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  • 1.
    Ahlbom, Anders
    et al.
    Karolinska Institutet.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Lundström, Hans
    Statistics Sweden.
    Den åldrande befolkningen2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 48, p. 3048-3051Article in journal (Refereed)
  • 2.
    Andersson, Gunnar
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Long-Distance Migration and Mortality in Sweden: Testing the Salmon Bias and Healthy Migrant Hypotheses2017In: Population, Space and Place, ISSN 1544-8444, E-ISSN 1544-8452, Vol. 23, no 4, article id UNSP e2032Article in journal (Refereed)
    Abstract [en]

    International migrants often have lower mortality rates than the native populations in their new host countries. Several explanations have been proposed, but in the absence of data covering the entire life courses of migrants both before and after each migration event, it is difficult to assess the validity of different explanations. In the present study, we apply hazard regressions to Swedish register data to study the mortality of long-distance migrants from Northern to Southern Sweden as well as the mortality of return migrants to the North. In this way, we can study a situation that at least partly resembles that of international migration while still having access to data covering the full demographic biographies of all migrants. This allows us to test the relative roles of salmon bias and healthy migrant status in observed mortality rates of long-distance migrants. We find no mortality differentials between residents in northern and southern Sweden, and no evidence of a selection of healthy migrants from the North to the South. In contrast, we provide clear evidence of salmon effects' in terms of elevated mortality of the return migrants to northern Sweden, which are produced when migrants return to their place of origin in relation to subsequent death.

  • 3.
    Billingsley, Sunnee
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Ghilagaber, Gebrenegus
    Stockholm University, Faculty of Social Sciences, Department of Statistics.
    An application of diagonal reference models and time-varying covariates in social mobility research on mortality and fertility2018In: Social Science Research, ISSN 0049-089X, E-ISSN 1096-0317, Vol. 75, p. 73-82Article in journal (Refereed)
    Abstract [en]

    In social mobility research, the diagonal reference model (DRM) is argued to best isolate the effect of social mobility from origin and destination status effects. In demographic research, standard analyses of the duration until an event occurs rely heavily on the appropriate use of covariates that change over time. We apply these best-practice methods to the study of social mobility and demographic outcomes in Sweden using register data that covers the years 1996–2012. The mortality analysis includes 1,024,142 women and 747,532 men and the fertility analysis includes 191,142 women and 164,368 men. We identify the challenges inherent in this combination and present strategies with an application to how social mobility is related to both fertility and mortality. Our application is successful at incorporating all requirements related to these methods. Our findings suggest, however, that certain data characteristics, such as a relatively high share of missing data, can be problematic. We also find that controlling for origin and destination status generally provides acceptable estimates of the mobility association in the specific case of Sweden and the relationship between social mobility and both fertility and mortality.

  • 4. De Santis, Gustavo
    et al.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Vignoli, Daniele
    A PERIOD TOTAL FERTILITY RATE WITH COVARIATES FOR SHORT-PANEL DATA2014In: Population, ISSN 0032-4663, E-ISSN 1957-7966, Vol. 69, no 3, p. 463-476Article in journal (Refereed)
    Abstract [en]

    Hoem and Muresan (2011a) have recently shown that the most widely used macro-level indicator of fertility, the total fertility rate (TER), can be reconciled with fertility estimates that derive from applications of event history analysis (EHA) to micro-data. The purpose of this paper is to extend their ideas and show that they can be usefully applied to short panels, i.e. when the same people are interviewed in two or more successive rounds over a very limited number of years. This method can also be applied to data collected for general purposes and not strictly for demographic research, including data of an economic nature (employment, income, geographic or professional mobility, etc.). Despite the absence of questions on fertility, group-specific fertility estimates can be obtained that are not otherwise available (e.g. fertility by income level before the birth of the child), which are not biased by memory or selection of respondents and can be made consistent with the TFR observed in that period for the entire population. An application to Italian EU-SILC data in the years 2004-2007 highlights the advantages and the limitations of the method.

  • 5. 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.

  • 6.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    How Does the Age Gap Between Partners Affect Their Survival?2010In: Demography, ISSN 0070-3370, E-ISSN 1533-7790, Vol. 47, no 2, p. 313-326Article in journal (Refereed)
    Abstract [en]

    I use hazard regression methods to examine how the age difference between spouses affects their survival. In many countries, the age difference between spouses at marriage has remained relatively stable for several decades. In Denmark, men are, on average, about three years older than the women they marry. Previous studies of the age gap between spouses with respect to mortality found that having a younger spouse is beneficial, while having an older spouse is detrimental for one's own survival. Most of the observed effects could not be explained satisfactorily until now, mainly because of methodological drawbacks and insufficiency of the data. The most common explanations refer to selection effects, caregiving in later life, and some positive psychological and sociological effects of having a younger spouse. The present study extends earlier work by using longitudinal Danish register data that include the entire history of key demographic events of the whole population from 1990 onward. Controlling for confounding factors such as education and wealth, results suggest that having a younger spouse is beneficial for men but detrimental for women, while having an older spouse is detrimental for both sexes.

  • 7.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    The Married Really Live Longer? The Role of Cohabitation and Socioeconomic Status2012In: Journal of Marriage and Family, ISSN 0022-2445, E-ISSN 1741-3737, Vol. 74, no 3, p. 462-475Article in journal (Refereed)
    Abstract [en]

    Numerous studies have shown that married women and men experience the lowest mortality. Legal marital status, however, does not necessarily reflect today's social reality because individuals are classified as never married, widowed, or divorced even when they are living with a partner. Denmark is one of the forerunners of developments in coresidential partnerships and one of only a few countries where administrative sources provide individual-level information on cohabitation for the whole population. Using register information from Statistics Denmark on 3,888,072 men and women ages 18–65, the author investigated mortality differences by living arrangement with hazard regression models. Overall, premature mortality was found to be lowest for married persons, followed by cohabiting persons. Adjusting for socioeconomic status reduced excess mortality of nonmarried individuals. Moreover, a mortality-crossover effect emerged in which cohabiters with above-average socioeconomic status had a lower risk of dying than married people. This finding was particularly pronounced for men.

  • 8.
    Drefahl, Sven
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Ahlbom, Anders
    Modig, Karin
    Losing Ground - Swedish Life Expectancy in a Comparative Perspective2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 2, p. e88357-Article in journal (Refereed)
    Abstract [en]

    Background: In the beginning of the 1970s, Sweden was the country where both women and men enjoyed the world's longest life expectancy. While life expectancy continues to be high and increasing, Sweden has been losing ground in relation to other leading countries. Methods: We look at life expectancy over the years 1970-2008 for men and women. To assess the relative contributions of age, causes of death, and smoking we decompose differences in life expectancy between Sweden and two leading countries, Japan and France. This study is the first to use this decomposition method to observe how smoking related deaths contribute to life expectancy differences between countries. Results: Sweden has maintained very low mortality at young and working ages for both men and women compared to France and Japan. However, mortality at ages above 65 has become considerably higher in Sweden than in the other leading countries because the decrease has been faster in those countries. Different trends for circulatory diseases were the largest contributor to this development in both sexes but for women also cancer played a role. Mortality from neoplasms has been considerably low for Swedish men. Smoking attributable mortality plays a modest role for women, whereas it is substantially lower in Swedish men than in French and Japanese men. Conclusions: Sweden is losing ground in relation to other leading countries with respect to life expectancy because mortality at high ages improves more slowly than in the leading countries, especially due to trends in cardiovascular disease mortality. Trends in smoking rates may provide a partial explanation for the trends in women; however, it is not possible to isolate one single explanatory factor for why Sweden is losing ground.

  • 9.
    Drefahl, Sven
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Kolk, Martin
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Turunen, Jani
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Dödlighet2017In: Demografi: Befolkningsperspektiv på samhället / [ed] Ann-Zofie Duvander, Jani Turunen, Lund: Studentlitteratur AB, 2017, p. 67-92Chapter in book (Other academic)
  • 10.
    Drefahl, Sven
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Lundström, Hans
    Modig, Karin
    Ahlbom, Anders
    The era of centenarians: mortality of the oldest old in Sweden2012In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 272, no 1, p. 100-102Article in journal (Refereed)
  • 11.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    All-cause mortality, age at arrival, and duration of residence among adult migrants in Sweden: A population-based longitudinal study2018In: SSM - Population Health, ISSN 2352-8273, Vol. 6, p. 16-25Article in journal (Refereed)
    Abstract [en]

    Background: A mortality advantage has been observed among recently arrived immigrants in multiple national contexts, even though many immigrants experience more social disadvantage compared to natives. This is the first study to investigate the combined influence of duration of residence and age at arrival on the association between region of origin and all-cause mortality among the adult immigrant population in Sweden.

    Methods: Using population-based registers, we conducted a follow-up study of 1,363,429 individuals aged 25-64 years from 1990 to 2008. Gompertz parametric survival models were fitted to derive hazard ratios (HR) for all-cause mortality.

    Results: Compared to native Swedes, we observed a health advantage in all group of immigrants, with the exception of individuals from Finland. However, when information on age at arrival and duration of residence was combined, an excess mortality risk was found among immigrants who arrived before age 18, which largely disappeared after 15 years of residence in Sweden. Non-European immigrants over age 18 showed similar or lower mortality risks than natives in all categories of age at arrival, regardless of duration of residence.

    Conclusions: The findings suggest that the mortality advantage commonly observed among immigrants is not universal. Combined information on age at arrival and duration of residence can be used to identify sensitive periods and to identify possible selection bias. The study also suggests that young immigrants are a vulnerable subpopulation. Given the increased number of unaccompanied minors arriving in Europe, targeted health or integration policies should be developed or reviewed.

  • 12. Karampampa, Korinna
    et al.
    Ahlbom, Anders
    Michaelsson, Karl
    Andersson, Tomas
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Karolinska Institutet, Sweden.
    Modig, Karin
    Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival - A nationwide study of the Swedish population 60 years and older2015In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 78, p. 55-61Article in journal (Refereed)
    Abstract [en]

    Background: Hip fracture is a common cause of disability and mortality among the elderly. Declining incidence trends have been observed in Sweden. Still, this condition remains a significant public health problem since Sweden has one of the highest incidences worldwide. Yet, no Swedish lifetime risk or survival trends have been presented. By examining how hip fracture incidence, post-fracture survival, as well as lifetime risk have developed between 1995 and 2010 in Sweden, this study aims to establish how the burden hip fractures pose on the elderly changed over time, in order to inform initiatives for improvements of their health. Material and Methods: The entire Swedish population 60 years-old and above was followed between 1987 and 2010 in the National Patient Register and the Cause of Death Register. Annual age-specific hip fracture cumulative incidence was estimated using hospital admissions for hip fractures. Three-month and one-year survival after the first hip fracture were also estimated. Period life table was used to assess lifetime risk of hip fractures occuring from age 60 and above, and the expected mean age of the first hip fracture. Results: The age-specific hip fracture incidence decreased between 1995 and 2010 in all ages up to 94 years, on average by 1% per year. The lifetime risk remained almost stable, between 9% and 11% for men, and between 18% and 20% for women. The expected mean age of a first hip fracture increased by 2.5 years for men and by 2.2 years for women. No improvements over time were observed for the 3-month survival for men, while for women a 1% decrease per year was observed. The 1-year survival slightly increased over time for men (0.4% per year) while no improvement was observed for women. Conclusions: The age-specific hip fracture incidence has decreased overtime. Yet the lifetime risk of a hip fracture has not decreased because life expectancy in the population has increased in parallel. Overall, survival after hip fracture has not improved.

  • 13. Karampampa, Korinna
    et al.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Andersson, Tomas
    Ahlbom, Anders
    Modig, Karin
    Trends in age at first hospital admission in relation to trends in life expectancy in Swedish men and women above the age of 602013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 9, p. e003447-Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine whether the first admission to hospital after the age of 60 has been postponed to higher ages for men and women in Sweden, in line with the shift in mortality.                                 

    Design: This nationwide observational study was based on data obtained from national registries in Sweden. The study cohort was created by linking the Register of the Total Population in Sweden with the National Patient Register and the Swedish Cause of Death Register.                                 

    Setting: The entire Swedish population born between 1895 and 1950 was followed up between 1987 and 2010 with respect to hospital admissions and deaths using the national registry data.                                 

    Primary outcome measures: The time from age 60 until the first admission to the hospital, regardless of the diagnosis, and the time from age 60 until death (remaining life expectancy, LE) were estimated for the years 1995–2010. The difference between these two measures was also estimated for the same period.                                 

    Results: Between 1995 and 2010 mortality as well as first hospital admission shifted to higher ages. The average time from age 60, 70, 80 and 90 until the first hospital admission increased at all ages. The remaining LE at age 60, 70 and 80 increased for men and women. For the 90-year-olds it was stable.                                 

    Conclusions: In Sweden, the first hospital admission after the age of 60 has been pushed to higher ages in line with mortality for the ages 60 and above. First admission to the hospital could indicate the onset of first severe morbidity; however, the reorganisation of healthcare may also have influenced the observed trends.

  • 14. Lagergren, Jesper
    et al.
    Andersson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Talbäck, Mats
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Bihagen, Erik
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Härkönen, Juho
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Feychting, Maria
    Ljung, Rickard
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Marital status, education, and income in relation to the risk of esophaegal and gastric cancer by histological type and site2016In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 122, no 2, p. 207-212Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Marital status, income, and education might influence the risk of esophageal and gastric cancer, but the literature is limited. A large study addressing subtypes of these tumors was used to clarify these associations.

    METHODS

    A nationwide, Swedish population–based cohort study from 1991 to 2010 included individuals who were 50 years old or older. Data on exposures, covariates, and outcomes were obtained from well-maintained registers. Four esophagogastric tumor subtypes were analyzed in combination and separately: esophageal adenocarcinoma, esophageal squamous cell carcinoma, cardia adenocarcinoma, and noncardia gastric adenocarcinoma. Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and adjusted for confounders.

    RESULTS

    Among 4,734,227 participants (60,634,007 person-years), 24,095 developed esophageal or gastric cancer. In comparison with individuals in a long marriage, increased IRRs were found among participants who were in a shorter marriage or were never married, remarried, divorced, or widowed. These associations were indicated for each tumor subtype but were generally stronger for esophageal squamous cell carcinoma. Higher education and income were associated with decreased IRRs in a seemingly dose-response manner and similarly for each subtype. In comparison with the completion of only primary school, higher tertiary education rendered an IRR of 0.64 (95% CI, 0.60-0.69) for men and an IRR of 0.68 (95% CI, 0.61-0.75) for women. Comparing participants in the highest and lowest income brackets (highest 20% vs lowest 20%) revealed an IRR of 0.74 (95% CI, 0.70-0.79) for men and an IRR of 0.83 (95% CI, 0.76-0.91) for women.

    CONCLUSIONS

    Divorce, widowhood, living alone, low educational attainment, and low income increase the risk of each subtype of esophageal and gastric cancer. These associations require attention when high-risk individuals are being identified.

  • 15.
    Ljung, Rickard
    et al.
    Karolinska Institutet.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Andersson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Lagergren, Jesper
    Kings College London.
    Socio-Demographic and Geographical Factors in Esophageal and Gastric Cancer Mortality in Sweden2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 4, p. e62067-Article in journal (Refereed)
    Abstract [en]

    Background

    Socio-demographic factors and area of residence might influence the development of esophageal and gastric cancer. Large-scale population-based research can determine the role of such factors.

    Methods

    This population-based cohort study included all Swedish residents aged 30–84 years in 1990–2007. Educational level, marital status, place of birth, and place of residence were evaluated with regard to mortality from esophageal or gastric cancer. Cox regression yielded hazard ratios (HR) with 95% confidence intervals (CI), adjusted for potential confounding.

    Results

    Among 84 920 565 person-years, 5125 and 12 230 deaths occurred from esophageal cancer and gastric cancer, respectively. Higher educational level decreased the HR of esophageal cancer (HR = 0.61, 95%CI 0.42–0.90 in women, HR = 0.71, 95%CI 0.60–0.84 in men) and gastric cancer (HR = 0.80, 95%CI 0.63–1.03 in women, HR = 0.73, 95%CI 0.64–0.83 in men). Being unmarried increased HR of esophageal cancer (HR = 1.64, 95%CI 1.35–1.99 in women, HR = 1.64, 95%CI 1.50–1.80 in men), but not of gastric cancer. Being born in low density populated areas increased HR of gastric cancer (HR = 1.23, 95%CI 1.10–1.38 in women, HR = 1.37, 95%CI 1.25–1.50 in men), while no strong association was found with esophageal cancer. Living in densely populated areas increased HR of esophageal cancer (HR = 1.31, 95%CI 1.14–1.50 in women, HR = 1.40, 95%CI 1.29–1.51 in men), but not of gastric cancer.

    Conclusion

    These socio-demographic inequalities in cancer mortality warrant efforts to investigate possible preventable mechanisms and to promote and support healthier lifestyles among deprived groups.

  • 16. Modig, Karin
    et al.
    Andersson, Tomas
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Ahlbom, Anders
    Age-Specific Trends in Morbidity, Mortality and Case-Fatality from Cardiovascular Disease, Myocardial Infarction and Stroke in Advanced Age: Evaluation in the Swedish Population2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 5, article id e64928Article in journal (Refereed)
    Abstract [en]

    Background

    It is not clear if the downward trend in cardiovascular disease (CVD) observed for ages up to 85 years can be extended to the oldest old, those 85 years and above.

    Methods and Findings

    This nationwide cohort study presents age specific trends of CVD as well as for myocardial infarction (MI) and stroke separately for the period 1994 to 2010 for individuals 85 to 99 years old in Sweden. Data were extracted from national registries. All analyses were based on one-year age- and sex- specific figures. The risk for CVD increased with every age above 85 years although the rate of increase leveled off with age. Over time, the risk for CVD and MI decreased for all ages, and for stroke for ages up to 89 years. However, the risk of MI increased until around 2001 in all age groups and both sexes but decreased after that. The overall mortality improved for all outcomes over the period 1994 to 2010, so did the survival within 28 days from an event. The average annual decline in mortality over all ages, 85 and above was 3% for MI, 2% for stroke and for 2% CVD. Corresponding figures for ages 60–84 was 4% for each of MI, stroke and CVD. The results were similar for men and women.

    Conclusions

    Improvements in CVD risks observed among ages up to 85 years appear to have extended also to ages above 85 years, even if the rate of improvement plateaued with age. The improvements in survival for all ages up to 99 years give no support to the hypothesis that more fragile individuals reach higher ages. Additional research is needed to find out if improvement in survival can be seen also for the second and third event of CVD, stroke and MI.

  • 17.
    Modig, Karin
    et al.
    Karolinska Institutet.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Ahlbom, Anders
    Karolinska Institutet.
    Limitless longevity: Comment on the Contribution of rectangularization to the secular increase of life expectancy2013In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 42, no 3, p. 914-916Article in journal (Other academic)
  • 18.
    Modig, Karin
    et al.
    Karolinska Institutet.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Andersson, Tomas
    Karolinska Institutet.
    Ahlbom, Anders
    Karolinska Institutet.
    The Aging Population in Sweden – Can Declining Incidence Rates in MI, Stroke and Cancer Counterbalance the Future Demographic Challenges?2012In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, ISSN 0393-2990, Vol. 27, no 2, p. 139-145Article in journal (Refereed)
    Abstract [en]

    It is often taken for granted that an ageing population will lead to an increased burden for the health care sector. However, for several diseases of big public health impact the rates have actually come down for a substantial period of time. In this study we investigate how much the incidence rates for myocardial infarction (MI), stroke, and cancer will have to decline in order to counterbalance future demographic changes (changes in population size and age structure) and compare these figures with observed historical trends. Information on incidence rates were obtained from the National Board of Health and Welfare and referred to the total Swedish population. Population projections were obtained from Statistics Sweden. We projected the number of MI events to increase 50–60% between 2010 and 2050. The decline in incidence rates that is required to keep the number of events constant over time is, on average, 1.2%/year for men and 0.9%/year for women, somewhat higher than the trend for the past 10 years. For stroke the corresponding figures were 1.3% (men) and 1% (women), well in line with historical trends. For cancer the results indicate an increasing number of events in the future. Population ageing is more important than population growth when projecting future number of MI, stroke and cancer events. The required changes in incidence rates in order to counterbalance the demographic changes are well in line with historical figures for stroke, almost in line regarding MI, but not in line regarding cancer. For diseases with age dependence similar to these diseases, a reduction of incidence rates in the order of 1–2% is sufficient to offset the challenges of the ageing population. These are changes that have been observed for several diseases indicating that the challenges posed by the ageing population may not be as severe as they may seem when considering the demographic component alone.

  • 19. Rigattieri, Stefano
    et al.
    Sciahbasi, Alessandro
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Mussino, Eleonora
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Cera, Maria
    Di Russo, Cristian
    Fedele, Silvio
    Pugliese, Francesco Rocco
    Transradial Access and Radiation Exposure in Diagnostic and Interventional Coronary Procedures2014In: The Journal of invasive cardiology, ISSN 1042-3931, E-ISSN 1557-2501, Vol. 26, no 9, p. 469-474Article in journal (Refereed)
    Abstract [en]

    Background. Although transradial access (TRA) is being increasingly used in interventional cardiology, there are concerns about a possible increase in radiation exposure (RE) as compared to transfemoral access (TFA). Methods. In this retrospective study, we aimed to compare RE during coronary angiography and percutaneous coronary intervention (PCI) according to the vascular access route (TRA vs TFA). We included all procedures performed in our laboratory, in which RE data (dose area product, cGy.cm(2)) were available, from May 2009 to May 2013. Both multiple linear regression analysis and propensity score matching were performed in order to compare RE between TRA and TFA after adjusting for clinical and procedural confounders. Results. DAP values were available for 1396 procedures; TRA rate was 82.6%. TRA patients were younger, less frequently female, and had higher body mass index as compared to TFA patients; the rates of PCI, ad hoc PCI, bypass angiography, thrombus aspiration, and primary angioplasty, as well as the number of stents implanted, fluoroscopy time, and contrast dose were significantly higher in TFA. Median DAP value was significantly higher in TFA than in TRA (9670 cGy.cm(2) vs 7635 cGy.cm(2); P<.01). After adjusting for clinical and procedural confounders, vascular access was not found to be an independent predictor of RE at multiple regression analysis; this was also confirmed by stratified comparison of DAP values by quintiles of propensity score. Conclusion. After adjusting for clinical and procedural confounders, TRA was not found to be associated with increased RE as compared to TFA in an experienced TRA center.

  • 20.
    Vignoli, Daniele
    et al.
    University of Florence.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    De Santis, Gustavo
    University of Florence.
    Whose Job Instability Affects the Likelihood of Becoming a Parent in Italy? A Tale of two Partners2012In: Demographic Research, ISSN 1435-9871, Vol. 26, no 2, p. 41-62Article in journal (Refereed)
    Abstract [en]

    We examine the likelihood of becoming a parent in Italy taking into account the employment (in) stability of both partners in a couple. We use data from four waves of the Italian section of the EU-SILC (Statistics on Income and Living Condition), 2004-2007, accounting for its longitudinal nature. Overall, our results suggest that Italian couples are neither fully traditional nor entirely modern: the "first pillar" (i.e., a male partner with a stable and well-paid job) is still crucial in directing fertility decisions, because, in our interpretation, it gives the household a feeling of (relative) economic security. But this "old" family typology is becoming rare. Increasingly, both partners are employed, and in this case the characteristics of their employment prove important. A permanent occupation for both partners is associated with higher fertility, while alternative job typologies for either of the two depress fertility.

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