, over longer follow-up periods, it approached (4-8 years) and exceeded (>8 years) the death risk of the general population. Conclusions: These findings corroborate and extend earlier findings suggesting elevated mortality risks also following the death of an adult child.

  • 47. Santacroce, Adriana
    et al.
    Wastesson, Jonas W.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Höhn, Andreas
    Christensen, Kaare
    Oksuzyan, Anna
    Gender differences in the use of anti-infective medications before and after widowhood: a register-based study2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 6, p. 526-531Article in journal (Refereed)
    Abstract [en]

    Background Recent findings suggest that bereavement due to spousal loss is associated with a decline in general immune functions, and thus to increased susceptibility to infections among widowed individuals. The present study aims to investigate whether spousal loss weakens immune defences more among men than among women using a 5% random sample of the total Danish population, and anti-infective medication use as a proxy for immune response.

    Methods We followed 6076 Danish individuals (67% women) aged 50 from 5years before and up to 5years after widowhood to examine changes in prescriptions of anti-infectives for systemic use.

    Results Women used more anti-infective drugs both before and after spousal loss (women: OR= 1.31; 95% CI 1.21 to 1.42). The age-related changes in the use of anti-infective medications in the period before widowhood were similar to that in the period after widowhood among both men and women. Also, age-related changes in the use of anti-infective medications were similar in both genders.

    Conclusions The present study shows that individuals are more likely to use anti-infective medication after being widowed than before being widowed, but this change is likely to be related to increasing age and it is similar in both genders.

  • 48.
    Shkolnikov, V.
    et al.
    Max Planck Inst Demog Res, D-18057 Rostock, Germany .
    Andreev, E.
    Max Planck Inst Demog Res, D-18057 Rostock, Germany .
    Jdanov, D.
    Jasilionis, D.
    Max Planck Inst Demog Res, D-18057 Rostock, Germany .
    Kravdal, Ö.
    Univ Oslo, Dept Econ, Oslo, Norway .
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Valkonen, T.
    Univ Helsinki, Dept Sociol, Helsinki, Finland .
    Increasing absolute mortality disparities by education in Finland, Norway and Sweden, 1971-20002012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 4, p. 372-378Article in journal (Refereed)
    Abstract [en]

    Background and objectives Studies on socioeconomic health disparities often suffer from a lack of uniform data and methodology. Using high quality, census-linked data and sensible inequality measures, this study documents the changes in absolute and relative mortality differences by education in Finland, Norway and Sweden over the period 1971 to 2000.

    Methods The age-standardised mortality rates and the population exposures for three educational categories were computed from detailed data provided by the national statistical offices. Mortality disparities by education were assessed using two range measures (rate differences and rate ratios), and two Gini-like measures (the average inter-group difference (AID) and the Gini coefficient (G)). The formulae for the decomposition of the change in the AID into (1) the contribution of change in population composition by education, and (2) the contribution of mortality change were introduced.

    Results Mortality decreases were often greater for high than for medium and low education. Both relative and absolute mortality disparities tend to increase over time. The magnitude and timing of the increases in absolute disparities vary by country. Both the rate differences and the AIDs have increased since the 1970s in Norway and Sweden, and since the 1980s in Finland. The contributions of the changes in population composition to the total AID increase were substantial in all countries, and for both sexes. The mortality contributions were substantial for males in Norway and Sweden.

    Conclusions The study reports increases in absolute mortality disparity, and its components. This trend needs to be further studied and addressed by policies.

  • 49. Sjölund, Sara
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Gustafsson, Jan-Eric
    Allebeck, Peter
    IQ and alcohol-related morbidity and mortality among Swedish men and women: the importance of socioeconomic position2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 9, p. 858-864Article in journal (Refereed)
    Abstract [en]

    Aims To investigate the association between intelligence in childhood and later risk of alcohol-related disease and death by examining (1) the mediating effect of social position as an adult and (2) gender as a possible moderator. Design Cohort study. Setting and participants 21 809 Swedish men and women, born in 1948 and 1953, from the Swedish Evaluation Through Follow-up database were followed until 2006/2007. Measurements IQ was measured in school at the age of 13 and alcohol-related disease and death (International Classification of Disease codes) were followed from 1971 and onwards. Findings We found an increased crude HR of 1.23 (95% CI 1.18 to 1.29) for every decrease in group of IQ test results for alcohol-related admissions and 1.14 (95% CI 1.04 to 1.24) for alcohol-related death. Social position as an adult was found to mediate both outcomes. Gender was not found to moderate the association. However, adjusting for socioeconomic position lowered the risk more among men than among women. Conclusions There was an inverse, graded association between IQ and alcohol-related disease and death, which at least partially was mediated by social position as an adult. For alcohol-related death, complete mediation by socioeconomic position as an adult was found. Gender does not moderate this association. The role of socioeconomic position may differ between the genders.

  • 50. Stenholm, Sari
    et al.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Salo, Paula
    Hyde, Martin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Pentti, Jaana
    Head, Jenny
    Kivimäki, Mika
    Vahtera, Jussi
    Age-related trajectories of physical functioning in work and retirement: the role of sociodemographic factors, lifestyle and disease2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 6, p. 503-509Article in journal (Refereed)
    Abstract [en]

    Background Loss of physical functioning is an early marker of declining health in older people. The objective of this study was to examine the age-related trajectories of physical functioning among those in full-time work and retirement. Methods Based on the Health and Retirement Study, participants who were working full-time or were in full-time retirement and 65-85 years of age during the follow-up period from 1992 to 2010 were included (n=17 844, n of observations from repeated measures in full-time work 5891 and in retirement 57 117). Details of physical functioning were asked about at all study phases and 10 items related to mobility and activities of daily living were summed to obtain a physical functioning score (0-10). Results The number of physical functioning difficulties increased every 10 years by 0.17 (95% CI 0.04 to 0.29) when in full-time work and by 0.46 (95% CI 0.41 to 0.50) in retirement after adjusting for age, sex, race, education, total wealth, Body Mass Index, smoking, physical activity and number of diseases. Factors that were associated with a significantly greater increase in number of physical functioning difficulties in full-time work and retirement include lifestyle-related risks and chronic conditions. Conclusions Physical functioning declines faster in retirement than in full-time work in employees aged 65 years or older and the difference is not explained by absence of chronic diseases and lifestyle-related risks.

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