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  • 1. Almroth, Melody
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Stockholm, Sweden.
    Kjellberg, Katarina
    Sorberg Wallin, Alma
    Andersson, Tomas
    van der Westhuizen, Amanda
    Falkstedt, Daniel
    Job control, job demands and job strain and suicidal behaviour among three million workers in Sweden2022In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 79, no 10, p. 681-689Article in journal (Refereed)
    Abstract [en]

    Objective To investigate the association between job control, job demands and their combination (job strain) and suicide attempts and deaths among male and female workers in Sweden.

    Methods Job control and demands were measured separately for men and women using a job exposure matrix, which was linked to around three million individuals based on their occupational title in 2005. Suicide attempts and deaths were measured in the hospital and cause of death registers from 2006 to 2016. HRs were estimated using discrete proportional hazards models with annually updated age as the time axis. Models were adjusted for sociodemographic, family, health, labour market and childhood factors, as well as the time-varying effects of unemployment, sick leave and family factors during follow-up.

    Results Low job control was associated with an increased risk of suicide attempts and deaths among both men and women while high job demands tended to be associated with a decreased risk. The combination of job control and job demands (job strain) reflected the increased risk of low control jobs and the decreased risk of high demand jobs. Associations were attenuated but still present after adjustments.

    Conclusions Low job control is related to suicide attempts and deaths, and this is only partially explained by important covariates measured both prebaseline and during follow-up. Attempts to increase job control among workers may be beneficial in preventing suicide.

  • 2. Almroth, Melody
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Sörberg Wallin, Alma
    Kjellberg, Katarina
    Falkstedt, Daniel
    Psychosocial workplace factors and alcohol-related morbidity: a prospective study of 3 million Swedish workers2022In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 3, p. 366-371Article in journal (Refereed)
    Abstract [en]

    Background: Psychosocial workplace factors may be associated with alcohol-related morbidity, but previous studies have had limited opportunities to take non-occupational explanatory factors into account. The aim of this study is to investigate associations between job control, job demands and their combination (job strain) and diagnosed alcohol-related morbidity while accounting for several potentially confounding factors measured across the life-course, including education. Methods: Job control, job demands and job strain were measured using the Swedish job exposure matrix measuring psychosocial workload on the occupational level linked to over 3 million individuals based on their occupational titles in 2005 and followed up until 2016. Cox regression models were built to estimate associations with alcohol-related diagnoses recorded in patient registers. Results: Low job control was associated with an increased risk of alcohol-related morbidity, while high job demands tended to be associated with a decreased risk. Passive and high-strain jobs among men and passive jobs among women were also associated with an increased risk of alcohol diagnoses. However, all associations were found to be weakened in models adjusted for other factors measured prospectively over the life-course, especially in models that included level of education. Conclusion: The associations between low job control and high job demands, and the risk of alcohol-related morbidity reflect underlying socioeconomic differences to some extent. Lower job control, however, remained associated with a higher risk of alcohol-related morbidity.

  • 3. Badarin, K.
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Almroth, M.
    Falkstedt, D.
    Hillert, L.
    Kjellberg, K.
    Does a change to an occupation with a lower physical workload reduce the risk of disability pension? A cohort study of employed men and women in Sweden2022In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 48, no 8, p. 662-671Article in journal (Refereed)
    Abstract [en]

    This study investigated if a change to an occupation with lowerphysical workload was associated with a reduced risk of disabilitypension (DP). A change to lower physical workload was associatedwith a reduced risk of DP. Older workers had the largest decreasedrisk for musculoskeletal DP. Generally, a larger reduction in physicalworkload was associated with the greatest reduced risk of DP.

  • 4. Badarin, Kathryn
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Almroth, Melody
    Falkstedt, Daniel
    Hillert, Lena
    Kjellberg, Katarina
    Combined exposure to heavy physical workload and low job control and the risk of disability pension: A cohort study of employed men and women in Sweden2023In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 96, no 7, p. 973-984Article in journal (Refereed)
    Abstract [en]

    Objective To investigate the separate and combined effects of overall heavy physical workload (PWL) and low decision authority on all-cause disability pension (DP) or musculoskeletal DP.

    Methods This study uses a sample of 1,804,242 Swedish workers aged 44–63 at the 2009 baseline. Job Exposure Matrices (JEMs) estimated exposure to PWL and decision authority. Mean JEM values were linked to occupational codes, then split into tertiles and combined. DP cases were taken from register data from 2010 to 2019. Cox regression models estimated sex-specific Hazard Ratios (HR) with 95% confidence intervals (95% CI). The Synergy Index (SI) estimated interaction effects.

    Results Heavy physical workload and low decision authority were associated with an increased risk of DP. Workers with combined exposure to heavy PWL and low decision authority often had greater risks of all-cause DP or musculoskeletal DP than when adding the effects of the single exposures. The results for the SI were above 1 for all-cause DP (men: SI 1.35 95%CI 1.18–1.55, women: SI 1.19 95%CI 1.05–1.35) and musculoskeletal disorder DP (men: SI 1.35 95%CI 1.08–1.69, women: 1.13 95%CI 0.85–1.49). After adjustment, the estimates for SI remained above 1 but were not statistically significant.

    Conclusion Heavy physical workload and low decision authority were separately associated with DP. The combination of heavy PWL and low decision authority was often associated with higher risks of DP than would be expected from adding the effects of the single exposures. Increasing decision authority among workers with heavy PWL could help reduce the risk of DP.

  • 5. Badarin, Kathryn
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Hillert, Lena
    Kjellberg, Katarina
    Physical workload and increased frequency of musculoskeletal pain: a cohort study of employed men and women with baseline occasional pain2021In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 78, no 8, p. 558-566Article in journal (Refereed)
    Abstract [en]

    Objectives Musculoskeletal pain (MSP) is prevalent among the workforce. This study investigates the long-term association between physical workload (PWL) and increased frequency of MSP among male and female employees with pre-existing occasional MSP.

    Methods This study uses the Stockholm Public Health cohort survey data from the baseline 2006. The sample includes 5715 employees with baseline occasional MSP (no more than a few days per month). Eight PWL exposures and overall PWL were estimated using a job-exposure matrix (JEM). The JEM was assigned to occupational titles from a national register in 2006. Follow-up survey data on frequent MSP (a few or more times a week) were collected from 2010. Logistic regressions produced sex-specific ORs with 95% CIs and were adjusted for education, health conditions, psychological distress, smoking, BMI, leisure-time physical activity and decision authority.

    Results Associations were observed between several aspects of heavy PWL and frequent MSP for men (eg, OR 1.57, 95% CI 1.13 to 2.20, among those in the highest exposure quartile compared with those in the lowest quartile for heavy lifting) and women (eg, OR 1.76, 95% CI 1.35 to 2.29, among those in the highest exposure quartile compared with those in the the lowest quartile for physically strenuous work). Small changes were observed in the OR after adjustment, but most of the ORs for PWL exposures among the men were no longer statistically significantly increased.

    Conclusion A high level of exposure to heavy PWL was associated with increased frequency of MSP 4 years later for men and women with baseline occasional pain.

  • 6. Badarin, Kathryn
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Hillert, Lena
    Kjellberg, Katarina
    The impact of musculoskeletal pain and strenuous work on self-reported physical work ability: a cohort study of Swedish men and women2022In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 95, no 5, p. 939-952Article in journal (Refereed)
    Abstract [en]

    Objective We investigated the separate and combined effects of musculoskeletal pain (MSP) and strenuous work (heavy physical workload (PWL)/low-decision authority) on poor physical work ability (WA).

    Methods This study uses baseline data from the 2010 Stockholm Public Health Questionnaire (SPHQ) including 9419 workers with good physical WA. Exposure to PWL and decision authority were estimated using sex-specific job-exposure matrices linked to occupations. Exposures (high/low) were combined with the presence of MSP. Follow-up data on physical WA were taken from the 2014 SPHQ and dichotomised (the responses: moderate, rather poor and very poor indicated poor WA). Logistic regression models calculated sex-specific odds ratios adjusting for age, education and health and lifestyle factors. Interaction between MSP and strenuous work was examined using the synergy index (SI). Analyses were conducted using SPSS.27.

    Results MSP, heavy PWL and low-decision authority were separately associated with poor WA. MSP was associated with higher odds of poor WA than strenuous work for women, the opposite for men. Combinations of MSP and strenuous work often resulted in higher risks of poor WA than when adding the effects of the single exposures (e.g., MSP and heavy PWL men: AOR 4.04 95% CI 2.00-8.15, women: AOR: 3.25 95% CI 1.81-5.83). The SI was non-significant for both sexes.

    Conclusion Workers with MSP and strenuous work often had higher risks of poor WA than would be expected from adding the effects of the single exposures. To decrease poor WA in this group, strenuous work should be lowered, and MSP addressed in workplaces.

  • 7. Balog, Piroska
    et al.
    Janszky, Imre
    Chen, Hua
    Rafael, Beatrix
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    László, Krisztina D.
    Social relations in late adolescence and incident coronary heart disease: a 38-year follow-up of the Swedish 1969-1970 Conscription Cohort2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 12, article id e030880Article in journal (Refereed)
    Abstract [en]

    Objectives Increasing evidence suggests that low social support is associated with an elevated risk of coronary heart disease (CHD). Earlier studies in this field were conducted in predominantly middle-aged or older samples; thus, the associations reported previously may have been confounded by subclinical manifestations of the disease. We investigated whether social relationships in late adolescence, that is, well before symptoms of subclinical disease manifest, are associated with CHD during a 38-year follow-up.

    Setting Sweden.

    Participants Men born 1949-1951 and conscripted for military service in Sweden during 1969-1970 (n=49321). At conscription, participants completed questionnaires about social relationships, lifestyle and health-related factors and underwent a medical examination.

    Primary and secondary outcome measures CHD, acute myocardial infarction (AMI).

    Results We found no relationship between having no confidant and frequency of confidential discussions with friends and the risk of CHD or AMI in the first 30 years of follow-up. However, after 30 years, men with no confidant at baseline had increased CHD and AMI risks relative to those having a confidant; the childhood socioeconomic status-adjusted HR and 95% Cls (CI) were 1.25 (1.10 to 1.41) and 1.27 (1.08 to 1.49), respectively. The frequency of confidential discussions with friends had an inverse Ushaped relationship with the outcomes after 30 years; the HR (95% CI) for 'sometimes' versus 'quite often' was 1.16 (1.04 to 1.29) for CHD and 1.16 (1.01 to 1.33) for AMI. These associations persisted after adjusting for mental ill-health, lifestyle factors and systolic blood pressure. A low number of friends in late adolescence was not related to an increased CHD or AMI risk.

    Conclusions Not having a confidant in late adolescence was associated positively, while the frequency of confidential discussions with friends had an inverse U-shaped relationship with CHD and AMI after 30 years of follow-up, suggesting that these associations are not due to subclinical disease manifestations.

  • 8. Berglund, Karin
    et al.
    Almroth, Melody
    Falkstedt, Daniel
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Kjellberg, Katarina
    The impact of cardiorespiratory fitness and physical workload on disability pension–a cohort study of Swedish men2024In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 97, no 1, p. 45-55Article in journal (Refereed)
    Abstract [en]

    Objective Understanding the impact of physical capacity in combination with high physical workload could be beneficial for the prevention of health-related exits from work. Therefore, the aim of this study was to investigate the separate and combined effects of low cardiorespiratory fitness and high physical workload on disability pension (DP) due to any cause, musculoskeletal disorders (MSD), and cardiovascular diseases (CVD).

    Methods A total of 279 353 men born between 1951 and 1961 were followed regarding DP between 2006 and 2020, ages 45–64. Cardiorespiratory fitness was assessed during military conscription, using an ergometer bicycle test. Physical workload was based on a job-exposure matrix (JEM) linked to occupational title in 2005. Cox regression models estimated separate and combined associations with DP.

    Results Low cardiorespiratory fitness and high physical workload were associated with increased risk of DP. For all cause DP, the fully adjusted hazard ratio and 95% confidence interval for those with low cardiorespiratory fitness was 1.38 (1.32–1.46) and for those with high physical workload 1.48 (1.39–1.57). For all cause and MSD DP, but not for CVD DP, the combination of low cardiorespiratory fitness and high physical workload resulted in higher risks than when adding the effect of the single exposures.

    Conclusion Both low cardiorespiratory fitness in youth and later exposure to high physical workload were associated with an increased risk of DP, where workers with the combination of both low cardiorespiratory fitness and a high physical workload had the highest risks (all-cause and MSD DP).

  • 9. Bodin, Theo
    et al.
    Matilla-Santander, Nuria
    Selander, Jenny
    Gustavsson, Per
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Johansson, Gun
    Jonsson, Johanna
    Kjellberg, Katarina
    Kreshpaj, Bertina
    Orellana, Cecilia
    Wadensjö, Eskil
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Albin, Maria
    Trends in Precarious Employment in Sweden 1992–2017: A Social Determinant of Health2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 19, article id 12797Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify trends in precarious employment in the Swedish workforce from 1992 to 2017. This is a repeated cross-sectional study, analyzing the total working population aged 16–75 in Sweden at five-year intervals. We used version 2.0 of the Swedish Register-based Operationalization of Precarious Employment, covering the following dimensions: employment insecurity, income inadequacy, lack of rights and protection. The proportion in precarious employment increased from 9.7 to 12% between 1992 and 2017, a relative increase of 24%. The prevalence was higher among those of lower age, of low education, and immigrants. Differences between sexes converged, and there were slightly more precarious men than women in 2017. The relative increase was most pronounced among men, especially those with low educational attainment and of European origin. The increasing proportion of precarious employees is a clear challenge to the tripartite Nordic model, which requires sufficient trade-union bargaining power.

  • 10.
    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.

  • 11. Chen, Hua
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Forsell, Yvonne
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Janszky, Imre
    László, Krisztina D.
    Death of a Parent During Childhood and the Risk of Ischemic Heart Disease and Stroke in Adult Men2020In: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 82, no 9, p. 810-816Article in journal (Refereed)
    Abstract [en]

    Objective

    The death of a parent during childhood is a severe life event with potentially long-term consequences. Earlier studies have shown an increased risk of cardiovascular diseases (CVD) after the death of a spouse, child, or sibling. Whether parental death during childhood is associated with an increased risk of incident CVD is unknown and was investigated in this study.

    Methods

    We studied 48,992 men born 1949 to 1951 and enlisted for military conscription in 1969 to 1970. We obtained information on death of a parent during childhood, CVD up to 2008, and covariates by linking the questionnaire and the clinical examination data from conscription with nationwide socioeconomic and health registers.

    Results

    Men who lost a parent during childhood had an increased risk of ischemic heart disease (IHD; adjusted hazard ratio (HR) and 95% confidence interval [CI] = 1.30 [1.13-1.49]) but not of stroke during the 39-year follow-up (adjusted HR [95% CI] = 0.87 [0.66-1.15]). Maternal death was associated with IHD both when the loss was due to cardiovascular (adjusted HR [95% CI] = 2.04 [1.02-4.08]) and unnatural causes (adjusted HR [95% CI] = 2.50 [1.42-4.42]); in case of paternal death, an increased IHD risk was observed only when the loss was due to cardiovascular causes (adjusted HR [95% CI] = 1.82 [1.37-2.42]). There were no substantial differences in CVD according to the child's age at the loss.

    Conclusions

    Parental death during childhood was associated with an increased risk of IHD in men. If these associations are confirmed in future studies, the long-term effects of childhood bereavement may warrant attention.

  • 12. Chen, Hua
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Janszky, Imre
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Forsell, Yvonne
    Meng, Linghui
    Liang, Yajun
    László, Krisztina D.
    Death of a parent during childhood and blood pressure in youth: a population-based cohort study of Swedish men2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 4, article id e043657Article in journal (Refereed)
    Abstract [en]

    Objective Compelling evidence suggests that childhood adversities are associated with an increased risk of hypertension in middle age and old age. The link between childhood adversities and blood pressure in youth is less clear. In this cohort study, we examined the association between death of a parent during childhood and blood pressure in early adulthood in men.

    Setting Sweden.

    Participants We studied 48 624 men born in 1949–1951 who participated in the compulsory military conscription in 1969/1970 in Sweden. Information on death of a parent during childhood was obtained from population-based registers. Information on covariates was obtained from the questionnaire and the clinical examination completed at conscription and from population-based registers.Outcome measures Blood pressure was measured at conscription according to standard procedures.

    Results The multivariable least square means of systolic and diastolic blood pressure did not differ between bereaved (128.25 (127.04–129.46) and 73.86 (72.89–74.84) mm Hg) and non-bereaved study participants (128.02 (126.86–129.18) and 73.99 (73.06–74.93) mm Hg). Results were similar when considering the cause of the parent’s death, the gender of the deceased parent or the child’s age at loss. Loss of a parent in childhood tended to be associated with an increased hypertension risk (OR and 95% CI: 1.10 (1 to 1.20)); the association was present only in case of natural deaths.

    Conclusion We found no strong support for the hypothesis that stress following the loss of a parent during childhood is associated with blood pressure or hypertension in youth in men.

  • 13. Chen, Hua
    et al.
    Li, Jiong
    Wei, Dang
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Janszky, Imre
    Forsell, Yvonne
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Institute of Environmental Medicine, Karolinska Institutet, Sweden.
    László, Krisztina D.
    Death of a Parent and the Risk of Ischemic Heart Disease and Stroke in Denmark and Sweden2022In: JAMA Network Open, E-ISSN 2574-3805, Vol. 5, no 6, article id e2218178Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Increasing evidence suggests that parental death is associated with unhealthy behaviors and mental ill-health. Knowledge regarding the link between parental death and the risk of ischemic heart disease (IHD) and stroke remains limited.

    OBJECTIVES To investigate whether parental death is associated with an increased risk of IHD and stroke and whether these associations differ by the characteristics of the loss.

    DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study, involving linkages between several nationwide registers, included 3 766 918 individuals born between 1973 and 1998 in Denmark and between 1973 and 1996 in Sweden. Participants were followed up until 2016 in Denmark and 2014 in Sweden. Data were analyzed from December 2019 to May 2021.

    EXPOSURES Death of a parent.

    MAIN OUTCOMES AND MEASURES Diagnosis with or death due to IHD or stroke. Poisson regression was used to analyze the associations between parental death and IHD and stroke risk.

    RESULTS Altogether, 48.8% of the participants were women, and 42.7% were from Denmark. A total of 523 496 individuals lost a parent during the study period (median age at loss, 25 years; IQR, 17-32 years). Parental death was associated with a 41% increased risk of IHD (incidence rate ratio [IRR], 1.41; 95% CI, 1.33-1.51) and a 30% increased risk of stroke [IRR, 1.30; 95% CI, 1.21-1.38). The associations were observed not only if the parent died because of cardiovascular or other natural causes but also in cases of unnatural deaths. The associations were stronger when both parents had died (IHD: IRR, 1.87; 95% CI, 1.59-2.21; stroke: IRR, 1.64; 95% CI, 1.35-1.98) than when 1 parent had died (IHD: IRR, 1.37; 95% CI, 1.28-1.47; stroke: IRR, 1.27; 95% CI, 1.19-1.36) but did not differ substantially by the offspring's age at loss or the deceased parents' sex. The risk of acute myocardial infarction was highest in the first 3 months after loss.

    CONCLUSIONS AND RELEVANCE In this cohort study, parental death in the first decades of life was associated with an increased risk of IHD and stroke. The associations were observed not only in cases of parental cardiovascular and other natural deaths but also in cases of unnatural deaths. Family members and health professionals may need to pay attention to the cardiovascular disease risk among parentally bereaved individuals.

  • 14. Danielsson, Anna-Karin
    et al.
    Agardh, Emilie
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Allebeck, Peter
    Falkstedt, Daniel
    Cannabis use in adolescence and risk of future disability pension: A 39-year longitudinal cohort study2014In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 143, p. 239-243Article in journal (Refereed)
    Abstract [en]

    Aims: This study aimed at examining a possible association between cannabis use in adolescence and future disability pension (DP). DP can be granted to any person in Sweden aged 16-65 years if working capacity is judged to be permanently reduced due to long-standing illness or injury. Methods: Data were obtained from a longitudinal cohort study comprising 49,321 Swedish men born in 1949-1951 who were conscripted to compulsory military service aged 18-20 years. Data on DP was collected from national registers. Results: Results showed that individuals who used cannabis in adolescence had considerably higher rates of disability pension throughout the follow-up until 59 years of age. In Cox proportional-hazards regression analyses, adjustment for covariates (social background, mental health, physical fitness, risky alcohol use, tobacco smoking and illicit drug use) attenuated the associations. However, when all covariates where entered simultaneously, about a 30% increased hazard ratio of DP from 40 to 59 years of age still remained in the group reporting cannabis use more than 50 times. Conclusions: This study shows that heavy cannabis use in late adolescence was associated with an increased relative risk of labor market exclusion through disability pension.

  • 15. Danielsson, Anna-Karin
    et al.
    Falkstedt, Daniel
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Allebeck, Peter
    Agardh, Emilie
    Cannabis use among Swedish men in adolescence and the risk of adverse life course outcomes: results from a 20 year-follow-up study2015In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 11, p. 1794-1802Article in journal (Refereed)
    Abstract [en]

    AimsTo examine associations between cannabis use in adolescence (at age 18) and unemployment and social welfare assistance in adulthood (at age 40) among Swedish men. DesignLongitudinal cohort study. Setting and ParticipantsA total of 49321 Swedish men born in 1949-51, who were conscripted to compulsory military service at 18-20 years of age. MeasurementsAll men answered two detailed questionnaires at conscription and were subject to examinations of physical aptitude psychological functioning and medical status. By follow-up in national databases, information on unemployment and social welfare assistance was obtained. FindingsIndividuals who used cannabis at high levels in adolescence had increased risk of future unemployment and of receiving social welfare assistance. Adjusted for all confounders (social background, psychological functioning, health behaviours, educational level, psychiatric diagnoses), an increased relative risk (RR) of unemployment remained in the group reporting cannabis use >50 times [RR=1.26, 95% confidence interval (CI)=1.04-1.53] only. For social welfare assistance, RR in the group reporting cannabis use 1-10 times was 1.15 (95% CI=1.06-1.26), RR for 11-50 times was 1.21 (95% CI=1.04-1.42) and RR for >50 times was 1.38 (95% CI=1.19-1.62). ConclusionsHeavy cannabis use among Swedish men in late adolescence appears to be associated with unemployment and being in need of social welfare assistance in adulthood. These associations are not explained fully by other health-related, social or behavioural problems.

  • 16. d'Errico, Angelo
    et al.
    Falkstedt, Daniel
    Almroth, Melody
    Badarin, Kathryn
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Kjellberg, Katarina
    Long-term sick leave for back pain, exposure to physical workload and psychosocial factors at work, and risk of disability and early-age retirement among aged Swedish workers2022In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 95, no 7, p. 1521-1535Article in journal (Refereed)
    Abstract [en]

    Purpose To assess the risk of disability and early-age retirement associated with previous long-term sickness absence for back pain (back-pain SA), exposure to high physical workload, low job control, high demands and high strain, and to evaluate effect modification by work factors on the relationship between back-pain SA and premature retirement.

    Methods All employed Swedish residents born 1946–1955 (n = 835,956) were followed up from 2010 to 2016 for disability (DP) and early-age pension (EAP). Associations of premature retirement with exposure to work factors and back-pain SA in the 3 years before follow-up were estimated through proportional hazards models. Retirement, back-pain SA and covariates were assessed through administrative sources, and exposure to work factors through a job-exposure matrix.

    Results In both genders, back-pain SA was associated with DP (> 1 episode: HR 3.23 among men; HR 3.12 among women) and EAP (> 1 episode: HR 1.24 among men; HR 1.18 among women). Higher physical workload and lower job control were also associated with an increased DP risk in both genders, whereas higher job demands showed a decreased risk. For EAP, associations with work factors were weak and inconsistent across genders. No effect modification by work factors was found, except for a negative effect modification by job strain on DP risk among women, i.e. a reduced effect of back-pain SA with increasing exposure.

    Conclusion Back-pain SA was a significant predictor of both DP and EAP, while work factors were consistently associated only with DP. Our results indicate that the joint effect of back-pain SA and work factors on DP is additive and does not support effect modification by work factors.

  • 17. Döring, Nora
    et al.
    Lundberg, Michael
    Dalman, Christina
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Rasmussen, Finn
    Sörberg Wallin, Alma
    Wicks, Susanne
    Magnusson, Cecilia
    Lager, Anton
    Labour market position of young people and premature mortality in adult life: A 26-year follow-up of 569 528 Swedish 18 year-olds2021In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 3, article id 100048Article in journal (Refereed)
    Abstract [en]

    Background: Throughout the industrialized world, demand for low skilled labour is falling. The length of schooling is increasing in response, but so is the proportion of individuals not finishing upper secondary school. The objective of this study was to evaluate the associations between labour market positions at age 18 and all-cause and suicide- and accident-specific mortality in later adulthood.

    Methods: Labour market positions at age 18 were categorized for all Swedes born 1972-77 (n=630 959) into four main groups: employed, successful students, students not about to qualify (SNAQs), and individuals not in employment, education or training (NEETs). Cox proportional hazard models were fitted to assess allcause, suicide and accident mortality up to 2016 (ages 39-44), adjusting for high school grades, parental and own prior psychiatric diagnoses, and childhood socioeconomic status.

    Findings: SNAQs had substantially increased all-cause (men: HR=2.10; 95% CI 1.92-2.28, women: HR=1.64; 95% CI: 1.44-1.86), suicide (men: HR=2.16; CI: 1.86-2.51, women: HR=2.10; 95% CI 1.64-2.69), and accident specific (men: HR=2.08; 95% CI 1.77-2.44, women: 1.87; 95% CI 1.33;2.62) mortality risks compared to successful students. The risks were similar for NEETs. There was no increased risk among full-time employed compared to successful students.

    Interpretation: Expanding the educational system may be a natural response to falling demand for low skilled labour but not by far one that corrects the major societal challenge of it. Unless educational systems adequately respond to this challenge, only more inequality is to be expected ahead.

  • 18. Falkstedt, Daniel
    et al.
    Almroth, Melody
    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.
    d'Errico, Angelo
    Albin, Maria
    Bodin, Theo
    Selander, Jenny
    Gustavsson, Per
    Kjellberg, Katarina
    Job demands and job control and their associations with disability pension—a register-based cohort study of middle-aged and older Swedish workers2023In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 96, no 8, p. 1137-1147Article in journal (Refereed)
    Abstract [en]

    Objectives Job demands and control at work and their combination, job strain, have been studied in relation to risk of disability pension (DP) previously. In the present study, based on registry data, we aimed to deepen the knowledge by analyzing major disease groups among the DPs, dose–response shape of the associations, and potential confounding effects of physical workload.

    Methods Approximately 1.8 million workers aged 44 or older and living in Sweden in 2005 were followed up for 16 years, up to a maximum of 65 years of age. We linked mean values of job demands and job control, estimated in a job-exposure matrice (JEM) by gender, to individuals through their occupational titles in 2005. These values were categorized by rank order, and, for the construction of job-strain quadrants, we used a median cut-off. Associations with DP were estimated in Cox proportional-hazards models.

    Results In models accounting for covariates including physical workload, low levels of job control were associated with higher risk of DP among both men and women. This association was most clear for DP with a psychiatric diagnosis, although a dose–response shape was found only among the men. High levels of job demands were associated with decreased risk of DP across diagnoses among men, but the same association varied from weak to non-existing among women. The high- and passive job-strain quadrants both showed increased risk of DP with a psychiatric diagnosis.

    Conclusion The results suggest that, at the occupational level, low job control, but not high job demands, contributes to an increased incidence of DP, particularly regarding DP with a psychiatric diagnosis.

  • 19. Falkstedt, Daniel
    et al.
    Backhans, Mona
    Lundin, Andreas
    Allebeck, Peter
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Do working conditions explain the increased risks of disability pension among men and women with low education?: A follow-up of Swedish cohorts2014In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 40, no 5, p. 483-492Article in journal (Refereed)
    Abstract [en]

    Objectives Rates of disability pension are greatly increased among people with low education. This study examines the extent to which associations between education and disability pensions might be explained by differences in working conditions. Information on individuals at age 13 years was used to assess confounding of associations. Method Two nationally representative samples of men and women born in 1948 and 1953 in Sweden (22 889 participants in total) were linked to information from social insurance records on cause (musculoskeletal, psychiatric, and other) and date (from 1986-2008) of disability pension. Education data were obtained from administrative records. Occupation data were used for measurement of physical strain at work and job control. Data on paternal education, ambition to study, and intellectual performance were collected in school. Results Women were found to have higher rates of disability pension than men, regardless of diagnosis, whereas men had a steeper increase in disability pension by declining educational level. Adjustment of associations for paternal education, ambition to study, and intellectual performance at age 13 had a considerable attenuating effect, also when disability pension with a musculoskeletal diagnosis was the outcome. Despite this, high physical strain at work and low job control both contributed to explain the associations between low education and disability pensions in multivariable models. Conclusion Working conditions seem to partly explain the increased rate of disability pension among men and women with lower education even though this association does reflect considerable selection effects based on factors already present in late childhood.

  • 20. Falkstedt, Daniel
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Albin, Maria
    Bodin, Theo
    Ahlbom, Anders
    Selander, Jenny
    Gustavsson, Per
    Andersson, Tomas
    Almroth, Melody
    Kjellberg, Katarina
    Disability pensions related to heavy physical workload: a cohort study of middle-aged and older workers in Sweden2021In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 94, p. 1851-1861Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of the study was to examine the associations between heavy physical workload among middle-aged and older workers and disability pension due to any diagnosis, as well as musculoskeletal, psychiatric, cardiovascular or respiratory diagnoses. The population-based design made it possible to examine dose-response and potential gender differences in the associations. Methods About 1.8 million men and women aged 44-63 years and registered as living in Sweden in 2005 were followed regarding disability pension during 2006-2016, until ages 55-65 years. Mean values of physical workload and job control, estimated through gender-specific job-exposure matrices (JEMs), were assigned to individuals through their occupational titles in 2005. Exposure values were ranked separately for women and men and divided into quintiles. Associations were analyzed with Cox proportional-hazards regression. Results The analyses showed robust, dose-response associations between physical workload and disability pension with a musculoskeletal diagnosis in both genders: the adjusted hazard ratio and 95% confidence interval for those with the heaviest exposure was 2.58 (2.37-2.81) in women and 3.34 (2.83-3.94) in men. Dose-response associations were also seen in relation to disability pension with a cardiovascular or a respiratory diagnosis, though the hazard ratios were smaller. Physical workload was not associated with disability pension with a psychiatric diagnosis after adjustment for job control. Conclusion This study of the entire Swedish population of middle-aged and older workers suggests that higher degrees of physical workload may increase the risk of disability pension overall, and specifically with musculoskeletal, cardiovascular or respiratory diagnosis, in both women and men.

  • 21. Falkstedt, Daniel
    et al.
    Sorjonen, Kimmo
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska institutet, Sverige.
    Deary, Ian J.
    Melin, Bo
    Psychosocial Functioning and Intelligence Both Partly Explain Socioeconomic Inequalities in Premature Death. A Population-Based Male Cohort Study2013In: PLOS ONE, E-ISSN 1932-6203, Vol. 8, no 12, article id e82031Article in journal (Refereed)
    Abstract [en]

    Objective: The possible contributions of psychosocial functioning and intelligence differences to socioeconomic status (SES)-related inequalities in premature death were investigated. None of the previous studies focusing on inequalities in mortality has included measures of both psychosocial functioning and intelligence. Methods: The study was based on a cohort of 49 321 men born 1949-1951 from the general community in Sweden. Data on psychosocial functioning and intelligence from military conscription at similar to 18 years of age were linked with register data on education, occupational class, and income at 35-39 years of age. Psychosocial functioning was rated by psychologists as a summary measure of differences in level of activity, power of initiative, independence, and emotional stability. Intelligence was measured through a multidimensional test. Causes of death between 40 and 57 years of age were followed in registers. Results: The estimated inequalities in all-cause mortality by education and occupational class were attenuated with 32% (95% confidence interval: 20-45%) and 41% (29-52%) after adjustments for individual psychological differences; both psychosocial functioning and intelligence contributed to account for the inequalities. The inequalities in cardiovascular and injury mortality were attenuated by as much as 51% (24-76%) and 52% (35-68%) after the same adjustments, and the inequalities in alcohol-related mortality were attenuated by up to 33% (8-59%). Less of the inequalities were accounted for when those were measured by level of income, with which intelligence had a weaker correlation. The small SES-related inequalities in cancer mortality were not attenuated by adjustment for intelligence. Conclusions: Differences in psychosocial functioning and intelligence might both contribute to the explanation of observed SES-related inequalities in premature death, but the magnitude of their contributions likely varies with measure of socioeconomic status and cause of death. Both psychosocial functioning and intelligence should be considered in future studies.

  • 22.
    Falkstedt, Daniel
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Wolff, Valerie
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Allebeck, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Danielsson, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke: A Population-Based Cohort Study of 45000 Swedish Men2017In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, no 2, p. 265-270Article in journal (Refereed)
    Abstract [en]

    Background and Purpose - Current knowledge on cannabis use in relation to stroke is based almost exclusively on clinical reports. By using a population-based cohort, we aimed to find out whether there was an association between cannabis use and early-onset stroke, when accounting for the use of tobacco and alcohol.

    Methods - The cohort comprises 49321 Swedish men, born between 1949 and 1951, who were conscripted into compulsory military service between the ages of 18 and 20. All men answered 2 detailed questionnaires at conscription and were subject to examinations of physical aptitude, psychological functioning, and medical status. Information on stroke events up to approximate to 60 years of age was obtained from national databases; this includes strokes experienced before 45 years of age.

    Results - No associations between cannabis use in young adulthood and strokes experienced 45 years of age or beyond were found in multivariable models: cannabis use >50 times, hazard ratios=0.93 (95% confidence interval [CI], 0.34-2.57) and 0.95 (95% CI, 0.59-1.53). Although an almost doubled risk of ischemic stroke was observed in those with cannabis use >50 times, this risk was attenuated when adjusted for tobacco usage: hazards ratio=1.47 (95% CI, 0.83-2.56). Smoking 20 cigarettes per day was clearly associated both with strokes before 45 years of age, hazards ratio=5.04 (95% CI, 2.80-9.06), and with strokes throughout the follow-up, hazards ratio=2.15 (95% CI, 1.61-2.88).

    Conclusions - We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age. Tobacco smoking, however, showed a clear, dose-response shaped association with stroke.

  • 23. Farioli, Andrea
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Kriebel, David
    Vascular risk factors and rhegmatogenous retinal detachment: a follow-up of a national cohort of Swedish men2016In: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 100, no 7, p. 907-913Article in journal (Refereed)
    Abstract [en]

    Background We aimed to investigate the role of vascular risk factors in the genesis of rhegmatogenous retinal detachment (RRD) using data from a large cohort of Swedish conscripts. Methods We used data from a nationwide cohort of 49 321 Swedish men born during 1949-1951, conscripted for compulsory military service in 19691970 with nearly complete follow-up to 2009. Information on surgically treated RRD between 1973 and 2009 was collected from the National Patient Register. We fitted Cox regression models stratified on myopia degree and including blood pressure levels, body mass index and cigarette smoking. Population attributable fractions of RRD were estimated through maximum likelihood methods. Results We observed 262 cases of RRD in 1 725 770 person-years. At multivariate analysis, the number of cigarettes per day showed a reverse association with the risk of RRD (p for trend 0.01). Conscripts with obesity presented a higher risk compared with normal subjects (adjusted HR 2.51, 95% CI 1.02 to 6.13). We found weak evidence of an association between blood pressure and RRD (HR for men with hypertension compared with normotension 1.41, 95% CI 0.93 to 2.13). All the observed associations were stronger when the analysis was restricted to non-myopic conscripts. In particular, the HR for hypertension was 2.33 (95% CI 1.30 to 4.19) compared with normotension. If this association is causal, we estimated that 42.0% of RRD cases (95% CI 11.5% to 62.0%) occurring among non-myopics are attributable to elevated blood pressure. Conclusions Vascular risk factors may be important determinants of RRD, particularly among non-myopics. Further investigations on the role of hypertension and obesity are needed.

  • 24. Farioli, Andrea
    et al.
    Kriebel, David
    Mattioli, Stefano
    Kjellberg, Katarina
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Occupational lifting and rhegmatogenous retinal detachment: a follow-up study of Swedish conscripts2017In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 74, no 7, p. 489-495Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate the association between occupational lifting and the risk of rhegmatogenous retinal detachment (RRD) using data from a large population of men.

    Methods We used data from a national cohort of 49 321 Swedish men conscripted for compulsory military service in 1969–1970. We collected information on surgically treated RRD from the National Patient Register and we followed up the cohort between 1991 and 2009 at ages 40–60 years. Exposure to occupational lifting was assessed by applying a job exposure matrix to occupational data from the 1990 census. Incidence rate ratios (IRRs) and 95% CIs were estimated through Poisson regression models adjusted by degree of myopia, income and education level.

    Results We observed 217 cases of RRD in 7 80 166 person-years. In univariate analyses we did not observe an association between occupational lifting and RRD. However, after adjustment for myopia and socioeconomic factors, we found an increased risk of RRD (IRR 2.38, 95% CI 1.15 to 4.93) for subjects in the highest category of exposure compared with those in the lowest one. The incidence rate of RRD among subjects lifting heavy loads at least twice per week, aged between 50 years and 59 years, and affected by severe myopia was as high as 7.9 cases per 1000 person-years, compared with an overall rate of 0.28.

    Conclusions Our study supports the hypothesis that heavy occupational lifting is a risk factor for RRD. Information on myopia degree and socioeconomic status is necessary when studying the association between occupational lifting and RRD.

  • 25.
    Gauffin, Karl
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    The effect of childhood socioeconomic position on alcohol-related disorders later in life: a Swedish national cohort study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 11, p. 932-938Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 26. Grahn, Karin
    et al.
    Gustavsson, Per
    Andersson, Tomas
    Lindén, Anders
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Selander, Jenny
    Wiebert, Pernilla
    Occupational exposure to particles and increased risk of developing chronic obstructive pulmonary disease (COPD): A population-based cohort study in Stockholm, Sweden2021In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 200, article id 111739Article in journal (Refereed)
    Abstract [en]

    Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a common respiratory disorder. Next to tobacco smoking, occupational exposure is the most important risk factor for COPD in high-income countries. To enable preventative measures, more knowledge is needed on which specific occupational exposures that are related to risk of developing COPD in men and women.

    Methods: A population-based cohort was formed from subjects responding to the Stockholm Public Health Surveys in 2002, 2006, and 2010, followed up until 2014. The dataset was linked to a quantitative job exposure matrix via occupational titles from the 1990 nation-wide Population and housing census. We identified COPD among subjects having medication for COPD and/or reporting a  physician’s  diagnosis of COPD. The gender- specific risks to develop COPD from occupational particle-exposure were estimated by proportional hazards regression model, adjusted for age and individual data on tobacco-smoking.

    Results: Men exposed to respirable crystalline silica (RCS) (HR 1.46, CI 1.13–1.90), gypsum and insulation material (HR 1.56, CI 1.18–2.05), diesel exhaust (HR 1.18, CI 0.99–1.41) and high levels of particles from asphalt/ bitumen (HR 1.71, CI 1.06–2.76) as well as welding fumes (HR 1.57, CI 1.12–2.21) had an increased smoking- adjusted risk for developing COPD. An increased risk was also observed among women highly exposed to various organic particles from soil, leather, plastic, soot, animal, textile, flour (HR 1.53, CI 1.15–2.04). Furthermore, a significant positive exposure-response trend was found among men exposed to RCS, iron dust, gypsum and insulation material, and diesel exhaust. A  tendency towards an exposure-response relationship was also seen among both men and women exposed to welding fumes and various organic particles, and among men exposed to particles from asphalt/bitumen. The population attributable fraction for COPD from occupational exposure to particles was 10.6% among men and 6.1% among women.

    Conclusions: This study indicates an increased smoking-adjusted risk of developing of COPD due to occupational exposure to particles. A positive exposure-response relationship was found for RCS, gypsum and insulation, diesel exhaust, and welding fumes. Also, exposure to high levels of asphalt/bitumen and various organic particles was associated with a higher risk for COPD. Reduction of these exposures in the work environment are important to prevent future cases of COPD. More studies are needed to investigate exposure-response relationships further, but this study indicates that the European occupational exposure limit (OEL) for RCS needs to be re-evaluated. 

  • 27. Hagström, Hannes
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Discacciati, Andrea
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Macquarie University, Australia.
    Alcohol consumption in late adolescence is associated with an increased risk of severe liver disease later in life2018In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 68, no 3, p. 505-510Article in journal (Refereed)
    Abstract [en]

    Background & Aims: High alcohol consumption is associated with an increased risk of severe liver disease. Current recommendations suggest it is safe for men to consume 30 grams of alcohol per day. We investigated the association between alcohol consumption early in life and later development of severe liver disease.

    Methods: We used data on alcohol consumption at conscription to military service from 43,296 men (18-20 years) in Sweden between 1969 and 1970. Outcomes were defined as incident diagnoses of severe liver disease from systematic national registration of clinical events until the end of 2009. A Cox regression model adjusted for body mass index, smoking, use of narcotics, cognitive ability and cardiovascular capacity was applied.

    Results: During a mean follow-up of 37.8 years, 383 men developed severe liver disease. Alcohol consumption was associated with an increased risk of development of severe liver disease in a dose-response pattern (adjusted hazard ratio for every one gram/day increase 1.02; 95% CI 1.01-1.02). No evidence of a threshold effect was found. Importantly, a clear trend pointed towards an increased risk of severe liver disease in men who consumed less than 30 grams of alcohol per day.

    Conclusion: Alcohol consumption in young men is associated with an increased risk of severe liver disease, up to 39 years later in life. The risk was dose-dependent, with no sign of a threshold effect. Current guidelines for safe alcohol intake in men might have to be revised.

    Lay summary: We investigated more than 43,000 Swedish men in their late teens enlisted for conscription in 1969–1970. After almost 40 years of follow-up, we found that alcohol consumption was a significant risk factor for developing severe liver disease, independent of confounders. This risk was dose-dependent, and was most pronounced in men consuming two drinks per day or more.

  • 28. Hagström, Hannes
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Discacciati, Andrea
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Macquarie University, Australia.
    Reply to: "A measure of alcohol consumption in late adolescence associated with liver disease after 39 years of follow-up is insufficient to guide alcohol safe limits"2018In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 69, no 1, p. 252-253Article in journal (Other academic)
  • 29. Hagström, Hannes
    et al.
    Stål, Per
    Hultcrantz, Rolf
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden .
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden .
    Overweight in late adolescence predicts development of severe liver disease later in life: A 39 years follow-up study2016In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 65, no 2, p. 363-368Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: The increased prevalence of overweight has been suggested to contribute to the worldwide increase in liver diseases. We investigated if body mass index (BMI) in late adolescence predicts development of severe liver disease later in life.

    METHODS: We performed a cohort study using data from 44,248 men (18-20years) conscribed to military service in Sweden between 1969 and 1970. Outcome data were collected from national registers to identify any diagnosis of severe liver disease (i.e., diagnosis of decompensated liver disease, cirrhosis or death in liver disease) until the end of 2009. A Cox regression model was applied using BMI as independent variable. The model was adjusted for use of alcohol, use of narcotics, smoking, high blood pressure and cognitive ability at time of conscription.

    RESULTS: During a follow-up period of a mean of 37.8years, 393 men were diagnosed with severe liver disease (mean time to diagnosis 24.7years). BMI (Hazard ratio [HR]=1.05 for each unit increase in BMI, 95% confidence interval [CI]: 1.01-1.09, p=0.008) and overweight (HR=1.64 for BMI 25-30 compared to BMI 18.5-22.5, 95% CI: 1.16-2.32, p=0.006) were associated with an increased risk of development of severe liver disease.

    CONCLUSIONS: Being overweight in late adolescence is a significant predictor of severe liver disease later in life in men.

    LAY SUMMARY: We investigated close to 45,000 Swedish men in their late teens enlisted for conscription in 1969-1970. After almost 40years of follow-up, we found that being overweight was a risk factor for developing severe liver disease, independent of established risk factors such as alcohol consumption.

  • 30.
    Hemmingsson, Tomas
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Danielsson, Anna-Karin
    Falkstedt, Daniel
    Fathers' alcohol consumption and risk of alcohol-related hospitalization in offspring before 60 years of age2017In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 24, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of the present study was to investigate the association between exposure to fathers' alcohol consumption and offspring's own risk of alcohol-related hospitalization. Methods: Data on circumstances in childhood and adolescence, e.g. fathers' alcohol consumption at different levels (never, rarely, occasionally, often), parental divorce, as well as offspring's own risky use of alcohol, smoking and mental health were collected among 49,321 men (sons), born in 1949-51, during conscription for compulsory military training in 1969/70, i.e. at ages 18-20. Data on alcohol-related diagnoses were collected from the Swedish In-patient Care register 1973-2009. Results: The relative risk of alcohol-related diagnoses among sons after the age of 20 increased with increasing level of alcohol consumption in the fathers. Compared with sons whose fathers never drank alcohol, those with fathers who drank alcohol occasionally or often had an increased hazard ratio (HR) of later hospitalization with alcohol-related diagnoses of 1.77 (95% confidence interval (CI)=1.57-1.99) and 3.69 (CI 95% = 3.16-4.32), respectively. The associations were markedly stronger when the men were followed from age 40 and onwards compared with follow-up between 20 and 40 years of age. Conclusion: Father's alcohol consumption was associated with an increased relative risk of alcohol-related hospitalization in offspring in adulthood.

  • 31. Hogstedt, Carl
    et al.
    Forsell, Yvonne
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Lundberg, Ingvar
    Lundin, Andreas
    Psychological Symptoms in Late Adolescence and Long-Term Risk of Suicide and Suicide Attempt2018In: Journal of Suicide and Life-threatening Behaviour, ISSN 0363-0234, E-ISSN 1943-278X, Vol. 48, no 3, p. 315-327Article in journal (Refereed)
    Abstract [en]

    Mental disorders in the general population are associated with increased risk of suicidality, but less is known about the independent predictive ability of self-reported psychological symptoms. We followed 49,321 screened and interviewed Swedish conscripts through 36-year follow-up to test whether psychological symptoms predicted suicide and hospitalization for suicide attempts. There were 619 suicides and 1,230 suicide attempts during the follow-up period. After excluding subjects with any psychiatric diagnoses (n=5,691, 12%) and controlling for other psychological symptoms, severe symptoms of anger, trouble falling asleep, and feeling down predicted suicide. Similarly anger, headaches, feeling down, and nervousness predicted suicide attempt. Self-reported psychological symptoms may have a predictive value beyond psychiatric diagnosis.

  • 32. Jonsson, Johanna
    et al.
    Muntaner, Carles
    Bodin, Theo
    Alderling, Magnus
    Balogh, Rebeka
    Burström, Bo
    Davis, Letitia
    Gunn, Virginia
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Julià, Mireia
    Kjellberg, Katarina
    Kreshpaj, Bertina
    Orellana, Cecilia
    Padrosa, Eva
    Wegman, David H.
    Matilla-Santander, Nuria
    Low-quality employment trajectories and risk of common mental disorders, substance use disorders and suicide attempt: a longitudinal study of the Swedish workforce2021In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 47, no 7, p. 509-520Article in journal (Refereed)
    Abstract [en]

    Objective High-quality longitudinal evidence exploring the mental health risk associated with low-quality employment trajectories is scarce. We therefore aimed to investigate the risk of being diagnosed with common mental disorders, substance use disorders, or suicide attempt according to low-quality employment trajectories.

    Methods A longitudinal register-study based on the working population of Sweden (N=2 743 764). Employment trajectories (2005–2009) characterized by employment quality and pattern (constancy, fluctuation, mobility) were created. Hazard ratios (HR) were estimated using Cox proportional hazards regression models for first incidence (2010–2017) diagnosis of common mental disorders, substance use disorders and suicide attempt as dependent on employment trajectories.

    Results We identified 21 employment trajectories, 10 of which were low quality (21%). With the exception of constant solo self-employment, there was an increased risk of common mental disorders (HR 1.07–1.62) and substance use disorders (HR 1.05–2.19) for all low-quality trajectories. Constant solo self-employment increased the risk for substance use disorders among women, while it reduced the risk of both disorders for men. Half of the low-quality trajectories were associated with a risk increase of suicide attempt (HR 1.08–1.76).

    Conclusions Low-quality employment trajectories represent risk factors for mental disorders and suicide attempt in Sweden, and there might be differential effects according to sex – especially in terms of self-employment. Policies ensuring and maintaining high-quality employment characteristics over time are imperative. Similar prospective studies are needed, also in other contexts, which cover the effects of the Covid-19 pandemic as well as the mechanisms linking employment trajectories with mental health.

  • 33. Järbrink-Sehgal, M. Ellionore
    et al.
    Schmidt, Peter T.
    Sköldberg, Filip
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Hagström, Hannes
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Macquarie University, Australia.
    Lifestyle Factors in Late Adolescence Associate With Later Development of Diverticular Disease Requiring Hospitalization2018In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 16, no 9, p. 1474-1480Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: The burden of diverticular disease on society is high and is increasing with an aging population. It is therefore important to identify risk factors for disease development or progression. Many lifestyle behaviors during adolescence affect risk for later disease. We searched for adolescent lifestyle factors that affect risk of diverticular disease later in life. METHODS: We performed a retrospective analysis of data from 43,772 men (age, 18-20 y) conscripted to military service in Sweden from 1969 through 1970, with a follow-up period of 39 years. All conscripts underwent an extensive mental and physical health examination and completed questionnaires covering alcohol consumption, smoking, and use of recreational drugs; cardiovascular fitness was assessed using an ergometer cycle at the time of conscription. Outcome data were collected from national registers to identify discharge diagnoses of diverticular disease until the end of 2009. We performed Cox regression analysis to determine whether body mass index, cardiovascular fitness, smoking, use of recreational drugs, alcohol consumption, and risky use of alcohol, at time of conscription are independent risk factors for development of diverticular disease. RESULTS: Overweight and obese men had a 2-fold increased risk of diverticular disease compared to normal-weight men (hazard ratio, 2.00; P < .001). A high level of cardiovascular fitness was associated with a reduced risk of diverticular disease requiring hospitalization (P = .009). Smoking (P = .003), but not use of recreational drugs (P = .11), was associated with an increased risk of diverticular disease requiring hospitalization. Risky use of alcohol, but not alcohol consumption per se, was associated with a 43% increase in risk of diverticular disease requiring hospitalization (P = .007). CONCLUSIONS: In a retrospective analysis of data from 43,772 men in Sweden, we associated being overweight or obese, a smoker, a high-risk user of alcohol, and/or having a low level of cardiovascular fitness in late adolescence with an increased risk of developing diverticular disease requiring hospitalization later in life. Improving lifestyle factors among adolescents might reduce the economic burden of diverticular disease decades later.

  • 34. Kjellberg, Katarina
    et al.
    Lundin, Andreas
    Falkstedt, Daniel
    Allebeck, Peter
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Long-term physical workload in middle age and disability pension in men and women: a follow-up study of Swedish cohorts2016In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 89, no 8, p. 1239-1250Article in journal (Refereed)
    Abstract [en]

    The study investigates the association between level of long-term physical workload in middle age and disability pension (DP) before 61 years of age with adjustments made for early life factors, level of education, and psychosocial working conditions. Associations with DP overall, DP due to musculoskeletal disorders and DP due to psychiatric disorders were examined.

    The study is based on cohorts of 21,809 Swedish men and women born in 1948 and 1953, with data on physical workload estimated with a job exposure matrix based on occupational titles in 1985 and 1990 and follow-up data on diagnosis-specific DP in the years 1991-2009. Data on paternal education and intelligence were collected in primary school. Data on level of education were taken from administrative records. Data on psychosocial working conditions were estimated with a job exposure matrix based on occupational titles in 1990.

    Long-term exposure to high physical workload measured 5 years apart at around age 40 was strongly associated with DP due to musculoskeletal disorders up to the age of 61 among both men (HR 5.44, 95 % CI 3.35-8.84) and women (HR 3.82, CI 95 % 2.88-5.08). For women, the association between high physical load and overall DP was also significantly increased (HR 2.33, CI 95 % 1.92-2.82). The increased risks remained but were clearly attenuated after adjustments for fathers' education, IQ in childhood, achieved education and level of control at work.

    Exposure to high physical workload is associated with long-term risk of DP due to musculoskeletal disorders, even though adjustments for early life factors, level of education and psychosocial working conditions clearly attenuated the risks.

  • 35. Kreshpaj, Bertina
    et al.
    Bodin, Theo
    Wegman, David H.
    Matilla-Santander, Nuria
    Burstrom, Bo
    Kjellberg, Katarina
    Davis, Letitia
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Jonsson, Johanna
    Håkansta, Carin
    Orellana, Cecilia
    Under-reporting of non-fatal occupational injuries among precarious and non-precarious workers in Sweden2022In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 79, no 1, p. 3-9Article in journal (Refereed)
    Abstract [en]

    Background Under-reporting of occupational injuries (OIs) among precariously employed workers in Sweden challenges effective surveillance of OIs and targeted preventive measures.

    Objective To estimate the magnitude of under-reporting of OIs among precarious and non-precarious workers in Sweden in 2013.

    Methods Capture–recapture methods were applied using the national OIs register and records from a labour market insurance company. Employed workers 18–65 resident in Sweden in 2013 were included in the study (n=82 949 OIs). Precarious employment was operationalised using the national labour market register, while injury severity was constructed from the National Patient Register. Under-reporting estimates were computed stratifying by OIs severity and by sociodemographic characteristics, occupations and precarious employment.

    Results Under-reporting of OIs followed a dose–response pattern according to the levels of precariousness (the higher the precarious level, the higher the under-reporting) being for the precarious group (22.6%, 95% CI 21.3% to 23.8%), followed by the borderline precarious (17.6%, 95% CI 17.1% to 18.2%) and lastly the non-precarious (15.0%, 95% CI 14.7% to 15.3%). Under-reporting of OIs, decreased as the injury severity increased and was higher with highest level of precariousness in all groups of severity. We also observed higher under-reporting estimates among all occupations in the precarious and borderline precarious groups as compared with the non-precarious ones.

    Conclusions This is the first register-based study to empirically demonstrate in Sweden that under-reporting of OIs is 50% higher among precariously employed workers. OIs under-reporting may represent unrecognised injuries that especially burden precariously employed workers as financial, health and social consequences shift from the employer to the employee.

  • 36. Kreshpaj, Bertina
    et al.
    Bottai, Matteo
    Matilla-Santander, Nuria
    Axén, Magnus
    Orellana, Cecilia
    Burström, Bo
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Jonsson, Johanna
    Håkansta, Carin
    Wegman, David H.
    Bodin, Theo
    Business performance and occupational injuries trajectories in the construction sector in Sweden2022In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 152, article id 105772Article in journal (Refereed)
    Abstract [en]

    Objective: To identify patterns in business performance and occupational injuries (OIs) in the Swedish construction sector between 2003 and 2015 and investigate associations between these trajectories.

    Methods: Company-level data were gathered from national registers. An open cohort of 13,089 private construction companies were classified by size. Yearly business performance indicators were return on equity, operating margin, and labor-to-revenue ratio. OIs rate was defined as number of injuries divided by number of employees. Group-based trajectory models were performed to identify companies with similar patterns in business performance and OIs rate over time. Associations were investigated with binomial regression models.

    Results: The model identified two main patterns (high/low) of injuries and business indicators for all company sizes. Trends in low labor-to-revenue ratio were associated with a high injury rate with a pooled estimate of 1.43 (95% CI 1.22–1.64) with some variation by company size: super small OR 1.3 (95% CI 1.01–1.62), small, OR 1.74 (95% CI 1.39–2.18), medium OR 1.3 (95% CI 0.9–1.8) and large OR 2.1 (95% CI 0.77–5.7). Similarly, low patterns of returns on equity were associated with high injury rate patterns across all company sizes, excluding small enterprises. No associations were found for operating margin patterns.

    Conclusions: Low returns on equity and labor-to-revenue ratio were associated with higher OIs rate trajectories in the Swedish construction sector, which has implications for injury prevention as well as targeted surveillance and inspection. Further studies could investigate other economic sectors and possible mechanisms for this association.

  • 37. Kreshpaj, Bertina
    et al.
    Orellana, Cecilia
    Burström, Bo
    Davis, Letitia
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Johansson, Gun
    Kjellberg, Katarina
    Jonsson, Johanna
    Wegman, David H.
    Bodin, Theo
    What is precarious employment? A systematic review of definitions and operationalizations from quantitative and qualitative studies2020In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 46, no 3, p. 235-247Article, review/survey (Refereed)
    Abstract [en]

    Objectives The lack of a common definition for precarious employment (PE) severely hampers the comparison of studies within and between countries, consequently reducing the applicability of research findings. We carried out a systematic review to summarize how PE has been conceptualized and implemented in research and identify the construct's dimensions in order to facilitate guidance on its operationalization.

    Methods According to PRISMA guidelines, we searched Web of Science and Scopus for publications with variations of PE in the title or abstract. The search returned 1225 unique entries, which were screened for eligibility. Exclusion criteria were (i) language other than English, (ii) lack of a definition for PE, and (iii) non-original research. A total of 63 full-text articles were included and qualitative thematic-analysis was performed in order to identify dimensions of PE.

    Results We identified several theory-based definitions of PE developed by previous researchers. Most definitions and operationalizations were either an accommodation to available data or the direct result of qualitative studies identifying themes of PE. The thematic-analysis of the selected articles resulted in a multidimensional construct including the following three dimensions: employment insecurity, income inadequacy, and lack of rights and protection.

    Conclusions Despite a growing number of studies on PE, most fail to clearly define the concept, severely restricting the advancement of the research of PE as a social determinant of health. Our combined theoretical and empirical review suggests that a common multidimensional definition could be developed and deployed in different labor market contexts using a variety of methodological approaches.

  • 38. Lager, Emil
    et al.
    Melin, Bo
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Sörberg Wallin, Alma
    The evolving relationship between premorbid intelligence and serious depression across the lifespan - A longitudinal study of 43,540 Swedish men2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 211, p. 37-43Article in journal (Refereed)
    Abstract [en]

    Background:

    An association between higher intelligence and lower probability of serious depression has previously been established. Yet, to our knowledge, no large prospective study has examined the relationship across the lifespan.

    Methods:

    A cohort of 49,321 Swedish men was followed from conscription in 1969-70 (age 18-20) through to 2008. Odds ratios (OR) for first time hospitalisation for depression (FTHD) were calculated in relation to intelligence for distinct time periods across the lifespan, while controlling for established risk factors for depression.

    Results:

    There was a linear association between higher intelligence in youth and lower odds for FTHD during the entire follow-up period, 1973-2008. The association got progressively weaker across the lifespan. During 1973-80, one step down on the stanine scale was associated with an unadjusted increase in OR of 1.34 [95% confidence interval (CI) 1.26-1.42], adjusted OR 1.23 [1.15-1.32]; while, during 2001-2008, the ORs were less than half of the magnitude of the first period, unadjusted 1.14 [1.07-1.21], and adjusted 1.09 [1.01-1.17].

    Limitations:

    The study includes men only, and the number of available places for in-patient care decreased during the follow-up period.

    Conclusion:

    For the first time, we have shown that the association between lower intelligence and depression decreases over time. The attenuation of the association in the adjusted models suggests a slower accumulation of depressogenic stressors among people with a higher IQ-score. Further exploration of intelligence's role in the etiology of depression across the lifespan is required in order to facilitate adequate diagnoses and ameliorating interventions.

  • 39.
    Landberg, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Danielsson, Anna-Karin
    Falkstedt, Daniel
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Fathers' Alcohol Consumption and Long-Term Risk for Mortality in Offspring2018In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 53, no 6, p. 753-759Article in journal (Refereed)
    Abstract [en]

    Aim: This study examined associations between fathers' alcohol consumption and risk for total and cause-specific mortality in offspring. Short summary: We examined the associations between fathers' alcohol consumption and total and cause-specific mortality in adult offspring. Fathers' alcohol consumption was associated with increased risk of alcohol-related mortality in offspring. The association appeared to be weaker for causes of death in which alcohol plays a smaller, or less direct, role. Methods: Data on fathers' alcohol consumption, and offspring's risky use of alcohol, smoking, mental health and contact with police/childcare authorities were collected among 46,284 men (sons) aged 18-20 years, during conscription for compulsory military training in 1969/70. Data on offspring mortality were obtained from the National Cause of Death register, 1971-2008. The mortality outcomes included total mortality, alcohol-related causes of death and violent causes of death (categorized into suicides vs violent/external causes excluding suicides). Results: Compared to sons whose fathers never used alcohol, the risk for total and alcohol-related mortality among sons increased with the father's consumption level. The risk of violent death was significantly elevated among sons whose fathers drank alcohol occasionally or often, but the risk of suicide increased in the highest consumption category only. After adjustment for covariates, the results remained for alcohol-related mortality whereas they were significantly attenuated, or disappeared, for total mortality, violent death and suicide. Conclusions: Fathers' alcohol consumption is associated with increased risk of alcohol-related mortality in the offspring. Alcohol use among fathers also increases the offspring's risk of later total mortality, suicide and violent death, but these associations appear to be mediated or confounded by factors related to parental drinking and/or adverse childhood psychosocial circumstances.

  • 40.
    Landberg, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institute, Sweden.
    Danielsson, Anna-Karin
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institute, Sweden.
    Fathers’ alcohol use and suicidal behaviour in offspring during youth and young adulthood2019In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, no 6, p. 563-573Article in journal (Refereed)
    Abstract [en]

    Objective

    To examine the association between various indicators of father's alcohol use and suicidal behaviour in offspring during youth and young adulthood.

    Methods

    The study is based on a cohort of 68 910 Swedish citizens who were born between 1970 and 1985 and have fathers who participated in conscription for compulsory military training in 1969/70. Information on fathers’ alcohol use was collected during conscription. Offspring was followed for suicide attempts or completed suicides (through linkage with national registers) from age 12 to end of follow‐up in 2008.

    Results

    After adjustment for confounders, the hazard ratio (HR) for offspring to fathers who were heavy drinkers was 1.4 (95% CI 1.02, 1.93) while the associations turned non‐significant for offspring to fathers who often drank into intoxication, HR 1.14 (0.68, 1.90). The highest risk for suicidal behaviour was found for offspring to fathers who had been apprehended for drunkenness two times or more, or with an alcohol‐related hospitalization, with adjusted HRs of 2.1 (1.4, 3,14) and 1.9 (1.27, 2,85) respectively.

    Conclusion

    Fathers’ alcohol use is associated with increased risk of suicidal behaviour among offspring in youth and young adulthood.

  • 41.
    Landberg, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; The Swedish Council for Information on Alcohol and Other Drugs, Sweden.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Sydén, Lovisa
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The Contribution of Alcohol Use, Other Lifestyle Factors and Working Conditions to Socioeconomic Differences in Sickness Absence2020In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 26, no 1, p. 40-51Article in journal (Refereed)
    Abstract [en]

    Introduction: This study investigates how alcohol use contributes to the social gradient in sickness absence. Other factors assessed include lifestyle factors (smoking, physical activity and body mass index), physical and psychosocial working conditions. Methods: The study used baseline data from the Stockholm public health cohort 2006, with an analytical sample of 17,008 respondents aged 25-64 years. Outcome variables included self-reported short-term (<14 days) and register-based long-term (>14 days) sickness absence. Socioeconomic position (SEP) was measured by occupational class. Alcohol use was measured by average weekly volume and frequency of heavy episodic drinking. Negative binominal regression was used to estimate sex-specific SEP differences in sickness absence, before and after adjusting for alcohol use and the additional explanatory factors. Results: Adjusting for alcohol use attenuated the SEP differences in long-term sickness absence by 20% for men and 14% for women. Alcohol use explained a smaller proportion of the differences in short-term sickness absence. Alcohol use in combination with other lifestyle factors attenuated the SEP differences (20-35%) for both outcomes. Physical working conditions explained more than half of the gradient in long-term sickness absence, whereas psychosocial conditions had greater impact on short-term sickness absence among men. Discussion/Conclusion: Alcohol use explains a substantial proportion of the SEP disparities in long-term sickness absence among men. The effect is smaller among women and for short-term sickness absence. Our findings support the notion that physical working conditions constitute the key explanatory variable for SEP differences in long-term sickness absence, but add that psychosocial working conditions have greater impact on the gradient in short-term sickness absence among men.

  • 42. Lundin, A.
    et al.
    Kjellberg, K.
    Leijon, O.
    Punnett, L.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    The Association Between Self-Assessed Future Work Ability and Long-Term Sickness Absence, Disability Pension and Unemployment in a General Working Population: A 7-Year Follow-Up Study2016In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 26, no 2, p. 195-203Article in journal (Refereed)
    Abstract [en]

    Purpose Work ability is commonly measured with self-assessments, in the form of indices or single items. The validity of these assessments lies in their predictive ability. Prospective studies have reported associations between work ability and sickness absence and disability pension, but few examined why these associations exist. Several correlates of work ability have been reported, but their mechanistic role is largely unknown. This study aims to investigate to what extent individual's own prognosis of work ability predicts labor market participation and whether this was due to individual characteristics and/or working conditions. Methods Self-assessed prognosis of work ability, 2 years from now, in the Stockholm Public Health Questionnaire (2002-2003) was linked to national registers on sickness absence, disability pension and unemployment up to year 2010. Effects were studied with Cox regression models. Results Of a total of 12,064 individuals 1466 reported poor work ability. There were 299 cases of disability pension, 1466 long-term sickness absence cases and 765 long-term unemployed during follow-up. Poor work ability increased the risk of long-term sickness absence (HR 2.25, CI 95 % 1.97-2.56), disability pension (HR 5.19, CI 95 % 4.07-6.62), and long-term unemployment (HR 2.18, CI 95 % 1.83-2.60). These associations were partially explained by baseline health conditions, physical and (less strongly) psychosocial aspects of working conditions. Conclusions Self-assessed poor ability predicted future long-term sickness absence, disability pension and long-term unemployment. Self-assessed poor work ability seems to be an indicator of future labor market exclusion of different kinds, and can be used in public health monitoring.

  • 43. Lundin, Andreas
    et al.
    Falkstedt, Daniel
    Lundberg, Ingvar
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Unemployment and coronary heart disease among middle-aged men in Sweden: 39 243 men followed for 8 years2014In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 71, no 3, p. 183-188Article in journal (Refereed)
    Abstract [en]

    Background Although unemployment may be a stressful life event, its association with coronary heart disease (CHD) remains unclear. This study examines the association between unemployment and later hospitalisation due to CHD. Methods The study was based on a Swedish military conscription cohort of 18 to 20-year-old men from 1969/1970 (n=49321) with information provided on health status and health behaviours. Information on unemployment in middle age was obtained from national registers. CHD information was obtained from hospital registers and the cause of death register. Cox proportional hazard analyses were run on the 39243 individuals who were in paid employment in 1996 and 1997. Results It was found that 90days of unemployment was associated with subsequent CHD during 8years follow-up (crude HR=1.47, 95% CI 1.23 to 1.75). Controlling for known risk factors for CHD reduced the association but a significant association remained (HR=1.24, 95% CI 1.04 to 1.48); 90days of unemployment was significantly associated with CHD during the first 4years (HR adjusted for known risk factors=1.31, 95% CI 1.01 to 1.71). Conclusions Unemployment was associated with increased risk of CHD after adjustment for confounders. We interpret the increased risk of CHD associated with unemployment as potentially the somatic result of a process started by stress.

  • 44. Lundin, Andreas
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Adolescent predictors of unemployment and disability pension across the life course – a longitudinal study of selection in 49 321 Swedish men2013Report (Other academic)
    Abstract [en]

    Objective: This study investigated the associations of adolescent cognitive ability, mental status and adaptability to school and work with unemployment from youth to mid-life. It also investigated the associations of youth unemployment with later unemployment and disability pension.

    Method: We used a cohort of 49 321 Swedish men, with information on cognitive ability, mental status, and school and personality characteristics in late adolescence in 1969. The information was linked to 32 years of annual administrative data to study predictors of unemployment and disability pension.

    Results: We found a strong and consistent association between cognitive ability and risk of unemployment, which was independent of other individual characteristics. Other notable independent risk factors were psychiatric diagnosis, contact with police or childcare authorities, smoking, risk use of alcohol, not being liked in school, and having been dismissed from or having quit a job due to unfair treatment. Unemployment before age 18 was found to be associated with unemployment across the life course, and also with disability pension, most of which was explained by individual characteristics.     

    Conclusion: Certain individuals are more likely to be unemployed, and to be unem­ployed for more than one period, due to individual characteristics, which include cognitive ability, mental health, and labour-market related behaviour across the life course. However, people who become unemployed in youth have, regardless of their individual characteristics, an increased risk of becoming unemployed again. People who experience youth unemployment are also more likely to receive disability pension.

  • 45. Lundin, Andreas
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Prediktorer för arbetslöshet och förtidspension2013Report (Other academic)
  • 46. Lundin, Andreas
    et al.
    Sörberg Wallin, Alma
    Falkstedt, Daniel
    Allebeck, Peter
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Intelligence and Disability Pension in Swedish Men and Women Followed from Childhood to Late Middle Age2015In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 6, article id 0128834Article in journal (Refereed)
    Abstract [en]

    Objective To investigate the association between intelligence and disability pension due to mental, musculoskeletal, cardiovascular, and substance-use disorders among men and women, and to assess the role of childhood social factors and adulthood work characteristics. Methods Two random samples of men and women born 1948 and 1953 (n = 10 563 and 9 434), and tested for general intelligence at age 13, were followed in registers for disability pension until 2009. Physical and psychological strains in adulthood were assessed using job exposure matrices. Associations were examined using Cox proportional hazard regression models, with increases in rates reported as hazard ratios (HRs) with 95% confidence intervals (95% CI) per decrease in stanine intelligence. Results In both men and women increased risks were found for disability pension due to all causes, musculoskeletal disorder, mental disorder other than substance use, and cardiovascular disease as intelligence decreased. Increased risk was also found for substance use disorder in men. In multivariate models, HRs were attenuated after controlling for pre-school plans in adolescence, and low job control and high physical strain in adulthood. In the fully adjusted model, increased HRs remained for all causes (male HR 1.11, 95% CI 1.07-1.15, female HR 1.06, 95% CI 1.02-1.09) and musculoskeletal disorder (male HR 1.16, 95% CI 1.09-1.24, female HR 1.08, 95% CI 1.03-1.14) during 1986 to 2009. Conclusion Relatively low childhood intelligence is associated with increased risk of disability pension due to musculoskeletal disorder in both men and women, even after adjustment for risk factors for disability pension measured over the life course.

  • 47. Löfving, Sofia
    et al.
    Allebeck, Peter
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institute, Sweden.
    Early life predictors of high alcohol consumption in middle age2018In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 25, no 3, p. 273-279Article in journal (Refereed)
    Abstract [en]

    Objective: A number of studies have investigated early life determinants of alcohol consumption in adolescence. In this study, we will investigate early life predictors of high alcohol consumption in middle age. Methods: Data on early life predictors, e.g. alcohol consumption and smoking, was collected from 49,321 Swedish men born 1949-1951 at conscription for military service in 1969/70. Follow-up data on alcohol consumption in the same men was collected from a random sample participating in one of the Swedish Survey of Living Condition in 1988/89, 1996/97 or 2004/05 (N=146), i.e. at age 37 or later. Odds Ratios (ORs) with 95% Confidence Intervals (CIs) were estimated in logistic regression analysis for the association between factors measured in late adolescence and high alcohol consumption middle-age. Results: The proportion of high consumers of alcohol increased from late adolescence to middle age. Smoking (OR 2.9, CI95% 1.3-6.2) and low education (OR 2.0, CI95% 1.0-4.0) measured at the conscription examination in late adolescence were associated with high alcohol consumption in middle age. A few other factors measured at the conscription examination, e.g. high alcohol consumption (OR 1.8, CI95% 0.7-4.4), showed elevated ORs but the associations were not significantly increased. Conclusion: Smoking and low education measured in late adolescence were associated with high alcohol consumption in middle age.

  • 48. Manrique-Garcia, E.
    et al.
    Zammit, S.
    Dalman, C.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Andreasson, S.
    Allebeck, P.
    Prognosis of schizophrenia in persons with and without a history of cannabis use2014In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 44, no 12, p. 2513-2521Article in journal (Refereed)
    Abstract [en]

    Background. The aim of the study was to determinate whether schizophrenia patients with a history of cannabis use have a different prognosis, with regards to readmission and hospital duration, compared with those without a history of cannabis use. Method. The present investigation was a cohort study of 50087 Swedish men with data on cannabis use at the ages of 18-20 years. A total of 357 cases of schizophrenia were identified from in-patient care and followed up from 1973 to 2007. Results. Schizophrenia patients with a history of cannabis use had a higher median duration of first hospital episode (59 days v. 30 days). Patients with a history of cannabis use had a higher median rate of readmission (10 times v. four times). Also, total number of hospital days was higher in patients with a history of cannabis use compared with those without (547 days v. 184 days). Patients with a history of cannabis use had an increased odds of having more than 20 hospital readmissions compared with non-users [3.1, 95% confidence interval (CI) 1.3-7.3] as well as an increased odds of hospital admission lasting more than 2 years (2.4, 95% CI 1.1-7.4) after controlling for diagnosis of personality disorders, family socio-economic position, IQ score, civil status, place of residence, risky use of alcohol and use of other drugs. Patients with a history of cannabis use were less likely to have paranoid schizophrenia compared with never users (8% v. 17%) in the first admission. Conclusions. Schizophrenia patients with a history of cannabis use had a significantly higher burden of lifetime inpatient care than non-cannabis users. Not only does cannabis increase the risk of schizophrenia, but also our findings indicate that the course and prognosis of schizophrenia may be more severe than schizophrenia cases in general.

  • 49. Matilla-Santander, Nuria
    et al.
    Muntaner, Carles
    Kreshpaj, Bertina
    Gunn, Virginia
    Jonsson, Johanna
    Kokkinen, Lauri
    Selander, Jenny
    Baron, Sherry L.
    Orellana, Cecilia
    Östergren, Per-Olof
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Wegman, David H.
    Bodin, Theo
    Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study2022In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 15, article id 100314Article in journal (Refereed)
    Abstract [en]

    Background The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke.

    Methods This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family.

    Findings Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1.08, CI95%:1.05-1.11 and RR:1.13, CI95%: 1.07-1.20 respectively) and stroke (RR:1.14, CI95%: 1.10-1.18 and HR:1.24, CI95%: 1.16-1.33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1.32, CI95%:1.04-1.68); moving from high to a low probability of having collective agreements (RR: 1.10, CI95%:1.01-1.20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women.

    Interpretation The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time.

  • 50. Nordström, Karin
    et al.
    Ekberg, Kerstin
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institute, Sweden.
    Johansson, Gun
    Sick leave and the impact of job-to-job mobility on the likelihood of remaining on the labour market - a longitudinal Swedish register study2014In: BMC Public Health, E-ISSN 1471-2458, Vol. 14, p. 305-Article in journal (Refereed)
    Abstract [en]

    Background: Change of job could be a strategy in vocational rehabilitation when return to the original job is not possible, but research is very limited concerning the effects of job mobility on the future vocational situation. The aim of the study was to investigate whether job-to-job mobility affects the likelihood of remaining on the labour market over time among persons who are employed and have experienced long-term sick leave. Methods: In a longitudinal register study, cohorts from three base years (1994, 1999 and 2004) were created, based on the Swedish population who were 20-60 years old, had sickness allowance insurance, and were employed in the base year and the following year (n > 3,000,000). The likelihood that individuals on long-term sick leave were employed later depending on whether or not they changed workplace during the present or next year of long-term sick leave was analyzed using logistic regression analysis. Age, sector, industry, children, marital status, education, income, rate of sick leave and earlier sick leave and earlier mobility were taken into consideration. Results: Women with more than 180 days' sick leave who changed workplaces were more likely to have a job later compared with those who did not change jobs. For men, the association was statistically significant with 1994 and 2004 as base years, but not in the cohort from 1999. Conclusions: The present study indicates that for those on long-term sick leave that changed workplaces, the opportunities to stay on the labour market might increase. However, the study has methodological limitations and the results for men are ambiguous. We do not therefore have enough evidence for recommending job change as a strategy for vocational rehabilitation.

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