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  • 1.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Childhood Peer Status and the Clustering of Social, Economic, and Health-related Circumstances in Adulthood2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 105, p. 67-75Article in journal (Refereed)
    Abstract [en]

    Within the school-class context, children attain a social position in the peer hierarchy to which varying amounts of status are attached. Studies have shown that peer status – i.e. the degree of acceptance and likeability among classmates – is associated with adult health. However, these studies have generally paid little attention to the fact that health problems are likely to coincide with other adverse circumstances within the individual. The overarching aim of the current study was therefore to examine the impact of childhood peer status on the clustering of social, economic, and health-related circumstances in adulthood. Using a 1953 cohort born in Stockholm, Sweden (n = 14,294), four outcome profiles in adulthood were identified by means of latent class analysis: ‘Average’, ‘Low education’, ‘Unemployment’, and ‘Social assistance recipiency and mental health problems’. Multinomial regression analysis demonstrated that those with lower peer status had exceedingly higher risks of later ending up in the more adverse clusters. This association remained after adjusting for a variety of family-related and individual factors. We conclude that peer status constitutes a central aspect of children's upbringing with important consequences for life chances.

  • 2.
    Banerjee, Albert
    et al.
    York University.
    Daly, Tamara
    York University .
    Armstrong, Pat
    York University.
    Szebehely, Marta
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Armstrong, Hugh
    Carleton University.
    LaFrance, Stirling
    Structural violence in long-term residential care for older people: Comparing Canada and Scandinavia2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 3, p. 390-398Article in journal (Refereed)
    Abstract [en]

    Canadian frontline careworkers are six times more likely to experience daily physical violence than their Scandinavian counterparts. This paper draws on a comparative survey of residential careworkers serving older people across three Canadian provinces (Manitoba, Nova Scotia, Ontario) and four countries that follow a Scandinavian model of social care (Denmark, Finland, Norway, Sweden) conducted between 2005 and 2006. Ninety percent of Canadian frontline careworkers experienced physical violence from residents or their relatives and 43 percent reported physical violence on a daily basis. Canadian focus groups conducted in 2007 reveal violence was often normalized as an inevitable part of elder-care. We use the concept of “structural violence”(Galtung, 1969) to raise questions about the role that systemic and organizational factors play in setting the context for violence. Structural violence refers to indirect forms of violence that are built into social structures and that prevent people from meeting their basic needs or fulfilling their potential. We applied the concept to long-term residential care and found that the poor quality of the working conditions and inadequate levels of support experienced by Canadian careworkers constitute a form of structural violence.Working conditions are detrimental to careworker's physical and mental health, and prevent careworkers from providing the quality of care they are capable of providing and understand to be part of their job. These conditions may also contribute to the violence workers experience, and further investigation is warranted.

  • 3.
    Barclay, Kieron
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. London School of Economics and Political Science, UK; Max Planck Institute for Demographic Research, Germany.
    Keenan, Katherine
    Grundy, Emily
    Kolk, Martin
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Myrskylä, Mikko
    Reproductive history and post-reproductive mortality: A sibling comparison analysis using Swedish register data2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 155, p. 82-92Article in journal (Refereed)
    Abstract [en]

    A growing body of evidence suggests that reproductive history influences post-reproductive mortality. A potential explanation for this association is confounding by socioeconomic status in the family of origin, as socioeconomic status is related to both fertility behaviours and to long-term health. We examine the relationship between age at first birth, completed parity, and post-reproductive mortality and address the potential confounding role of family of origin. We use Swedish population register data for men and women born 1932-1960, and examine both all-cause and cause-specific mortality. The contributions of our study are the use of a sibling comparison design that minimizes residual confounding from shared family background characteristics and assessment of cause-specific mortality that can shed light on the mechanisms linking reproductive history to mortality. Our results were entirely consistent with previous research on this topic, with teenage first time parents having higher mortality, and the relationship between parity and mortality following a U-shaped pattern where childless men and women and those with five or more children had the highest mortality. These results indicate that selection into specific fertility behaviours based upon socioeconomic status and experiences within the family of origin does not explain the relationship between reproductive history and post-reproductive mortality. Additional analyses where we adjust for other lifecourse factors such as educational attainment, attained socioeconomic status, and post-reproductive marital history do not change the results. Our results add an important new level of robustness to the findings on reproductive history and mortality by showing that the association is robust to confounding by factors shared by siblings. However it is still uncertain whether reproductive history causally influences health, or whether other confounding factors such as childhood health or risk-taking propensity could explain the association.

  • 4.
    Barclay, Kieron
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Myrskylä, Mikko
    Department of Social Policy, London School of Economics and Political Science, UK.
    Birth Order and Physical Fitness in Early Adulthood: Evidence from Swedish Military Conscription Data2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 123, p. 141-148Article in journal (Refereed)
    Abstract [en]

    Physical fitness at young adult ages is an important determinant of physical health, cognitive ability, and mortality. However, few studies have addressed the relationship between early life conditions and physical fitness in adulthood. An important potential factor influencing physical fitness is birth order, which prior studies associate with several early- and later-life outcomes such as height and mortality. This is the first study to analyse the association between birth order and physical fitness in late adolescence. We use military conscription data on 218,873 Swedish males born between 1965 and 1977. Physical fitness is measured by a test of maximal working capacity, a measure of cardiovascular fitness closely related to V02max. We use linear regression with sibling fixed effects, meaning a within-family comparison, to eliminate the confounding influence of unobserved factors that vary between siblings. To understand the mechanism we further analyse whether the association between birth order and physical fitness varies by sibship size, parental socioeconomic status, birth cohort or length of the birth interval. We find a strong, negative and monotonic relationship between birth order and physical fitness. For example, third-born children have a maximal working capacity approximately 0.1 (p<0.000) standard deviations lower than first-born children. The association exists both in small (3 or less children) and large families (4 or more children), in high and low socioeconomic status families, and amongst cohorts born in the 1960s and the 1970s. While in the whole population the birth order effect does not depend on the length of the birth intervals, in two-child families a longer birth interval strengthens the advantage of the first-born. Our results illustrate the importance of birth order on physical fitness, and suggest that the first-born advantage already arises in late adolescence.

  • 5. Bijlsma, Maarten J.
    et al.
    Tarkiainen, Lasse
    Myrskylä, Mikko
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany: University of Helsinki,, Finland.
    Unemployment and subsequent depression: A mediation analysis using the parametric G-formula2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 194, p. 142-150Article in journal (Refereed)
    Abstract [en]

    The effects of unemployment on depression are difficult to establish because of confounding and limited understanding of the mechanisms at the population level. In particular, due to longitudinal interdependencies between exposures, mediators and outcomes, intermediate confounding is an obstacle for mediation analyses. Using longitudinal Finnish register data on socio-economic characteristics and medication purchases, we extracted individuals who entered the labor market between ages 16 and 25 in the period 1996 to 2001 and followed them until the year 2007 (n = 42,172). With the parametric G-formula we estimated the population averaged effect on first antidepressant purchase of a simulated intervention which set all unemployed person years to employed. In the data, 74% of person-years were employed and 8% unemployed, the rest belonging to studying or other status. In the intervention scenario, employment rose to 85% and the hazard of first antidepressant purchase decreased by 7.6%. Of this reduction 61% was mediated, operating primarily through changes in income and household status, while mediation through other health conditions was negligible. These effects were negligible for women and particularly prominent among less educated men. By taking complex interdependencies into account in a framework of observed repeated measures data, we found that eradicating unemployment raises income levels, promotes family formation, and thereby reduces antidepressant consumption at the population-level.

  • 6.
    Billingsley, Sunnee
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Intragenerational mobility and mortality in Russia: Short and longer-term effects2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 12, p. 2326-2336Article in journal (Refereed)
    Abstract [en]

    This study uses the Russian Longitudinal Monitoring Survey to explore the relationship betweenmortality of men age 65 or younger and intragenerational mobility, measured objectively throughhousehold income and subjectively through social ranking. This relationship is considered in light of thesocial selection and social causation mechanisms developed in the literature as well as a proposedmechanism in which mobility itself is a consequential life event. The analysis spans the years 1994e2010,which covers the transitional period in Russia characterized by labor market restructuring and economiccrisis as well as a later period of economic growth and recovery. Using Cox proportional hazard models,immediate and longer-term associations between mobility and mortality are estimated. Both subjectiveand objective downward mobility had an immediate positive association with mortality risk (increasedby 44% and 24%, respectively). In contrast, upward mobility had a more pronounced effect over a longertermhorizon and lowered mortality risk by 17%. Controlling for destination status attenuated someassociations, but findings were robust to the adjustment of selection-related factors such as alcoholconsumption and health status in the year preceding mobility. Findings suggest that the negative relationshipbetween upward mobility and mortality may be driven by social causation, whereas downwardmobility may have an independent effect beyond selection or causation.

  • 7. Björkenstam, Emma
    et al.
    Burström, Bo
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Björkenstam, Charlotte
    Pebley, Anne R.
    Cumulative exposure to childhood stressors and subsequent psychological distress. An analysis of US panel data2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 142, p. 109-117Article in journal (Refereed)
    Abstract [en]

    Research has shown that childhood stress increases the risk of poor mental health later in life. We examined the effect of childhood stressors on psychological distress and self-reported depression in young adulthood. Data were obtained from the Child Development Supplement (CDS) to the national Panel Study of Income Dynamics (PSID), a survey of US families that incorporates data from parents and their children. In 2005 and 2007, the Panel Study of Income Dynamics was supplemented with two waves of Transition into Adulthood (TA) data drawn from a national sample of young adults, 18-23 years old. This study included data from participants in the CDS and the TA (n = 2128), children aged 4-13 at baseline. Data on current psychological distress was used as an outcome variable in logistic regressions, calculated as odds ratios (OR) with 95% confidence intervals (CI). Latent Class Analyses were used to identify clusters based on the different childhood stressors. Associations were observed between cumulative exposure to childhood stressors and both psychological distress and self-reported depression. Individuals being exposed to three or more stressors had the highest risk (crude OR for psychological distress: 2.49 (95% Cl: 1.16-5.33), crude OR for self-reported depression: 2.07 (95% CI: 1.15-3.71). However, a large part was explained by adolescent depressive symptoms. Findings support the long-term negative impact of cumulative exposure to childhood stress on psychological distress. The important role of adolescent depression in this association also needs to be taken into consideration in future studies.

  • 8.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Pros and cons of social relations: An analysis of adolescents’ health complaints2006In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 63, no 3, p. 611-623Article in journal (Refereed)
    Abstract [en]

    This paper examines the association between social relations and psychological and psychosomatic health complaints, among adolescents in Sweden. We focused on relationships with parents, as well as relationships with peers in school and in leisure time. Both the structure and the content of relations were analysed. For the latter, we looked at supportive as well as strained relations. The data was the pooled child supplements of the Swedish welfare surveys conducted in 2000–2003. This constitutes a nationally representative, cross-sectional sample of 10–18-year-olds (n=5137), where information was collected from both adolescents and their parents. Results showed that young people's social relations with parents and peers clearly covaried with their health complaints. With regard to family relations and psychological complaints, the association was more pronounced for relational content than for relational structure. For instance, whether relations with parents were strained or not seemed more relevant than family structure and parental working hours. Moreover, strained relations were more strongly associated with health complaints, especially psychosomatic complaints, than were supportive relations. This applied to relationships with parents as well as with peers in school.

  • 9. Celeste, R. K.
    et al.
    Nadanovsky, P.
    Ponce de Leon, A.
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 69, no 10, p. 1468-1475Article in journal (Refereed)
    Abstract [en]

    We evaluate the association between incomeinequality (Gini index) and oralhealth and in particular the role of alternative models in explaining this association. We also studied whether or not income at the individual level modifies the Gini effect. We used data from an oralhealth survey in Brazil in 2002–2003. Our analysis included 23,568 15–19 and 22,839 35–44 year-olds nested in 330 municipalities. Different models were fitted using multilevel analysis. The outcomes analysed were the number of untreated dental caries (count), having at least one missing tooth (dichotomous) and being edentulous (dichotomous). To assess interaction as a departure from additivity we used the Synergy Index. For this, we dichotomized the Gini coefficient (high vs low inequality) by the median value across municipalities and the individualincome in the point beyond which it showed roughly no association with oralhealth. Adjusted rate ratio of mean untreated dental caries, respectively for the 15–19 and 35–44 age groups, was 1.12 and 1.16 for each 10 points increase in Gini scale. Adjusted odds ratio of a 15–19 year-old having at least one missing tooth or a 35–44 year-old being edentulous was, respectively, 1.19 and 1.01. High incomeinequality had no statistically significant synergistic effect with being poor or living in a poor municipality. Higher levels of incomeinequality at the municipal level were associated with worse oralhealth and there was an unexplained residual effect after controlling for potential confoundings and mediators. Municipal level incomeinequality had a similar, detrimental effect, among individuals with lower or higher income.

  • 10.
    Chaparro, Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Illona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The impact of parental educational trajectories on their adult offspring's overweight/obesity status: a study of three generations of Swedish men and women2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 120, p. 199-207Article in journal (Refereed)
  • 11.
    Dahlin, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Härkönen, Juho
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Cross-national differences in the gender gap in subjective health in Europe: Does country level gender equality matter?2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 98, p. 24-28Article in journal (Refereed)
    Abstract [en]

    Multiple studies have found that women report being in worse health despite living longer. Gender gaps vary cross-nationally, but relatively little is known about the causes of comparative differences. Existing literature is inconclusive as to whether gender gaps in health are smaller in more gender equal societies. We analyze gender gaps in self-rated health (SRH) and limiting longstanding illness (LLI) with five waves of European Social Survey data for 191,104 respondents from 28 countries. We use means, odds ratios, logistic regressions, and multilevel random slopes logistic regressions. Gender gaps in subjective health vary visibly across Europe. In many countries (especially in Eastern and Southern Europe), women report distinctly worse health, while in others (such as Estonia, Finland, and Great Britain) there are small or no differences. Logistic regressions ran separately for each country revealed that individual-level socioeconomic and demographic variables explain a majority of these gaps in some countries, but contribute little to their understanding in most countries. In yet other countries, men had worse health when these variables were controlled for. Cross-national variation in the gender gaps exists after accounting for individual-level factors. Against expectations, the remaining gaps are not systematically related to societal-level gender inequality in the multilevel analyses. Our findings stress persistent cross-national variability in gender gaps in health and call for further analysis.

  • 12.
    Darin-Mattsson, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Andel, Ross
    Celeste, Roger Keller
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Linking financial hardship throughout the life-course with psychological distress in old age: Sensitive period, accumulation of risks, and chain of risks hypotheses2018In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 201, p. 111-119Article in journal (Refereed)
    Abstract [en]

    The primary objective was to investigate the life course hypotheses - sensitive period, chain of risks, and accumulation of risks - in relation to financial hardship and psychological distress in old age. We used two Swedish longitudinal surveys based on nationally representative samples. The first survey includes people 18-75 years old with multiple waves, the second survey is a longitudinal continuation, including people 76 + years old. The analytical sample included 2990 people at baseline. Financial hardship was assessed in childhood (retrospectively), at the mean ages of 54, 61, 70, and 81 years. Psychological distress (self-reported anxiety and depressive symptoms) was assessed at the same ages. Path analysis with WLSMV estimation was used. There was a direct path from financial hardship in childhood to psychological distress at age 70 (0.26, p = 0.002). Financial hardship in childhood was associated with increased risk of psychological distress and financial hardship both at baseline (age 54), and later. Financial hardship, beyond childhood, was not independently associated with psychological distress at age 81. Higher levels of education and employment decreased the negative effects of financial hardship in childhood on the risk of psychological distress and financial hardship later on. There was a bi-directional relationship between psychological distress and financial hardship; support for health selection was slightly higher than for social causation. We found that psychological distress in old age was affected by financial hardship in childhood through a chain of risks that included psychological distress earlier in life. In addition, financial hardship in childhood seemed to directly affect psychological distress in old age, independent of other measured circumstances (i.e., chains of risks). Education and employment could decrease the effect of an adverse financial situation in childhood on later-life psychological distress. We did not find support for accumulation of risks when including tests of all hypotheses in the same model.

  • 13. Donrovich, Robyn
    et al.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet.
    Early life conditions, partnership histories, and mortality risk for Swedish men and women born 1915-19292014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 108, p. 60-67Article in journal (Refereed)
    Abstract [en]

    This paper investigates the relationship between early life biological and social factors, partnership history, and mortality risk. Mortality risks for Swedish men and women over age 50 in the Uppsala Birth Cohort born 1915-1929 were estimated using survival analysis. Relative mortality risk was evaluated through nested multiplicative Gompertz models for 4348 men and 3331 women, followed from age 50 to the end of 2010. Being born to an unmarried mother was associated with higher mortality risk in later life for men and women, and relative to married individuals, being unmarried after age 50 was associated with elevated mortality risk. Single women and divorced men were the highest risk groups, and women were negatively impacted by a previous divorce or widowhood, while men were not. Both genders showed direct effects of early life variables on later life mortality and were vulnerable if unmarried in later life. However, in this study, previous marital disruptions appeared to have more (negative) meaning in the long-term for women.

  • 14.
    Dunlavy, Andrea C.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Garcy, Anthony M.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Educational mismatch and health status among foreign-born workers in Sweden2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 154, p. 36-44Article in journal (Refereed)
    Abstract [en]

    Foreign-born workers have been shown to experience poorer working conditions than native-born workers. Yet relationships between health and educational mismatch have been largely overlooked among foreign-born workers. This study uses objective and self-reported measures of educational mismatch to compare the prevalence of educational mismatch among native (n = 2359) and foreign born (n = 1789) workers in Sweden and to examine associations between educational mismatch and poor self-rated health. Findings from weighted multivariate logistic regression which controlled for social position and individual-level demographic characteristics suggested that over-educated foreign-born workers had greater odds ratios for poor-self rated health compared to native-born matched workers. This association was particularly evident among men (OR = 2.14, 95% CI: 1.04-4.39) and women (OR = 2.13, 95% CI: 1.12-4.03) from countries outside of Western Europe, North America, and Australia/New Zealand. Associations between under-education and poor-self rated health were also found among women from countries outside of Western Europe, North America, and Australia/New Zealand (OR = 2.02, 95% CI: 1.27-3.18). These findings suggest that educational mismatch may be an important work-related social determinant of health among foreign-born workers. Future studies are needed to examine the effects of long-term versus short-term states of educational mismatch on health and to study relationships over time.

  • 15.
    Essén, Anna
    Stockholm University, Faculty of Social Sciences, School of Business.
    The two facets of electronic care surveillance: An exploration of the views of older people who live with monitoring devices2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, no 1, p. 128-136Article in journal (Refereed)
    Abstract [en]

    Scholars are increasingly questioning the notion that electronic surveillance merely constrains individuals' liberty and privacy. However, illustrations of alternative perspectives are few and there is a need for empirical research exploring the actual experience of surveilled subjects. This study, carried out in Sweden, seeks to offer a nuanced account of how senior citizens experience electronic care surveillance in relation to their privacy. It is based on in-depth interviews with 17 seniors who have participated in a telemonitoring project and who have experience of being continuously activity monitored in their own homes. The findings suggest that senior citizens can perceive electronic care surveillance as freeing and as protecting their privacy, as it enables them to continue living in their own home rather than moving to a nursing home. One individual, however, experienced a privacy violation and the surveillance service was interrupted at her request. This illustrates the importance of built-in possibilities for subjects to exit such services. In general, the study highlights that e-surveillance can be not only constraining but also enabling. Hence, it supports the view of the dual nature of surveillance. The study also illustrates the agency of the surveilled subject, extending the argument that various agents actually participate in the construction of surveillance practices. It analyzes the indirect role and responsibility of the surveilled subject, and thereby questions the traditional roles ascribed to the agents and targets of surveillance.

  • 16.
    Essén, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Stockholm Business School.
    Lindblad, Staffan
    Innovation as emergence in healthcare: Unpacking change from within2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 93, p. 203-211Article in journal (Refereed)
    Abstract [en]

    The contemporary healthcare literature suffers from a disproportionate focus on 'given' externally created innovations, and belief in ordered, planned and well-funded implementation processes. As an alternative, the present paper highlights the potential of emergent change processes, using the continuous invention and re-invention of the Rheumatology Quality Registry in Sweden as an example. This 19 year long process, which is still ongoing, does not exhibit the sequential steps that are allegedly determinants of success in the innovation and implementation literature. Yet, it has produced system-wide improvements. We draw on more than 100 informal and formal meetings with practitioners involved in the process studied, observations, documentation analysis and quantitative registry-data. A total of 67 interviews with registry-users and external stakeholders were also performed. The dissipative structures model (complexity theory) was used to analyze the data. The studied process illustrates an ongoing, practice-driven improvement process, which was sparked by abstract and indirect energies that interacted with more concrete innovations such as new drugs. For example, participants tapped new information technologies, changing perspectives and governmental priorities to challenge current ways of working and introduce new ideas. Ideas were realized and spread through various self-organized processes that involved the re-arrangement of existing resources rather than acquisition of new resources. Taken together, these processes brought Swedish rheumatology to new levels of functioning 1992-2011. An important implication of our work is that incremental and practice-driven change processes can significantly transform care systems in the long run. Policy makers need to acknowledge and foster such ongoing innovation processes at micro-level, rather than focusing exclusively on innovations as externally created 'things' that await 'implementation'.

  • 17.
    Eyjólfsdóttir, Harpa S.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Baumann, I.
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Prolongation of working life and its effect on mortality and health in older adults: Propensity score matching2019In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 226, p. 77-86Article in journal (Refereed)
    Abstract [en]

    Many countries are raising the age of pension eligibility because of increases in life expectancy. Given the social gradient in life expectancy and health, it is important to understand the potential late-life health effects of prolonging working life and whether any effects differ by socioeconomic position. We examined the effect of prolonging working life beyond age 65 on mortality and a series of indicators of late-life physical health (the ability to climb stairs without difficulty, self-rated health, ADL limitations, and musculoskeletal pain) in a representative sample of the Swedish population. In addition to average effects, we also examined heterogeneous effects, for instance by occupational social class. To do this, we use propensity score matching, a method suitable for addressing causality in observational data. The data came from two linked Swedish longitudinal surveys based on nationally representative samples with repeated follow-ups; The Swedish Level of Living Survey and the Swedish Panel Study of Living conditions of the Oldest Old, and from national income and mortality registries. The analytical sample for the mortality outcome included 1852 people, and for late-life physical health outcomes 1461 people. We found no significant average treatment effect on the treated (ATT) of working to age 66 or above on the outcomes, measured an average of 12 years after retirement: mortality (ATT-0.039), the ability to climb stairs (ATT -0.023), self-rated health (ATT -0.009), ADL limitations (ATT -0.023), or musculoskeletal pain (ATT -0.009) in late life. Analyses of whether the results varied by occupational social class or the propensity to prolong working life were inconclusive but suggest a positive effect of prolonging working life on health outcomes. Accordingly, more detailed knowledge about the precise mechanisms underlying these results are needed. In conclusion, working to age 66 or above did not have effect on mortality or late-life physical health.

  • 18.
    Garcy, Anthony M.
    et al.
    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).
    The length of unemployment predicts mortality, differently in men and women, and by cause of death: A six year mortality follow-up of the Swedish 1992-1996 recession2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 12, p. 1911-1920Article in journal (Refereed)
    Abstract [en]

    This study examines the relationship between the total amount of accumulated unemployment during the deep Swedish recession of 1992-1996 and mortality in the following 6 years. Nearly 3.4 million Swedish men and women, born between 1931 and 1965 who were gainfully employed at the time of the 1990 census were included. Almost 23% of these individuals were unemployed at some point during the recession. We conduct a prospective cohort study utilizing Cox proportional hazard regression with a mortality follow-up from January 1997 to December 2002. We adjust for health status (1982-1991), baseline (1991) social, family, and employer characteristics of individuals before the recession. The findings suggest that long-term unemployment is related to elevated all-cause mortality for men and women. The excess mortality effects were small for women and attributable to a positive, linear increase in the hazard of alcohol disease-related mortality and external causes-of-death not classified as suicides or transport accidents. For men, the excess hazard of all-cause mortality was best represented by a cubic, non-linear shape. The predicted hazard increases rapidly with the shortest and longest accumulated levels of unemployment. However, the underlying pattern differed by cause-of-death. The cancer, circulatory, and alcohol disease-related analyses suggest that mortality peaks with mid-levels of accumulated unemployment and then declines with longer duration unemployment. For men, we observed a positive, linear increase in the hazard ratios associated with transport and suicide mortality, and a very steep non-linear increase in the excess hazard ratio associated with other external causes of death that were not classified as suicide or transport accidents. In conclusion, mortality risk increases with the duration of unemployment among men and women. This was best described by a cubic function for men and a linear function for women. Behind this pattern, different causes-of-death varied in their relation to the accumulation of unemployment.

  • 19.
    Gisselmann, Marit
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Hemström, Örjan
    The contribution of maternal working conditions to socio-economic inequalities in birth outcome2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 66, no 6, p. 1297-1309Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to examine the association between maternal working conditions and birth outcomes, and to determine the extent to which these contributed to class inequalities in six birth outcomes. We used an existing job exposure matrix developed from survey data collected in 1977 and 1979 to apply occupational-level information on working conditions to the national Swedish Registry, including approximately 280,000 mothers and 360,000 births during the period 1980–1985. Data were analysed using multivariate logistic regressions. Low levels of job control, high levels of physical demands and job hazards were more common in manual compared to non-manual classes. The self-employed had intermediate levels of such exposures. Job exposures, particularly low levels of job control, were generally and significantly associated with higher risks for low birthweight, very low birthweight, small for gestational age, all preterm, very preterm and extremely preterm births, but not with mortality. Compared to middle non-manuals (the reference group), lower non-manual and manual classes had higher risks for all birth outcomes, and these risks were nearly all significant. The highest odds ratios were found for skilled and unskilled manual workers in the manufacturing sector, with ratios between 1.35 and 2.66 (all significant). Job control explained a considerable proportion of inequalities in all birth outcomes. Job hazards contributed particularly to very low birthweight and extremely preterm birth, and physical demands to low birthweight and all preterm births. In conclusion, class differences in maternal working conditions clearly contributed to class differences in low birthweight (explained fraction 14–38%), all preterm births (20–46%), very (14–46%) and extremely (12–100%) preterm births. For very low birthweight and small for gestational age, there was a similar contribution in the manufacturing sector only. For all birth outcomes, class differences could still be detected after working conditions were taken into consideration.

  • 20.
    Helgertz, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Lund University, Sweden.
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Small for gestational age and adulthood risk of disability pension: the contribution of childhood and adulthood conditions2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 119, p. 249-257Article in journal (Refereed)
    Abstract [en]

    Early exiting from the labor force and into disability pension (DP) represents a major social problem in Sweden and elsewhere. We examined how being asymmetric (A-SGA) or symmetric (S-SGA) small for gestational age predicts transitioning into DP. We analyzed a longitudinal sample of 8125 men and women from the Stockholm Birth Cohort (SBC), born in 1953 and not on DP in 1990. The SBC consists of data from various sources, including self-reported information and data from administrative registers. The follow-up period was from 1991 to 2009. Yearly information on the receipt of DP benefits from register data was operationalized as a dichotomous variable. 13 percent of the sample moved into DP during follow-up. Cox proportional hazards regression was used to examine whether disadvantageous fetal growth - A-SGA and S-SGA - predicted DP. Men and women born A-SGA had a substantially increased hazard of DP. The full model suggested a hazard ratio of 1.68 (CI: 1.11-2.54), only being affected slightly by adulthood conditions. Several childhood conditions were also associated with DP. Such factors, however, mainly affected DP risk through adulthood conditions. The effect of SGA on DP appeared particularly strong among individuals from socioeconomically disadvantaged backgrounds. The evidence presented suggests that being A-SGA influences the risk of DP, independent of childhood and adulthood conditions, and similarly for men and women. Due to A-SGA being rather infrequent, reducing the occurrence of A-SGA would, however, only have a marginal impact on the stock of DP pensioners. For the individual affected, the elevation in the risk of DP was nevertheless substantial. Other childhood conditions exercised a larger influence on the stock of DP recipients, but they mostly operated through adulthood attainment. The importance of socioeconomic resources in childhood for the long term health consequences of SGA is interesting from a policy perspective and warrants further research.

  • 21. Hemmingsson, Tomas
    et al.
    v. Essen, Jan
    Melin, Bo
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Allebeck, Peter
    Lundberg, Ingvar
    The association between cognitive ability measured at ages 18-20 and coronary heart disease in middle age among men: A prospective study using the Swedish 1969 conscription cohort2007In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 65, no 7, p. 1410-1419Article in journal (Refereed)
    Abstract [en]

    An association between childhood cognitive ability measured with IQ-tests and coronary heart disease (CHD) incidence has been reported recently. It is not clear from those studies to what extent the increased relative risk associated with lower cognitive ability may be explained by CHD risk factors. This study aims to investigate the association between cognitive ability measured at age 18-20 and incidence of CHD, acute myocardial infarction (AMI), and stroke among middle aged men adjusting for risk factors for CHD over the life course. Data on cognitive ability, and other risk factors for CHD (height, parental cardiovascular diseases (CVD) mortality, blood pressure, smoking, risky use of alcohol, BMI), were collected from 49,321 men, born in 1949-51, at conscription for compulsory military training in 1969/70 in Sweden. Information on socioeconomic factors in childhood (socioeconomic position and crowded housing) and adulthood (education, socioeconomic position, and income), as well as information on mortality and morbidity, was collected through national registers. Cognitive ability showed an inverse and graded association with CHD incidence. Adjustment for indicators of poor childhood circumstances, behavioural factors measured in late adolescence, and adult social circumstances strongly attenuated the increased risks of CHD and AMI. The contribution from adult social circumstances, after adjustment from all other factors, was very small. After adjustment for all risk factors no significantly increased relative risk was seen for stroke incidence. After adjustment for risk factors over the life course, the risk of CHD and AMI associated with cognitive ability decreased substantially, and was of borderline significance. Given the results from this study it is unlikely that cognitive ability is a risk factor on its own for CHD, AMI and stroke among men below 54 years of age.

  • 22. Hiyoshi, Ayako
    et al.
    Udumyan, Ruzan
    Osika, Walter
    Bihagen, Erik
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Fall, Katja
    Montgomery, Scott
    Stress resilience in adolescence and subsequent antidepressant and anxiolytic medication in middle aged men: Swedish cohort study2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 134, p. 43-49Article in journal (Refereed)
    Abstract [en]

    It is unclear whether psychological resilience to stress in adolescence represents a persistent characteristic relevant to the subsequent risk for depression and anxiety in later adulthood. We aimed to test whether low psychological stress resilience assessed in adolescence is associated with an increased risk of receiving medication for depression and anxiety in middle age. We utilized Swedish register-based cohort study. Men born between 1952 and 1956 (n = 175,699), who underwent compulsory assessment for military conscription in late adolescence were followed to examine subsequent risk of pharmaceutically-treated depression and anxiety in middle age, from 2006 to 2009 corresponding to ages between 50 and 58 years, using Cox regression. The associations of stress resilience with prescription of antidepressant and anxiolytics medication through potential mediating factors cognitive and physical function and adult socioeconomic factors were calculated. Low stress resilience was associated with elevated risks for antidepressant (hazard ratio (HR):1.5 (95% CI 1.4 1.6)) and anxiolytics (HR:2.4 (CI 2.0 2.7)) medication. Adjustment for measures of childhood living circumstances attenuated the associations somewhat. Around a third of association with low stress resilience, and a half of that with moderate resilience, was mediated through cognitive and physical function in adolescence and adult socioeconomic factors. The magnitude of the inverse association of higher cognitive function with antidepressant medication was eliminated among those with low stress resilience. These results indicate that low stress resilience in adolescence is associated with an increased risk for antidepressant and anxiolytics medication over 30 years later, in part mediated through developmental factors in adolescence and socioeconomic circumstances in adulthood, and low stress resilience can diminish or eliminate the inverse association of higher cognitive function with antidepressant medication.

  • 23.
    Johansson, Gunn
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Huang, Qinghai
    Stockholm University.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    A life-span perspective on women's careers, health, and well-being2007In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 65, no 4, p. 685-697Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate if and how health and well-being in mid-life are influenced by the ways in which individuals have combined educational, occupational, and family involvement throughout their adult lives. Lifecareer patterns (LC) and occupational career patterns (OC) were retrieved from a longitudinal cohort of Swedish women born in the 1950s. Retrospective occupational biographies retrieved at age 43 generated nine LC and 10 OC patterns which served as the basis for the present study. LC patterns combined timing, ordering, duration, and content of activities (e.g., education, work, and parenthood), while OC patterns considered occupational level and its stability over time. Data on life and job satisfaction, psychological well-being, work-family conflict, optimism, and mental distress were collected at age 49. For a sub-sample of the women who took part in a medical examination, seven biomarkers were combined into a measure of allostatic load (AL). The results showed that LC pattern-groups differed significantly but modestly in four aspects of health and well-being whereas OC pattern-groups displayed significant between-group differences in all outcome variables except life satisfaction. The results are interpreted in terms of a social-health gradient effect and a supportive societal context of the Swedish welfare state, which offered a considerable amount of free choice to the women in the cohort.

  • 24.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    The weight of inequalities: Duration of residence and offspring’s birthweight among migrants in Sweden2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 175, p. 81-90Article in journal (Refereed)
    Abstract [en]

    In this study we assessed the effect duration of residence on the association between maternal origin and birthweight in Sweden. Considering sibling information, we also investigated how far the presence or lack of such an effect could be biased by the use of cross-sectional data, since there may be a selection among those mothers who decide to have a child soon after moving to the country (e.g. those with a more stable family situation). Using the Swedish Medical Birth Register for the period 1992-2012, we performed linear and multinomial regressions, multilevel linear regressions, and random effect meta-analysis. Offspring of foreign-born mothers were lighter on average (−120 g [-143,-60]) and had a higher risk of having low birthweight (RRR:1.70 [1.61,1.80]) compared to those with Swedish-born mothers. The variation of birthweight by duration of residence was small (less than 50 g) compared to the gradient found between countries grouped according to the human development index (HDI), where the difference between countries with low and very high HDI was of 105 g. Moreover, no clear pattern toward a convergence with the Swedish population was observed after nine years in the country, which was confirmed when we compared the between- and within-mother analyses by HDI categories. Overall, our results support the thesis that contextual early life conditions have an impact on adult health (reproductive health in this case) with consequences in the next generation that cannot be buffered by the situation experienced in the host country.

  • 25. Kilpi, Fanny
    et al.
    Silventoinen, Karri
    Konttinen, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute of Demographic Research, Germany.
    Early-life and adult socioeconomic determinants of myocardial infarction incidence and fatality2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 177, p. 100-109Article in journal (Refereed)
    Abstract [en]

    Social inequalities in coronary heart disease mortality have roots in childhood conditions, but it is unknown whether they are associated both with the incidence of the disease and the following survival. We studied how several different early-life socioeconomic factors, together with later socioeconomic attainment, were associated with myocardial infarction (MI) incidence and fatality in Finland. The data was based on a register-based sample of households from a census in 1950 that also provided information on childhood circumstances. MI hospitalizations and mortality in 1988-2010 were studied in those who were up to 14 years of age at the time of the census and resident in Finland in 1987 (n = 94,501). Parental education, occupation, household crowding, home ownership, and family type were examined together with adulthood education and income. Hazard and odds ratios with 95% confidence intervals (CI) were calculated using Cox regression (incidence and long-term fatality) and logistic regression (short-term fatality) models. Lower parental education, occupational background and greater household crowding were associated with MI incidence. In models adjusted for adulthood variables, crowding increased the risk by 16% (95% CI 5-29%) in men and 25% (95% CI 3-50%) in women. Shortterm survival was more favourable in sons of white-collar parents and daughters of owner-occupied households, but most aspects of childhood circumstances did not strongly influence long-term fatality risk. Socioeconomic attainment in adulthood accounted for a substantial part of the effects of childhood conditions, but the measured childhood factors explained little of the disparities by adulthood education and income. Moreover, income and education remained associated with MI incidence when adjusted for unobserved shared family factors in siblings. Though social and economic development in society seems to have mitigated the disease burden associated with poor childhood living conditions in Finland, low adult socioeconomic resources have remained a strong determinant of MI incidence and fatality.

  • 26.
    Kjellsson, Sara
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Accumulated occupational class and self-rated health. Can information on previous experience of class further our understanding of the social gradient in health?2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 81, p. 26-33Article in journal (Refereed)
    Abstract [en]

    Previous research has shown a social gradient in health with better health for people in more advantaged positions in society. This research has mainly been on the relationship between current position and health, or social position in childhood and health, but less is known about the potential accumulative impact of positions held in adulthood. In this paper I use the economic activity histories from the Swedish Level of Living survey to examine the relationship between accumulated occupational class positions and health. Step-wise linear probability models are used to investigate how to best capture the potential association between class experience and self-rated health (SRH), and whether the effect of current class is modified when measures of accumulated class are included. I then further test the potentially lasting association between previous exposure to the health risk of working class by analysing only individuals currently in higher or intermediate level service class; the classes under least exposure. I find a positive association between accumulated experiences of working class and less than good SRH. Furthermore, even for employees currently in non-manual positions the risk for less than good SRH increases with each added year of previous experience within working class. This suggests that the social gradient can be both accumulative and lasting, and that more information on the mechanisms of health disparities can be found by taking detailed information on peoples' pasts into account. Although gender differences in health are not a focus in this paper, results also indicate that the influence of class experiences on health might differ between men and women.

  • 27. Landstedt, Evelina
    et al.
    Almquist B., Ylva
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Eriksson, Malin
    Hammarström, Anne
    Disentangling the directions of associations between structural social capital and mental health: Longitudinal analyses of gender, civicengagement and depressive symptoms2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 163, p. 135-143Article in journal (Refereed)
    Abstract [en]

    The present paper analysed the directions of associations between individual-level structural socialcapital, in the form of civic engagement, and depressive symptoms across time from age 16e42 years inSwedish men and women. More specifically, we asked whether civic engagement was related to changesin depressive symptoms, if it was the other way around, or whether the association was bi-directional.This longitudinal study used data from a 26-year prospective cohort material of 1001 individuals inNorthern Sweden (482 women and 519 men). Civic engagement was measured by a single-item questionreflecting the level of engagement in clubs/organisations. Depressive symptoms were assessed by acomposite index. Directions of associations were analysed by means of gender-separate cross-laggedstructural equation models. Models were adjusted for parental social class, parental unemployment,parental health, and family type at baseline (age 16). Levels of both civic engagement and depressivesymptoms were relatively stable across time. The model with the bestfit to data showed that, in men,youth civic engagement was negatively associated with depressive symptoms in adulthood, thus sup-porting the hypothesis that involvement in social networks promotes health, most likely through pro-vision of social and psychological support, perceived influence, and sense of belonging. Accordingly,interventions to promote civic engagement in young men could be a way to prevent poor mental healthfor men later on in life. No cross-lagged effects were found among women. We discuss this genderdifference in terms of gendered experiences of civic engagement which in turn generate differentmeanings and consequences for men and women, such as civic engagement not being as positive forwomen’s mental health as for that of men. We conclude that theories on structural social capital andinterventions to facilitate civic engagement for health promoting purposes need to acknowledgegendered life circumstances.

  • 28. Leinonen, Taina
    et al.
    Laaksonen, Mikko
    Chandola, Tarani
    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.
    Health as a predictor of early retirement before and after introduction of a flexible statutory pension age in Finland2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 158, p. 149-157Article in journal (Refereed)
    Abstract [en]

    Background: Little is known of how pension reforms affect the retirement decisions of people with different health statuses, although this is crucial for the understanding of the broader societal impact of pension policies and for future policy development. We assessed how the Finnish statutory pension age reform introduced in 2005 influenced the role of health as a predictor of retirement. Methods: We used register-based data and cox regression analysis to examine the association of health (measured by purchases of psychotropic medication, hospitalizations due to circulatory and musculoskeletal diseases, and the number of any prescription medications) with the risk of retirement at age 63-64 among those subject to the old pension system with fixed age limit at 65 (pre-reform group born in 1937-1941) and the new flexible system with 63 as the lower age limit (post-reform group born in 1941-1945) while controlling for socio-demographic factors. Results: Retirement at age 63-64 was more likely among the post- than the pre-reform group (HR = 1.50; 95% CI 1.43-1.57). This reform-related increase in retirement was more pronounced among those without a history of psychotropic medication or hospitalizations due to circulatory and musculoskeletal diseases, as well as among those with below median level medication use. As a result, poor health became a weaker predictor of retirement after the reform. Conclusion: Contrary to the expectations of the Finnish pension reform aimed at extending working lives, offering choice with respect to the timing of retirement may actually encourage healthy workers to choose earlier retirement regardless of the provided economic incentives for continuing in work.

  • 29.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Politics, public health and pessimism: should we take studies on welfare states and public health further? A commentary on Tapia Granados2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 71, no 5, p. 851-852Article in journal (Refereed)
  • 30. Mackenbach, JP
    et al.
    Kulhanova, I
    Bopp, M
    Deboosere, P
    Eikemo, TA
    Hoffmann, R
    Kulik, MC
    Leinsalu, M
    Martikainen, P
    Menvielle, G
    Regidor, E
    Wojtyniak, B
    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.
    Variations in the relation between education and cause-specific mortality in 19 European populations: A test of the “fundamental causes” theory of social inequalities in health2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 127, p. 51-62Article in journal (Refereed)
    Abstract [en]

    Link and Phelan have proposed to explain the persistence of health inequalities from the fact that socioeconomic status is a “fundamental cause” which embodies an array of resources that can be used to avoid disease risks no matter what mechanisms are relevant at any given time. To test this theory we compared the magnitude of inequalities in mortality between more and less preventable causes of death in 19 European populations, and assessed whether inequalities in mortality from preventable causes are larger in countries with larger resource inequalities.

    We collected and harmonized mortality data by educational level on 19 national and regional populations from 16 European countries in the first decade of the 21st century. We calculated age-adjusted Relative Risks of mortality among men and women aged 30–79 for 24 causes of death, which were classified into four groups: amenable to behavior change, amenable to medical intervention, amenable to injury prevention, and non-preventable.

    Although an overwhelming majority of Relative Risks indicate higher mortality risks among the lower educated, the strength of the education–mortality relation is highly variable between causes of death and populations. Inequalities in mortality are generally larger for causes amenable to behavior change, medical intervention and injury prevention than for non-preventable causes. The contrast between preventable and non-preventable causes is large for causes amenable to behavior change, but absent for causes amenable to injury prevention among women. The contrast between preventable and non-preventable causes is larger in Central & Eastern Europe, where resource inequalities are substantial, than in the Nordic countries and continental Europe, where resource inequalities are relatively small, but they are absent or small in Southern Europe, where resource inequalities are also large.

    In conclusion, our results provide some further support for the theory of “fundamental causes”. However, the absence of larger inequalities for preventable causes in Southern Europe and for injury mortality among women indicate that further empirical and theoretical analysis is necessary to understand when and why the additional resources that a higher socioeconomic status provides, do and do not protect against prevailing health risks.

  • 31.
    Martikainen, Pekka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Korhonen, Kaarina
    Moustgaard, Heta
    Aaltonen, Mikko
    Remes, Hanna
    Substance abuse in parents and subsequent risk of offspring psychiatric morbidity in late adolescence and early adulthood: A longitudinal analysis of siblings and their parents2018In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 217, p. 106-111Article, review/survey (Refereed)
    Abstract [en]

    The effects of substance abuse on other family members are not fully established. We estimate the contribution of parental substance abuse on offspring psychiatric morbidity in late adolescence and early adulthood, with emphasis on the timing and persistency of exposure. We used a nationally representative 20% sample of Finnish families with children born in 1986-1996 (n = 136,604) followed up in 1986-2011. We identified parental substance abuse and offspring psychiatric morbidity from hospital discharge records, death records and medication registers. The effects of parental substance abuse at ages 0-4, 5-9 and 10-14 on psychiatric morbidity after age 15 were estimated using population averaged and sibling fixed effects models; the latter controlling for unobserved factors shared by siblings. Parental substance abuse at ages 0-14 was associated with almost 2-fold increase in offspring psychiatric morbidity (HR = 1.86, 95% CI 1.78-1.95). Adjustment for childhood parental education, income, social class and family type reduced these effects by about 50%, with some further attenuation after adjustment for time-varying offspring characteristics. In the sibling fixed effects models those exposed at 0-4 or 5-9 years had 20% (HR = 1.20, 95% CI 0.90-1.60) and 33% (HR = 1.33, 95% CI 1.01-1.74) excess morbidity respectively. Also in sibling models those with early exposure at ages 0-4 combined with repeated exposure in later childhood had about 80-90% higher psychiatric morbidity as compared to never exposed siblings (e.g. for those exposed throughout childhood HR = 1.81, 95% CI 1.01-3.25). Childhood exposure to parental substance abuse is strongly associated with subsequent psychiatric morbidity. Although these effects are to a large extent due to other characteristics shared within the parental home, repeated exposure to parental substance abuse is independently associated with later psychiatric morbidity.

  • 32.
    Meinow, Bettina
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Parker, Marti G.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Thorslund, Mats
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Consumers of eldercare in Sweden: The semblance of choice2011In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 73, no 9, p. 1285-1289Article in journal (Refereed)
    Abstract [en]

    In Sweden and other countries, the benefits of user choice and market forces are often voiced in relation to the provision of medical care and social services. Policy makers increasingly view people as customers and consumers of care services. Among very old people the most frequent care users how many have the capacity necessary to find information and make decisions concerning providers of medical and social services? Using a nationally representative sample of Swedes aged 77+ (SWEOLD) in 2002 this study describes the prevalence of cognitive, physical and sensory resources associated with the capacity to make and carry out informed choices concerning medical and social care providers. Results showed that one third of a nationally representative sample of persons aged 77+ scored low on a cognitive test or they were so cognitively impaired that they could not be interviewed directly. Another 22% scored poorly on a test of the ability to find and process information. A further 32% had adequate cognition but had limitations in sensory function or mental vitality or were unable to go outside on their own. A total of 10% did not report any of the measured problems. In general, care utilisation increases with age. As health problems increase, physical and cognitive abilities decline. Results suggest that those elderly people who are most dependent on care services and who could benefit most from a good choice, are also those who have the highest prevalence of cognitive and physical limitations associated with the capacity to act as a rational consumer of care services.

  • 33. Midanik, L.
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Contributions of social science to the alcohol field in an era of biomedicalization2005In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 60, no 5, p. 1107-1116Article in journal (Refereed)
    Abstract [en]

    In an era of biomedicalization where findings in genetic and neurobiological research are seen as "breakthroughs" by the media and hence by the general public, it is important for social scientists to acknowledge the effect of their contributions to the alcohol field not only to their own colleagues but also to the public at-large. Contributions of social science research to the development and evaluation of alcohol policies are illustrated in the following four areas: (1) alcohol epidemiological research focusing on the importance of examining drinking patterns and their relation to alcohol-related problems; (2) alcohol's contribution to the burden of disease; (3) alcohol control policies and their impact; and (4) brief interventions that provide strategies for at-risk drinkers as well as those who are alcohol dependent.

  • 34.
    Miething, Alexander
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    A matter of perception: Exploring the role of income satisfaction in the income-mortality relationship in German survey data 1995-20102013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 99, p. 72-79Article in journal (Refereed)
    Abstract [en]

    Individual- and community-level income has been shown to be linked to social inequalities in health and mortality. On the individual level, social comparisons and relative deprivation resulting from them have been identified as relevant mechanisms involved in the relationship between income and health, but it is mainly income-based measures of relative deprivation that have been considered in previous studies. Using income satisfaction, this study employs a perception-based indicator of relative deprivation.

    The study, covering the period between 1995 and 2010, utilized the German Socio-Economic Panel. The follow-up included 11,056 men and 11,512 women at employment age 25–64. Discrete-time survival analysis with Cox regression was performed to estimate the effects of relative income position and income satisfaction on all-cause mortality.

    The univariate analysis revealed an income gradient on mortality and further showed a strong association between income satisfaction and survival. After education and employment status were adjusted for, the effect of discontent with income on mortality was still present in the female sample, whereas in the male sample only the income gradient prevailed. When self-rated health was controlled for, the hazard ratios of income satisfaction attenuated and turned non-significant for both men and women while the effects of income position remained stable.

    In conclusion, the findings suggest that income satisfaction and income position measure different aspects of income inequality and complement one another. Income satisfaction appeared to be a possible contributing component to the causal pathway between income and mortality.

  • 35.
    Miething, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rydgren, Jens
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Access to occupational networks and ethnic variation of depressive symptoms in young adults in Sweden2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 190, p. 207-216Article in journal (Refereed)
    Abstract [en]

    Social capital research has recognized the relevance of occupational network contacts for individuals’ life chances and status attainment, and found distinct associations dependent on ethnic background. A still fairly unexplored area is the health implications of occupational networks. The current approach thus seeks to study the relationship between access to occupational social capital and depressive symptoms in early adulthood, and to examine whether the associations differ between persons with native Swedish parents and those with parents born in Iran and the former Yugoslavia.

    The two-wave panel comprised 19- and 23-year-old Swedish citizens whose parents were born in either Sweden, Iran or the former Yugoslavia. The composition of respondents’ occupational networks contacts was measured with a so-called position generator. Depressive symptoms were assessed with a two-item depression screener. A population-averaged model was used to estimate the associations between depressive symptoms and access to occupational contact networks.

    Similar levels of depressive symptoms in respondents with parents born in Sweden and Yugoslavia were contrasted by a notably higher prevalence of these conditions in those with an Iranian background. After socioeconomic conditions were adjusted for, regression analysis showed that the propensity for depressive symptoms in women with an Iranian background increased with a higher number of manual class contacts, and decreased for men and women with Iranian parents with a higher number of prestigious occupational connections. The respective associations in persons with native Swedish parents and parents from the former Yugoslavia are partly reversed.

    Access to occupational contact networks, but also perceived ethnic identity, explained a large portion of the ethnic variation in depression. Mainly the group with an Iranian background seems to benefit from prestigious occupational contacts. Among those with an Iranian background, social status concerns and expected marginalization in manual class occupations may have contributed to their propensity for depressive symptoms.

  • 36. Mäki, Netta
    et al.
    Martikainen, Pekka
    Eikemo, Terje
    Menvielle, Gwenn
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Jasilionis, Domantas
    Mackenbach, Johan P.
    Educational differences in disability-free life expectancy: a comparative study of long-standing activity limitation in eight European countries2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 94, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Healthy life expectancy is a composite measure of length and quality of life and an important indicator of health in aging populations. There are few cross-country comparisons of socioeconomic differences in healthy life expectancy. Most of the existing comparisons focus on Western Europe and the United States, often relying on older data. To address these deficiencies, we estimated educational differences in disability-free life expectancy for eight countries from all parts of Europe in the early 2000s. Long-standing severe disability was measured as a Global Activity Limitation Indicator (GALI) derived from the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Census-linked mortality data were collected by a recent project comparing health inequalities between European countries (the EURO-GBD-SE project). We calculated sex-specific educational differences in disability-free life expectancy between the ages of 30 and 79 years using the Sullivan method. The lowest disability-free life expectancy was found among Lithuanian men and women (33.1 and 39.1 years, respectively) and the highest among Italian men and women (42.8 and 44.4 years, respectively). Life expectancy and disability-free life expectancy were directly related to the level of education, but the educational differences were much greater in the latter in all countries. The difference in the disability-free life expectancy between those with a primary or lower secondary education and those with a tertiary education was over 10 years for males in Lithuania and approximately 7 years for males in Austria, Finland and France, as well as for females in Lithuania. The difference was smallest in Italy (4 and 2 years among men and women, respectively). Highly educated Europeans can expect to live longer and spend more years in better health than those with lower education. The size of the educational difference in disability-free life expectancy varies significantly between countries. The smallest and largest differences appear to be in Southern Europe and in Eastern and Northern Europe, respectively.

  • 37.
    Nelson, Kenneth
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Welfare states and population health: the role of minimum income benefits for mortality2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 112, p. 63-71Article in journal (Refereed)
    Abstract [en]

    The causes of cross-national differences in population health are subject for intense discussion, often focusing on the role of structural economic factors. Although population health is widely believed to reflect the living conditions in society, surprisingly few comparative studies systematically assess policy impacts of anti-poverty programs. In this paper we estimate the influence of minimum income benefits on mortality using international data on benefit levels in 18 countries 1990-2009. Included are all major non-contributory benefits that low-income households may receive. Our analyses, based on fixed effects pooled time-series regression, show that minimum income benefits improve mortality, measured in terms of age-standardized death rates and life expectancy. The results on country-level links between minimum income benefits and mortality are remarkably robust in terms of measured confounding effects.

  • 38. Pampel, Fred
    et al.
    Legleye, Stephane
    Goffette, Céline
    Piontek, Daniela
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Khlat, Myriam
    Cohort changes in educational disparities in smoking: France, Germany and the United States2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 127, p. 41-50Article in journal (Refereed)
    Abstract [en]

    This study investigates the evolution of educational disparities in smoking uptake across cohorts for menand women in three countries. Nationally representative surveys of adults in France, Germany and theUnited States in 2009e2010 include retrospective measures of age of uptake that are compared for threecohorts (born 1946e1960, 1961e1975, and 1976e1992). Discrete logistic regressions and a relativemeasure of education are used to model smoking histories until age 34. The following patterns are found:a strengthening of educational disparities in the timing of uptake from older to younger cohorts; anearlier occurrence of the strengthening for men than women and for the United States than France orGermany; a faster pace of the epidemic in France than in the United States, and; a divide between thehighest level of education and the others in the United States, as opposed to a gradient across categoriesin France. Those differences in smoking disparities across cohorts, genders and countries help identifythe national and temporal circumstances that shape the size and direction of the relationship betweeneducation and health and the need for policies that target educational disparities.

  • 39. Pega, Frank
    et al.
    Blakely, Tony
    Carter, Kristie
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    The explanation of a paradox?: A commentary on Mackenbach with perspectives from research on financial credits and risk factor trends2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 4, p. 770-773Article in journal (Refereed)
  • 40. Pega, Frank
    et al.
    Kawachi, Ichiro
    Rasanathan, Kumanan
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Mid Sweden University, Sweden.
    Politics, policies and population health: A commentary on Mackenbach, Hu and Looman (2013)2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 93, p. 176-179Article in journal (Refereed)
  • 41.
    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).
    Early life circumstances and male suicide: A 30-year follow-up of a Stockholm cohort born in 19532010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 3, p. 420-427Article in journal (Refereed)
    Abstract [en]

    This study analyses the relationship between early life circumstances and suicide during adolescence and young adulthood among men in a Stockholm birth cohort born in 1953. Relevant variables were derived from Durkheim's proposition of social integration and suicide and Merton's strain theory of deviance. The links between our background variables and suicide were estimated with rare events logistic regression, a statistical method specially developed for situations in which rare events are endemic to the data. We found that self-rated loneliness at age 12–13 as an indicator of social isolation, school absenteeism at the same age as an indicator of school integration, and growing up in a family which received means-tested social assistance at least once during the period 1953–1965 as an indicator of childhood poverty, were statistically related to subsequent suicide risk between 1970 and 1984. Furthermore, following Bourdieu's rereading of Durkheim's Suicide, we argue that social isolation and school integration can be seen as important forms of deprivation, since “social integration” can also be understood in terms of “social recognition”. This view emphasises the importance of taking the emotional and social poverty of children just as seriously as their material poverty when it comes to suicide.

  • 42.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Commentary: Childhood parental loss and adulthood health: Discussing the role of parental cause of death, child's age at death and historical context2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 131, p. 190-192Article in journal (Refereed)
  • 43.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kölegård, Maria
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). The National Board of Health and Welfare, Sweden.
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Income inequality and self-rated health in Stockholm, Sweden: A test of the ‘income inequality hypothesis’ on two levels of aggregation2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 7, p. 1091-1098Article in journal (Refereed)
    Abstract [en]

    The number of studies analysing income inequality and health are voluminous. However, when empirically testing the income inequality hypothesis, the level of aggregation could be crucial for whether we find an association or not and for the mechanisms we believe are active. This study hence investigates: 1) the two-year lagged effect by income inequality on health at two levels of aggregation; municipalities and neighbourhoods in Sweden; 2) whether spending on social goods accounts for the association between income inequality and health; 3) the effect by income inequality among the affluent and the disadvantaged in municipalities and neighbourhoods, respectively.

    The empirical data is based on a Swedish public health survey in 2002 and includes residents of Stockholm aged 18–84 years. The sample consists of 28,092 individuals nested within 22 municipalities and 709 neighbourhoods in the county of Stockholm with a non-response rate of 37 percent. A total population register (HSIA) is further used for the construction of contextual-level indicators. Primary method used is multi-level logistic regression.

    The findings indicate a moderate effect by high and very high income inequality on self-rated poor health at the municipality-level. The association, however, ceases after adjustment for spending on social goods. No detrimental effect by income inequality on self-rated health at the neighbourhood-level is found. The results further suggest that poor individuals residing in high inequality neighbourhoods do not have poorer health than those residing in low inequality contexts while high inequality is most deleterious for poor individuals at the municipality-level. In sum, the findings suggest that reduced spending on social goods could account for the association between income inequality and health at the municipality-level. The contrasting findings at the neighbourhood- and municipality-level indicate that it is important to consider the level of aggregation when studying health effects by income inequality.

  • 44. Saarela, Jan
    et al.
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Åbo Akademi University, Finland.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Birth order and mortality in two ethno-linguistic groups: register-based evidence from Finland2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 158, p. 8-13Article in journal (Refereed)
    Abstract [en]

    Previous research has documented an association between birth order and suicide, although no study has examined whether it depends on the cultural context. Our aim was to study the association between birth order and cause-specific mortality in Finland, and whether it varies by ethno-linguistic affiliation. We used data from the Finnish population register, representing a 5% random sample of all Finnish speakers and a 20% random sample of Swedish speakers, who lived in Finland in any year 1987-2011. For each person, there was a link to all children who were alive in 1987. In total, there were 254,059 siblings in 96,387 sibling groups, and 9797 deaths. We used Cox regressions stratified by each siblings group and estimated all-cause and cause-specific mortality risks during the period 1987-2011. In line with previous research from Sweden, deaths from suicide were significantly associated with birth order. As compared to first-born, second-born had a suicide risk of 1.27, third-born of 1.35, and fourth- or higher-born of 1.72, while other causes of death did not display an evident and consistent birth-order pattern. Results for the Finnish-speaking siblings groups were almost identical to those based on both ethno-linguistic groups. In the Swedish-speaking siblings groups, there was no increase in the suicide risk by birth order, but a statistically not significant tendency towards an association with other external causes of death and deaths from cardiovascular diseases. Our findings provided evidence for an association between birth order and suicide among Finnish speakers in Finland, while no such association was found for Swedish speakers, suggesting that the birth order effect might depend on the cultural context.

  • 45. Shaw, Benjamin A.
    et al.
    McGeever, Kelly
    Vasquez, Elizabeth
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Socioeconomic inequalities in health after age 50: Are health risk behaviors to blame?2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 101, p. 52-60Article in journal (Refereed)
    Abstract [en]

    Recent studies indicate that socioeconomic inequalities in health extend into the elderly population, even within the most highly developed welfare states. One potential explanation for socioeconomic inequalities in health focuses on the role of health behaviors, but little is known about the degree to which health behaviors account for health inequalities among older adults, in particular. Using data from the Health and Retirement Study (N = 19,245), this study examined the degree to which four behavioral risk factors smoking, obesity, physical inactivity, and heavy drinking are associated with socioeconomic position among adults aged 51 and older, and whether these behaviors mediate socioeconomic differences in mortality, and the onset of disability among those who were disability-free at baseline, over a 10-year period from 1998 to 2008. Results indicate that the odds of both smoking and physical inactivity are higher among persons with lower wealth, with similar stratification in obesity, but primarily among women. The odds of heavy drinking decrease at lower levels of wealth. Significant socioeconomic inequalities in mortality and disability onset are apparent among older men and women; however, the role that health behaviors play in accounting for these inequalities differs by age and gender. For example, these health behaviors account for between 23 and 45% of the mortality disparities among men and middle aged women, but only about 5% of the disparities found among women over 65 years. Meanwhile, these health behaviors appear to account for about 33% of the disparities in disability onset found among women survivors, and about 9-14% among men survivors. These findings suggest that within the U.S. elderly population, behavioral risks such as smoking and physical inactivity contribute moderately to maintaining socioeconomic inequalities in health. As such, promoting healthier lifestyles among the socioeconomically disadvantaged older adults should help to reduce later life health inequalities.

  • 46.
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Positive welfare state dynamics? Sickness benefits and sickness absence in Europe 1997-20112017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 177, p. 158-168Article in journal (Refereed)
    Abstract [en]

    Sickness absence is associated with great costs for individuals, companies and society at large. Influenced by neo-classical economic theory, policy advice has emphasized the role of sickness benefit programs for reducing sickness absence rates: too generous benefits without proper control will increase the number of recipients and prolong absence spells as well as possibly cause negative dynamic effects in the long term. This study provides an alternative interpretation of the relationship between sickness benefits and sickness absence. By combining an epidemiological approach to sickness absence and a resource-based approach to welfare, we argue that sickness benefits might be viewed as a collective resource that, by providing economic support during times of ill-health, might have positive health effects. Statistical analysis of short-term sickness absence using innovative methodological approaches and combined micro- and macro-level data for 21 EU countries over the period of 1992-2011 indicates that the long run effects of relatively generous sickness benefits is rather to reduce sickness absence. This result also has implications for sickness benefit reform: whereas benefit cuts to some extent may reduce absence in the short run, in the longer run such reforms may actually increase sickness absence rates.

  • 47. Tiikkaja, Sanna
    et al.
    Olsson, Marita
    Malki, Ninoa
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sparén, Pär
    Familial risk of premature cardiovascular mortality and the impact of intergenerational occupational class mobility2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 10, p. 1883-1890Article in journal (Refereed)
    Abstract [en]

    The negative impact of low social class on cardiovascular disease (CVD) and mortality has been consistently documented. However, less scientific consistency exists in terms of whether a unique health effect of social mobility from childhood to adulthood prevails. This study explored how childhood and adult social class and the transition between them (social mobility), are related to premature CVD mortality when familial aggregation of CVD among siblings is also considered. The study includes nearly 1.9 million Swedish residents born 1939-1959 distributed over 1,044,725 families, of whom 14,667 died prematurely from CVD in 1990-2003. Information on parental class (1960) and own mid-life occupational class (1990) was retrieved from the respective censuses. Odds ratios for premature CVD mortality according to trajectory-specific social mobility, along with pairwise mean odds ratios for sibling resemblance of premature CVD mortality, were calculated by means of alternating logistic regression. This model calculates the remaining dependency of CVD mortality within sibships after accounting for available risk factors (like parental and adult social class) in the population mean model. Results showed that premature CVD mortality was associated with both parental and own adult social class. A clear tendency for the downwardly mobile to have increased, and for the upwardly mobile to experience a decreased risk of premature DID mortality was found, as well as a corresponding unique effect of social mobility per se among the manual and non-manual classes. This effect was verified for men, but not for women, when they were analysed separately. The pairwise mean odds ratios for premature CVD mortality among full siblings were 1.78 (95% CI: 1.52-2.08), and were independent of parental CVD mortality and parental or adult occupational class.

  • 48.
    Torssander, Jenny
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Adult children's socioeconomic positions and their parents' mortality: a comparison of education, occupational class, and income2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 122, p. 148-156Article in journal (Refereed)
    Abstract [en]

    Recent research has shown that the parents of well-educated children live longer than do other parents and that this association is only partly confounded by the parent's own socioeconomic position. However, the relationships between other aspects of children's socioeconomic position (e.g., occupational class and economic resources) and parental mortality have not been examined. Using the Swedish Multi-generation Register that connects parents to their children, this paper studies the associations of children's various socioeconomic resources (education, occupation, and income) and parents' mortality. The models are adjusted for a range of parental socioeconomic resources and include the resources of the parents' partners. In addition to all-cause mortality, five causes of death are analyzed separately (circulatory disease mortality, overall cancer, lung cancer, breast cancer, and prostate cancer). The results show net associations between all included indicators of children's socioeconomic position and parents' mortality risk, with the clearest association for education. Children's education is significantly associated with all of the examined causes of death except prostate cancer. Breast cancer mortality is negatively related to offspring's education but not the mothers' own education. To conclude, children's education seems to be a key factor compared with other dimensions of socioeconomic position in the offspring generation. This finding suggests that explanations linked to behavioral norms or knowledge are more plausible than those linked to access to material resources. However, it is possible that children's education to a greater degree than class and income captures unmeasured parental characteristics. The cause-specific analyses imply that future research should investigate whether offspring's socioeconomic position is linked to the likelihood of developing diseases and/or the chances of treating them. A broader family perspective in the description and explanations of social inequalities in health that includes the younger generation may increase our understanding of why these inequalities persist across the life course.

  • 49. Wennerstad, Karin Modig
    et al.
    Silventoinen, Karri
    Tynelius, Per
    Bergman, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Kaprio, Jaakko
    Rasmussen, Finn
    Associations between IQ and cigarette smoking among Swedish male twins2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 4, p. 575-581Article in journal (Refereed)
    Abstract [en]

    It has been suggested that certain health behaviours, such as smoking, may operate as mediators of the well-established inverse association between IQ and mortality risk. Previous research may be afflicted by unadjusted confounding by socioeconomic or psychosocial factors. Twin designs offer a unique possibility to take genetic and shared environmental factors into account. The aim of the present national twin Study was to determine the interrelations between IQ at age 18, childhood and attained social factors and smoking status in young adulthood and mid-life. We studied the association between IQ at age 18 and smoking in later life in a population of 11 589 male Swedish twins. IQ was measured at military conscription, and data on smoking and zygosity was obtained from the Swedish Twin Register. Information on social factors was extracted from censuses. Data on smoking was self-reported by the twins at the age of 22-47 years. Logistic regression models estimated with generalised estimating equations were used to explore possible associations between IQ and smoking among the twins as individuals as well as between-and within twin-pairs. A strong inverse association between IQ and smoking status emerged in unmatched analyses over the entire range of IQ distribution. In within-pair and between-pair analyses it transpired that shared environmental factors explained most of the inverse IQ-smoking relationship. In addition, these analyses indicated that non-shared and genetic factors contributed only slightly (and non-significantly) to the IQ-smoking association. Analysis of twin pairs discordant for IQ and smoking status displayed no evidence that non-shared factors contribute substantially to the association. The question of which shared environmental factors might explain the IQ-smoking association is an intriguing one for future research.

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