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  • 1. 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.

  • 2. 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.

  • 3. 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.

  • 4. Falkstedt, Daniel
    et al.
    Sorjonen, Kimmo
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    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, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 12, p. e82031-Article 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.

  • 5.
    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.

  • 6. 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.

  • 7. 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.

  • 8.
    Gauffin, Karl
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet.
    The effect of childhood socioeconomic position on alcohol-related disorders later in life: a Swedish national cohort study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 11, p. 932-938Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 9. 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.

  • 10. 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.

  • 11.
    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.

  • 12. 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.

  • 13. 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.

  • 14. 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.

  • 15. 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.

  • 16. 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.

  • 17. 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)
  • 18. 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, ISSN 1932-6203, 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.

  • 19. 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.

  • 20. 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.

  • 21. 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, ISSN 1471-2458, 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.

  • 22. Nordström, Karin
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Ekberg, Kerstin
    Johansson, Gun
    SICKNESS ABSENCE IN WORKPLACES: DOES IT REFLECT A HEALTHY HIRE EFFECT?2016In: International Journal of Occupational Medicine and Environmental Health, ISSN 1232-1087, E-ISSN 1896-494X, Vol. 29, no 2, p. 315-330Article in journal (Refereed)
    Abstract [en]

    Objectives: Sickness absence in workplaces may reflect working conditions. It may also reflect a healthy hire effect, i.e., that workplaces recruit individuals with experience of sickness absence differently. The purpose of the study was to determine if a history of sickness absence among recruits is associated with the average level of sickness absence in workplaces. Material and Methods: In a register-based follow-up study, Swedish workplaces with at least 5 employees in 2006 were selected (approximately 127 000 workplaces with 3.9 million employees). The workplaces were categorized according to the average workplace sickness absence in 2006 and the recruits were categorized according to the individual sickness absence in 2005. The workplaces with a high average level of sickness absence were more likely than those with a low level to hire employees with high sickness absence in the year preceding employment: men - odds ratio (OR) = 7.2, 95% confidence interval (CI): 6.6-7.8, women OR = 7.5, 95% CI: 6.9-8.1. Results: The results show that there is a greater likelihood of employing individuals with high levels of sickness absence in the workplaces with many days of the average sickness absence than in the workplaces with few days of the average sickness absence. Conclusions: The results suggest that sickness absence in workplaces may reflect a healthy hire effect.

  • 23. Sjölund, Sara
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Allebeck, Peter
    IQ and Level of Alcohol Consumption-Findings from a National Survey of Swedish Conscripts2015In: Alcoholism: Clinical and Experimental Research, ISSN 0145-6008, E-ISSN 1530-0277, Vol. 39, no 3, p. 548-555Article in journal (Refereed)
    Abstract [en]

    Background: Studies of the association between IQ and alcohol consumption have shown conflicting results. The aim of this study was to investigate the association between IQ test results and alcohol consumption, measured as both total alcohol intake and pattern of alcohol use.

    Methods: The study population consists of 49,321 Swedish males born 1949 to 1951 who were conscripted for Swedish military service 1969 to 1970. IQ test results were available from tests performed at conscription. Questionnaires performed at conscription provided data on total alcohol intake (consumed grams of alcohol/wk) and pattern of drinking. Multinomial and binomial logistic regressions were performed on the cross-sectional data to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Adjustments were made for socioeconomic position as a child, psychiatric symptoms and emotional stability, and father's alcohol habits.

    Results: We found an increased OR of 1.20 (1.17 to 1.23) for every step decrease on the stanine scale to be a high consumer versus a light consumer of alcohol. For binge drinking, an increased OR of 1.09 (95% CI=1.08 to 1.11) was estimated for every step decrease on the stanine scale. Adjustment for confounders attenuated the associations. Also, IQ in adolescence was found to be inversely associated with moderate/high alcohol consumption measured in middle age.

    Conclusions: We found that lower results on IQ tests are associated with higher consumption of alcohol measured in terms of both total alcohol intake and binge drinking in Swedish adolescent men.

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

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

  • 25. Sorberg, Alma
    et al.
    Allebeck, Peter
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    IQ and somatic health in late adolescence2014In: Intelligence, ISSN 0160-2896, E-ISSN 1873-7935, Vol. 44, p. 155-162Article in journal (Refereed)
    Abstract [en]

    Intelligence quotient (IQ) is associated with mental health in youth onwards, as well as somatic health and longevity later in life. However, little is known about the association with somatic health in youth. We aimed to investigate the cross-sectional association between IQ and a range of somatic diagnoses and health indicators in late adolescence. In a cohort comprising 49321 Swedish men, IQ test performance and health status were recorded at conscription in 1969-70, at ages 18-20. Information on socioeconomic factors in childhood was obtained from the national census. Odds ratios (ORs) were estimated by logistic regression. With adjustment for socioeconomic background, each step decrease in IQ test performance on a nine-point scale was associated with an increased OR for the following somatic diagnoses; impaired hearing (1.14, 1. 1.12-1.16), endocrine disorders (1.13, 1.10-1.17), symptoms and ill-defined conditions (1.11, 1.08-1.14), back pain (1.10, 1.08-1.12), digestive system diseases (1.08,1.05-1.10) and injuries (1.02,1.00-1.05); and a decreased OR for hayfever (0.87, 0.85-0.90) and refractive errors (0.87, 0.86-0.88). IQ was also associated with increased ORs for low physical capacity (1.12, 1.10-1.14), signs of inflammation (1.07, 1.06-1.09) and low self-rated health (1.03, 1.02-1.05). Several diagnoses were not associated with IQ In conclusion, lower IQ at conscription was associated with a higher risk for several diagnoses and indicators of poor health, but the risk was decreased for a few of the diagnoses. The mechanisms underlying the associations presumably differ. However, socioeconomic factors in childhood could not explain the associations. 

  • 26. Sorjonen, Kimmo
    et al.
    Farioli, Andrea
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Melin, Bo
    Refractive state, intelligence, education, and Lord's paradox2017In: Intelligence, ISSN 0160-2896, E-ISSN 1873-7935, Vol. 61, p. 115-119Article in journal (Refereed)
    Abstract [en]

    In a cohort of Swedish men (N = 45.906), we found that men with myopia had higher' levels of intelligence and education than men with emmetropia and both these groups had higher levels than men with hyperopia. The educational advantage of myopia was reduced by 47-66 percent when adjusting for intelligence but still remained significant. When adjusting for intelligence hyperopes had a higher level of education than emmetropes. Hyperopes also had the highest level of education compared to their level of intelligence. The reversal in the difference between hyperopes and emmetropes when adjusting for intelligence could be seen as an example of Lord's paradox, possibly due to hyperopes having a higher level of intelligence than emmetropes with the same intelligence test score.

  • 27. Sorjonen, Kimmo
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Deary, Ian J.
    Melin, Bo
    Mediation of the gravitational influence of intelligence on socio-economic outcomes2015In: Intelligence, ISSN 0160-2896, E-ISSN 1873-7935, Vol. 53, p. 8-15Article in journal (Refereed)
    Abstract [en]

    The 'gravitational hypothesis' posits that the strength of the association between intelligence and occupational position should increase with age. Here, it is tested in an age-homogeneous, population-representative sample of Swedish men (N = 49,246). Intelligence had a positive effect on occupational and income trajectories, supporting the hypothesis. Although weaker, socio-economic background also had a positive effect on occupational and income trajectories. Both the effect of intelligence and of socioeconomic background was to a large extent mediated by subjects' education level. Intelligence, socio-economic background, and level of education were also found to have a positive association with a deceleration of the increase in occupational position and income with age.

  • 28. Sörberg, Alma
    et al.
    Gunnell, David
    Falkstedt, Daniel
    Allebeck, Peter
    Åberg, Maria
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Body Mass Index in Young Adulthood and Suicidal Behavior up to Age 59 in a Cohort of Swedish Men2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 7, p. e101213-Article in journal (Refereed)
    Abstract [en]

    An association of higher body mass index (BMI) with lower risk of attempted and completed suicide has been reported. In contrast, increasing BMI has been found to be associated with depression and other risk factors for suicidal behavior. We aimed to investigate this possible paradox in a cohort comprising 49 000 Swedish men. BMI, mental health, lifestyle and socioeconomic measures were recorded at conscription in 1969-70, at ages 18-20. Information on attempted suicide 1973-2008 and completed suicide 1971-2008 was obtained from national records. Hazard ratios (HR) were estimated by Cox proportional hazard models. We found that each standard deviation (SD) increase in BMI was associated with a 12% lower risk of later suicide attempt (HR 0.88, 95% CI 0.83-0.94). Associations were somewhat weaker for completed suicide and did not reach conventional levels of statistical significance (HR 0.93, 95% CI 0.85-1.01). Adjustment for a wide range of possible confounding factors had little effect on the associations. Lower BMI at conscription was also associated with higher prevalence of psychiatric diagnoses, low emotional control and depressed mood. Our results confirm previous findings regarding the association of higher BMI with a reduced risk of suicide, extending them to show similar findings in relation to suicide attempts. The associations were little affected by adjustment for a range of possible confounding factors. However, we found no evidence that high BMI was associated with an increased risk of depression cross-sectionally or longitudinally.

  • 29. Sörberg, Alma
    et al.
    Lundin, Andreas
    Allebeck, Peter
    Melin, Bo
    Falkstedt, Daniel
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institute, Sweden .
    Cognitive Ability in Late Adolescence and Disability Pension in Middle Age: Follow-Up of a National Cohort of Swedish Males2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 10, p. e78268-Article in journal (Refereed)
    Abstract [en]

    Low cognitive ability in late adolescence has previously been shown to be associated with disability pension (DP) in young adulthood. However, most DP's are granted later in working life, and the mechanisms of the association are not fully understood. We aimed to investigate the association between cognitive ability in late adolescence and DP at ages 40-59, and investigate the role of individual and socioeconomic factors. Information on cognitive ability, health status, personality aspects and health behaviours at age 18-20 was obtained from the 1969-70 conscription cohort, comprising 49 321 Swedish men. Data on DP's 1991-2008 was obtained from the Longitudinal Database of Education, Income and Employment. Information on socioeconomic and work-related factors in childhood and adulthood was obtained from national sociodemographic databases. Hazard ratios for DP during follow-up were estimated by Cox proportional hazards models. We found a graded relationship between cognitive ability in late adolescence and DP in middle age. One step decrease on the nine-point stanine scale of cognitive ability was associated with a crude hazard ratio of 1.26 (95 % CI 1.24-1.27). Socioeconomic and work-related circumstances in adulthood explained much of the association, but factors measured already in late adolescence also showed importance. The findings suggest an accumulation of risks over the life course. Although attenuated, the graded relationship remained after adjusting for all factors.

  • 30. Sörberg Wallin, Alma
    et al.
    Lundin, Andreas
    Melin, Bo
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Fathers' intelligence measured at age 18-20 years is associated with offspring smoking: linking the Swedish 1969 conscription cohort to the Swedish Survey of Living Conditions2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 4, p. 396-401Article in journal (Refereed)
    Abstract [en]

    Background An association between lower IQ of parents, measured early in life, and smoking among their offspring has been reported. The extent to which other background factors account for this association is unknown. Methods Data on IQ, smoking, mental health, social class, parental divorce and social problems in a cohort of men born during 1949-1951 and conscripted for military service in 1969 were linked to smoking data on 682 offspring interviewed in the Swedish Surveys of Living Conditions 1984-2009. Results In an age-adjusted model, a one-step decrease on a stanine scale was associated with an OR of 1.19 (95% CI 1.04 to 1.35) for offspring smoking. Adjusting for father's socioeconomic background and smoking, mental illness and social problems in youth only marginally lowered the OR's. Conclusions Lower IQ among fathers measured at ages 18-20years was associated with smoking in their offspring. The association was not explained by father's social class in childhood or a higher prevalence of mental illness, social problems or smoking measured among the fathers in their late adolescence.

  • 31. Thern, Emelie
    et al.
    de Munter, Jeroen
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Rasmussen, Finn
    Long-term effects of youth unemployment on mental health: does an economic crisis make a difference?2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 4, p. 344-349Article in journal (Refereed)
    Abstract [en]

    Background Ill health is a risk factor and a consequence of unemployment, which might vary depending on the national rate of unemployment. We investigated the long-term effect of youth unemployment on mental health and explored the possible interaction during periods of high (economic crisis) and low (non-crisis) unemployment rates. Methods A register-linked population-based cohort study was conducted including individuals aged 1724 years. The crisis cohort (n= 6410) took part in the Labour Force Survey during the economic crisis (1991-1994) in Sweden and the non-crisis cohort (n= 8162) took part in the same survey before the crisis (1983-1986). Follow-up was 19 years. Adjusted HRs and 95% CIs for an inpatient care discharge mental diagnosis with employed people as the reference group were calculated by Cox regressions models. Results In fully adjusted models, <3 months (HR: 1.69; 95% CI 1.14 to 2.49), 3-6 months (2.19; 1.43 to 3.37) and > 6 months (2.70; 1.71 to 4.28) of unemployment were associated with increased risks of getting a mental diagnosis in the crisis cohort. In the non-crisis cohort the risks were: 1.92; 1.40 to 2.63, 2.60; 1.72 to 3.94 and 3.33; 2.00 to 5.57, respectively. No interactions between labour force status and level of unemployment were found. Conclusions Youth unemployment is related to mental health problems, independent of the overall national rate of unemployment, which is important as the youth unemployment rates are currently at stable high level.

  • 32. Thern, Emelie
    et al.
    de Munter, Jeroen
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Smith, George Davey
    Ramstedt, Mats
    Tynelius, Per
    Rasmussen, Finn
    Effects of increased alcohol availability during adolescence on the risk of all-cause and cause-specific disability pension: a natural experiment2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 6, p. 1004-1012Article in journal (Refereed)
    Abstract [en]

    Aim To test if being exposed to increased alcohol availability during adolescence is associated with an increased risk of receiving disability pension due to all-cause, alcohol use disorders and mental disorders. Design Register-based population-based study using a natural experiment setting, the alcohol policy change in Sweden (1967-68), with increased access to strong beer in a narrow time window and geographical area. The individuals exposed to the policy change were compared with non-exposed individuals living in the rest of Sweden, excluding a border area. Setting Sweden. Participants A total of 518810 individuals (70761 in the intervention group; 448049 in the control group) born 1948-1953, aged 14-20 years during the policy change. Measurements Date and diagnosis of the outcome variable of disability pension due to all-cause, alcohol use disorders and mental disorders were obtained from the Swedish National Social Insurance Agency database from 1971 to 2013. Individual and family level socio-demographic and health-related covariates, as well as a regional level covariate, were included. Findings Compared with the control group, adolescents exposed to the alcohol policy change were at an increased risk of receiving disability pension due to all-causes [hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.07-1.11], alcohol use disorders (HR=1.17, 95% CI=1.05-1.30) and mental disorders (HR=1.19, 95% CI=1.15-1.23). Conclusion In Sweden, a natural experiment with a 43-year follow-up suggests that exposure to increased alcohol availability during adolescence is associated with an increased risk of receiving a disability pension due to all-cause, alcohol use disorder and mental disorder diagnoses.

  • 33. Wallin, Alma Sorberg
    et al.
    Falkstedt, Daniel
    Allebeck, Peter
    Melin, Bo
    Janszky, Imre
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Does high intelligence improve prognosis?: The association of intelligence with recurrence and mortality among Swedish men with coronary heart disease2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 4, p. 347-353Article in journal (Refereed)
    Abstract [en]

    Background Lower intelligence early in life is associated with increased risks for coronary heart disease (CHD) and mortality. Intelligence level might affect compliance to treatment but its prognostic importance in patients with CHD is unknown. Methods A cohort of 1923 Swedish men with a measure of intelligence from mandatory military conscription in 1969-1970 at age 18-20, who were diagnosed with CHD 1991-2007, were followed to the end of 2008. Primary outcome: recurrent CHD event. Secondary outcome: case fatality from the first event, cardiovascular and all-cause mortality. National registers provided information on CHD events, comorbidity, mortality and socioeconomic factors. Results The fully adjusted HRs for recurrent CHD for medium and low intelligence, compared with high intelligence, were 0.98, (95% CIs 0.83 to 1.16) and 1.09 (0.89 to 1.34), respectively. The risks were increased for cardiovascular and all-cause mortality with lower intelligence, but were attenuated in the fully adjusted models (fully adjusted HRs for cardiovascular mortality 1.92 (0.94 to 3.94) and 1.98 (0.89 to 4.37), respectively; for all-cause mortality 1.63 (1.00 to 2.65) and 1.62 (0.94 to 2.78), respectively). There was no increased risk for case-fatality at the first event (fully adjusted ORs 1.06 (0.73 to 1.55) and 0.97 (0.62 to 1.50), respectively). Conclusions Although we found lower intelligence to be associated with increased mortality in middle-aged men with CHD, there was no evidence for its possible effect on recurrence in CHD.

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