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  • 1.
    Almroth, Melody
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Falkstedt, Daniel
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Albin, Maria
    Badarin, Kathryn
    Selander, Jenny
    Gustavsson, Per
    Bodin, Theo
    Thern, Emelie
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Pan, Kuan-Yu
    Kjellberg, Katarina
    Labour market exit routes in high- and low-educated older workers before and after social insurance and retirement policy reforms in Sweden2024In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779Article in journal (Refereed)
    Abstract [en]

    Few previous studies have investigated how socioeconomic differences in labour market exit have changed after restrictions in social insurance policies. The aim of this register-based study is to investigate how early labour market exit pathways among older men and women with different levels of education changed after major restrictive social insurance and retirement policy reforms in Sweden. Cohort 1 (pre-reform) consisted of individuals who were 60 or 61 years old in 2005 (N = 186,145) and Cohort 2 (post-reform) consisted of individuals who were 60 or 61 years old in 2012 (N = 176,216). Educational differences in four labour market exit pathways were investigated using Cox proportional hazards regression; the exit pathways were disability pension, early old-age pension with and without income respectively, and no income for two consecutive years. As expected, exits through disability pension were rarer in Cohort 2. Lower education was also more strongly associated with disability pension in Cohort 2. Parallel to this, lower education showed a stronger association with both early old-age pension types in Cohort 2. Additionally, a tendency towards a relatively higher likelihood of earning no income was seen among the less educated. Increases in inequalities tended to be greater for women. Our results indicate that educational inequalities in labour market exit have grown significantly after restrictions in social insurance and changes in retirement policies, which can have negative financial repercussions for those already in a vulnerable position. These results indicate that careful analyses of effects on disparities are needed before making major changes in welfare systems.

  • 2.
    Almroth, Melody
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Falkstedt, Daniel
    Kjellberg, Katarina
    Carlsson, Emma
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Pan, Kuan-Yu
    Berglund, Karin
    Thern, Emelie
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    The role of working conditions in educational differences in all-cause and ischemic heart disease mortality among Swedish men2024In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 50, no 4, p. 300-309Article in journal (Refereed)
    Abstract [en]

    Objectives This study aims to investigate the extent to which low job control and heavy physical workload in middle age explain educational differences in all-cause and ischemic heart disease (IHD) mortality while accounting for important confounding factors.

    Methods The study is based on a register-linked cohort of men who were conscripted into the Swedish military at around the age of 18 in 1969/1970 and were alive and registered in Sweden in 2005 (N=46 565). Cox proportional hazards regression models were built to estimate educational differences in all-cause and IHD mortality and the extent to which this was explained by physical workload and job control around age 55 by calculating the reduction in hazard ratio (HR) after adjustments. Indicators of health, health behavior, and other factors measured during conscription were accounted for.

    Results We found a clear educational gradient for all-cause and IHD mortality (HR 2.07 and 2.47, respectively, for the lowest compared to the highest education level). A substantial part was explained by the differential distribution of the confounding factors. However, work-related factors, especially high physical workload, also played important explanatory roles.

    Conclusion Even after accounting for earlier life factors, low job control and especially high physical workload seem to be important mechanistic factors in explaining educational inequalities in all-cause and IHD mortality. It is therefore important to find ways to reduce physical workload and increase job control in order to decrease inequalities in mortality.

  • 3.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Thern, Emelie
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Using repeated measures to study the contribution of alcohol consumption and smoking to the social gradient in all‐cause mortality: Results from the Stockholm Public Health Cohort2023In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 42, no 7, p. 1850-1859Article in journal (Refereed)
    Abstract [en]

    Introduction: The social gradient in consumption behaviours has been suggestedto partly explain health inequalities. The majority of previous studies have onlyincluded baseline measurements and not considered potential changes in behav-iours over time. The study aimed to investigate the contribution of alcohol con-sumption and smoking to the social gradient in mortality and to assess whetherthe use of repeated measurements results in larger attenuations of the main asso-ciation compared to using single baseline assessments.

    Methods: Longitudinal survey data from the population-based Stockholm PublicHealth Cohort from 2006 to 2014 was linked to register data on mortality until2018 for 13,688 individuals and analysed through Cox regression.

    Results: Low socioeconomic position (SEP) was associated with increased mortal-ity compared with high SEP; hazard ratios 1.56 (95% CI 1.30–1.88) for occupa-tional status and 1.77 (95% CI 1.49–2.11) for education, after adjustment fordemographic characteristics. Using repeated measurements, alcohol consumptionand smoking explained 44% of the association between occupational status andall-cause mortality. Comparing repeated and baseline measures, the percentageattenuation due to alcohol consumption increased from 11% to 18%, whereas itremained similar for smoking (25–23%).

    Discussion and Conclusions: Smoking and alcohol consumption explained alarge part of the association between SEP and mortality. Comparing results fromtime-fixed and time-varying models, there was an increase in overall percentageattenuation that was mainly due to the increased proportion explained by alcoholconsumption. Repeated measurements provide a better estimation of the contri-bution of alcohol consumption, but not smoking, for the association between SEPand mortality.

  • 4.
    Carlsson, Emma
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Stockholm, Sweden.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Stockholm, Sweden.
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Stockholm, Sweden.
    Burström, Bo
    Thern, Emelie
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Stockholm, Sweden.
    Do early life factors explain the educational differences in early labour market exit? A register-based cohort study2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 1680Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic inequalities in labour market participation are well established. However, we do not fully know what causes these inequalities. The present study aims to examine to what extent factors in childhood and late adolescence can explain educational differences in early labour market exit among older workers.

    Methods: All men born in 1951–1953 who underwent conscription examination for the Swedish military in 1969–1973 (n = 145 551) were followed from 50 to 64 years of age regarding early labour market exit (disability pension, long-term sickness absence, long-term unemployment and early old-age retirement with and without income). Early life factors, such as cognitive ability, stress resilience, and parental socioeconomic position, were included. Cox proportional-hazards regressions were used to estimate the association between the level of education and each early labour market exit pathway, including adjustment for early life factors.

    Results: The lowest educated men had a higher risk of exit through disability pension (HR: 2.72), long-term sickness absence (HR: 2.29), long-term unemployment (HR: 1.45), and early old-age retirement with (HR: 1.29) and without income (HR: 1.55) compared to the highest educated men. Factors from early life explained a large part of the educational differences in disability pension, long-term sickness absence and long-term unemployment but not for early old-age retirement. Important explanatory factors were cognitive ability and stress resilience, whilst cardiorespiratory fitness had negligible impact.

    Conclusions: The association between education and early exit due to disability pension, long-term sickness absence and long-term unemployment was to a large part explained by factors from early life. However, this was not seen for early old-age retirement. These results indicate the importance of taking a life-course perspective when examining labour market participation in later working life.

  • 5.
    Landberg, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Thern, Emelie
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Is the association between alcohol use and sickness absence modified by socioeconomic position? findings from the Stockholm public health cohort2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 1490Article in journal (Refereed)
    Abstract [en]

    BackgroundThe distribution of sickness absence tends to be socially patterned less is however known about the underlying mechanisms and pathways of the social gradient found in sickness absence. The present study aims to investigate (i) if the risk function between average volume of alcohol consumption and sickness absence is modified by socio-economic position (SEP), and (ii) whether such an effect modification can be attributed to differences in drinking patterns and other risk factors including other lifestyle behaviours, health status, and working conditions.MethodsThe study was based on data from the Stockholm public health cohort 2006, with an analytical sample of 13 855 respondents aged 18-64 years. Self-reported information on occupational class (a measure of SEP), alcohol consumption, other lifestyle behaviour, health and working conditions was collected from the survey. The outcome of long-term (> 14 days) sickness absence between 2006 and 2008 was obtained from national registers. Negative binomial regression was used to estimate the Incidence Rate Ratios (IRR) with 95% confidence intervals (CI).ResultsIn the initial analyses, heavy drinking manual workers had a 5-fold increased risk of long-term sickness absence compared to non-manual employees who were moderate drinkers, and approximately 60% of the excess risk among heavy drinking manual workers was attributable to an interaction between alcohol use and SEP. Adjusting for working conditions was associated with the largest attenuation of the risk estimate, compared to other lifestyle behaviors and health. In the fully adjusted model, the IRR was further attenuated for the manual workers and the joint effect of SEP and heavy drinking remained in the final model with an attributable proportion of 49%.ConclusionsIndividuals in Sweden with lower levels of SEP appear to be more vulnerable to alcohol consumption in relation to sickness absence, where differences in working conditions explained a large part but not all of the differential vulnerability.

  • 6.
    Thern, Emelie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Elling, Devy L.
    Badarin, Kathryn
    Rodríguez, Julio César Hernando
    Bodin, Theo
    Precarious employment in young adulthood and later alcohol-related morbidity: a register-based cohort study2024In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 81, no 4, p. 201-208Article in journal (Refereed)
    Abstract [en]

    Objectives The prevalence of precarious employment is increasing, particularly among young adults where less is known about the long-term health consequences. The present study aims to test if being precariously employed in young adulthood is associated with an increased risk of alcohol-related morbidity later in life.

    Methods A register-based cohort study was conducted in Sweden. The Swedish Work, Illness, and Labor-market Participation (SWIP) cohort was used to identify individuals who were aged 27 years between 2000 and 2003 (n=339 403). Information on labour market position (precarious employment, long-term unemployment, substandard employment and standard employment relations) was collected for young people 3 years after graduation from school using nationwide registers. Details about alcohol-related morbidity during a 28-year follow-up period were collected from the National Hospital Discharge Register. Data on sex, age, country of birth, education and previous poor health were also obtained from the registers.

    Results Young adults in precarious employment had an increased risk of alcohol-related morbidity compared with individuals of the same age in standard employment (HR 1.43, 95% CI 1.32 to 1.55), after adjusting for several important covariates. A stronger association was found among young men who were precariously employed compared with young women.

    Conclusion This nationwide register-based study conducted in Sweden with a long-term follow-up suggests that being precariously employed in young adulthood is associated with an increased risk of alcohol-related morbidity later in life.

  • 7.
    Thern, Emelie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Falkstedt, Daniel
    Almroth, Melody
    Kjellberg, Katarina
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Bodin, Theo
    Melin, Bo
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Educational qualification differences and early labor market exit among men: the contribution of labor market marginalization measured across the working life2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 1015Article in journal (Refereed)
    Abstract [en]

    Background: The present study aims to investigate the association between educational qualification and early labor market exit among men and to examine the contribution of labor market marginalization measured across the working life on this association.

    Method: A register-linked cohort study was conducted including men who completed military service in 1969/70 (born between 1949 and 1951) and were alive at age 55 and not disability pension beneficiaries (n = 40 761). Information on the highest level of educational qualification and the outcome of early exit (disability pension, sickness absence, unemployment, and early old-age pension) was obtained from Swedish nationwide registers between the ages of 55 and 64 years. Labor market marginalization was defined as periods of long-term unemployment and sickness absence over the working life and up to follow-up. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI).

    Results: Low-educated men were more likely to leave the labor force early due to disability pension or sickness absence (HR: 2.48), unemployment (HR: 2.09), and early old-age pension with- (HR:1.25) and without -income (HR: 1.58). Labor market marginalization across the working life explained a large part of the association for the more involuntary early exit routes (disability pensions, sickness absence, unemployment) and explained very little with regards to the more voluntary early exit routes (early old-age pension with and without income).

    Conclusion: Exposure to labor market marginalization across the working life was important in explaining educational differences in early labor market exit due to disability pension or sickness absence and unemployment. This study underscores the importance of identifying and implementing preventive measures in the workplace (e.g. adaptions) to prevent new spells of sickness absence and unemployment, especially among low educated individuals.

  • 8.
    Thern, Emelie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Understanding the differential effect of alcohol consumption on the relation between socio-economic position and alcohol-related health problems: results from the Stockholm Public Health Cohort2021In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 116, no 4, p. 799-808Article in journal (Refereed)
    Abstract [en]

    Aim To test (i) whether the harmful effects of average volume of alcohol consumption (AC) and heavy episodic drinking (HED) differ by socio‐economic position (SEP), and (ii) if so, to what extent such differential effects can be attributed to an unequal distribution of harmful levels and patterns of drinking, health, life‐style and social factors. Design A longitudinal cohort study with baseline in 2002 or 2006, with record‐linkage to national registers. Setting Stockholm County, Sweden. Participants A total of 37484 individuals, aged 25–70 years, responding to the survey in 2002 or 2006. Measurements The outcome of alcohol‐related health problems was obtained from the National Patient Register and Cause of Death Register using the Swedish index diagnoses related to alcohol use. Self‐reported information on occupational class (measure of SEP), AC, HED as well as other health‐related factors were extracted from the surveys. Average follow‐up time was 13.3 years. Findings During follow‐up, a total of 1237 first‐time events of alcohol‐related health problems occurred. After initial adjustments, heavy drinking appeared to be more harmful to individuals with low SEP compared with high SEP (P ¼ 0.001). Differences in HED frequency explained the largest part of the differential effect of AC. Engaging in weekly HED was more harmful to individuals with low SEP (P ¼ 0.031) than high SEP. Differences in AC, together with other factors, explained a large part of the differential effect of HED. Conclusions The greater adverse impact of alcohol consumption on health in Sweden on people with lower socio‐economic position may be largely attributable to higher prevalence of heavy episodic drinking, as well as other behavioral and social risk factors.

  • 9.
    Thern, Emelie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Educational differences in labor market marginalization among mature-aged working men: the contribution of early health behaviors, previous employment histories, and poor mental health2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 1784Article in journal (Refereed)
    Abstract [en]

    Background: Social inequalities in labor force participation are well established, but the causes of these inequalities are not fully understood. The present study aims to investigate the association between educational qualification and labor market marginalization (LMM) among mature-aged working men and to examine to what extent the association can be explained by risk factors over the life course.

    Method: The study was based on a cohort of men born between 1949 and 1951 who were examined for Swedish military service in 1969/70 and employed in 2000 (n=41,685). Data on educational qualification was obtained in 2000 and information on the outcome of LMM (unemployment, sickness absence, and disability pension) was obtained between 2001 and 2008. Information on early health behaviors, cognitive ability, previous employment histories, and mental health was collected from conscription examinations and nationwide registers.

    Results: Evidence of a graded association between years of education and LMM was found. In the crude model, compared to men with the highest level of education men with less than 12years of schooling had more than a 2.5-fold increased risk of health-related LMM and more than a 1.5-fold increased risk of non-health-related LMM. Risk factors measured across the life course explained a large part of the association between education and health-related LMM (33-61%) and non-health-related LMM (13-58%).

    Conclusions: Educational differences remained regarding LMM among mature-aged workers, even after considering several important risk factors measured across the life course. Previous health problems and disrupted employment histories explained the largest part of the associations.

  • 10.
    Thern, Emelie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Matilla-Santander, Nuria
    Bodin, Theo
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Precarious employment at a young age and labor-market marginalization during middle-adulthood: A register-linked cohort study2023In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 49, no 3, p. 201-210Article in journal (Refereed)
    Abstract [en]

    Objective The present study aims to investigate the association between exposure to precarious employment three years after graduation and the risk of labor market marginalization (LMM) ten years later.

    Methods A registered-linked cohort study based on the Swedish Work, Illness, and Labor-market Participation (SWIP) cohort was conducted among all individuals born between 1973 and 1976, who were registered in Sweden the year they turned 27 years old (N=365 702). Information on the exposure of labor market establishment three years after graduating from school and outcome of LMM ten years after graduating was collected from nationwide registers. Relative risk ratios (RRR) with 95% confidence intervals (CI) were obtained by multinominal logistic regression.

    Results After considering important covariates, young adults in precarious employment three years after graduation were at an increased risk of future long-term unemployment (RRR 2.31), later precarious employment (RRR 2.85), and long-term sickness absence/disability pension (RRR 1.43) compared to individuals who had obtained standard employment arrangements within three years of graduating. Young precariously employed men had a slightly strong association compared to females with regards to all outcomes.

    Conclusion The result of this study suggests that both young men and women in precarious employment three years after graduation are more likely to have a weaker attachment to the labor force later in life compared to individuals of the same age in standard employment. This is important as the prevalence of precarious employment is increasing globally, and young adults appear to be especially vulnerable.

  • 11.
    Thern, Emelie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Matilla-Santander, Nuria
    Hernando-Rodriguez, Julio C.
    Almroth, Melody
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Bodin, Theo
    Precarious employment in early adulthood and later mental health problems: a register-linked cohort study2023In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 77, no 12, p. 755-761Article in journal (Refereed)
    Abstract [en]

    BackgroundPrecarious employment is a determinant of self-reported mental health problems among young adults. Less is known about more severe and objectively measured health outcomes, such as mental health problems requiring inpatient care. The current study aims to investigate the effect of precarious employment in early adulthood on later mental health problems requiring inpatient care. MethodA register-based cohort study, based on the Swedish Work, Illness and Labor-market Participation cohort, was conducted, following a cohort of young adults aged 27 years between 2000 and 2003 (born between 1973 and 1976) (n=339 403). Information on labour market position in early adulthood (precarious employment, substandard employment, unemployment and standard employment) was collected from registers 3 years after graduating from school. Information on the outcome of mental health problems (depression, anxiety and stress-related disorders) was collected from the National Patient Register. HRs with 95% CIs were obtained by Cox regression analyses. ResultsAfter adjusting for important covariates, such as prior mental health problems, compared with individuals in standard employment, individuals who were precariously employed in early adulthood had an increased risk of later mental health problems (HRadjusted: 1.51 95% CI 1.42 to 1.60). The association between precarious employment and mental health was slightly stronger for males. ConclusionsIn Sweden, entry into the labour market with precarious employment is associated with an increased risk of mental health problems, which is important given that precarious employment is becoming more prevalent among young adults.

  • 12. Thern, Emelie
    et al.
    Ramstedt, Mats
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. The Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden.
    Long-term effects of youth unemployment on alcoholrelated morbidity2020In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 115, no 3, p. 418-425Article in journal (Refereed)
    Abstract [en]

    Aim

    To test if exposure to unemployment in young adulthood is associated with an increased risk of later alcohol‐related morbidity.

    Design

    A nation‐wide register‐linked longitudinal population‐based study.

    Setting

    Sweden.

    Participants

    A total of 16 490 individuals born between 1967 and 1978, who had participated in the Labour Force Survey between the ages of 16–24 years during 1990–95.

    Measurement

    Information on the outcome of alcohol‐related morbidity was obtained from the National Hospital Discharge Register. The Swedish index of alcohol‐related in‐patient care was used to define the outcome. Information on sex, age and country of birth, as well as parents’ level of education, socio‐economic status and alcohol‐related health problems, were also obtained. Average follow‐up time was 22 years. Cox regression analysis was used to obtain hazard ratios (HR) with 95% confidence intervals (CI).

    Findings

    Compared with full‐time students, individuals who experienced short‐ and long‐term unemployment spells at a young age were at an increased risk of later alcohol‐related morbidity; < 3 months (HR = 2.04, 95% CI = 1.35–3.09), 3–6 months (HR = 2.20, 95% CI = 1.29–3.75) and > 6 months (HR = 1.99, 95% CI = 1.06–3.71) of unemployment, after adjusting for several important individual and family level covariates.

    Conclusion

    In Sweden, a nation‐wide register‐based study with a 22‐year follow‐up suggests that being unemployed in young adulthood is associated with an increased risk of alcohol‐related morbidity later in life.

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