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  • 1.
    Aradhya, Siddartha
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Brandén, Maria
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Linköping University, Sweden.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Obućina, Ognjen
    Andersson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Mussino, Eleonora
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 9, article id e048952Article in journal (Refereed)
    Abstract [en]

    Objectives To evaluate the role of language proficiency and institutional awareness in explaining excess COVID-19 mortality among immigrants.Design Cohort study with follow-up between 12 March 2020 and 23 February 2021.

    Setting Swedish register-based study on all residents in Sweden.

    Participants 3 963 356 Swedish residents in co-residential unions who were 30 years of age or older and alive on 12 March 2020 and living in Sweden in December 2019.

    Outcome measures Cox regression models were conducted to assess the association between different constellations of immigrant-native couples (proxy for language proficiency and institutional awareness) and COVID-19 mortality and all other causes of deaths (2019 and 2020). Models were adjusted for relevant confounders.

    Results Compared with Swedish-Swedish couples (1.18 deaths per thousand person-years), both immigrants partnered with another immigrant and a native showed excess mortality for COVID-19 (HR 1.43; 95%CI 1.29 to 1.58 and HR 1.24; 95%CI 1.10 to 1.40, respectively), which translates to 1.37 and 1.28 deaths per thousand person-years. Moreover, similar results are found for natives partnered with an immigrant (HR 1.15; 95%CI 1.02 to 1.29), which translates to 1.29 deaths per thousand person-years. Further analysis shows that immigrants from both high-income and low-income and middleincome countries (LMIC) experience excess mortality also when partnered with a Swede. However, having a Swedish-born partner is only partially protective against COVID-19 mortality among immigrants from LMIC origins.

    Conclusions Language barriers and/or poor institutional awareness are not major drivers for the excess mortality from COVID-19 among immigrants. Rather, our study provides suggestive evidence that excess mortality among immigrants is explained by differential exposure to the virus.

  • 2.
    Aradhya, Siddartha
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Lund University, Sweden.
    Katikireddi, Srinivasa Vittal
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Glasgow, Glasgow, UK.
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Immigrant ancestry and birthweight across two generations born in Sweden: an intergenerational cohort study2022In: BMJ Global Health, E-ISSN 2059-7908, Vol. 7, no 4, article id e007341Article in journal (Refereed)
    Abstract [en]

    Introduction Differences in birthweight are often seen between migrants and natives. However, whether migrant-native birthweight inequalities widen, narrow or remain persistent across generations when comparing the descendants of immigrants and natives remains understudied. We examined inequalities in birthweight of mothers (G2) and daughters (G3) of foreign-born grandmothers (G1) compared with those of Swedish-born grandmothers.

    Methods We used population registers with multigenerational linkages to identify 314 415 daughters born in Sweden during the period 1989–2012 (G3), linked to 246 642 mothers (G2) born in Sweden during 1973–1996, and to their grandmothers (G1) who were Swedish or foreign-born. We classified migrants into non-western, Eastern European, the rest of Nordic and Western. We used multivariable methods to examine mean birthweight and low birthweight (<2500 g; LBW).

    Results Birthweight between individuals with Swedish background (G1) and non-western groups increased from -80 g to -147 g between G2 (mothers) and G3 (daughters), respectively. Furthermore, the odds of LBW increased among the G3 non-western immigrants compared with those with Swedish grandmothers (OR: 1.38, 95% CI 1.12 to 1.69). Birthweight increased in both descendants of Swedes and non-western immigrants, but less so in the latter (83 g vs 16 g).

    Conclusion We observed an increase in birthweight inequalities across generations between descendants of non-western immigrants and descendants of Swedes. This finding is puzzling considering Sweden has been lauded for its humanitarian approach to migration, for being one of the most egalitarian countries in the world and providing universal access to healthcare and education.

  • 3. Axelsson Fisk, Sten
    et al.
    Alex-Petersen, Jesper
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Liu, Can
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Social inequalities in the risk of giving birth to a small for gestational age child in Sweden 2010–16: a cross-sectional study adopting an intersectional approach 2024In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 34, no 1, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Background: Well-established associations exist between the risk of small for gestational age (SGA) and unidimensional sociodemographic factors. We investigated social inequalities in SGA risk and adopted an intersectional approach that simultaneously considers different social categories. By doing so, we could assess heterogeneities in SGA risk within unidimensional sociodemographic categories.

    Methods: We included all live 679 694 singleton births in Sweden between 2010 and 2016. The outcome was SGA, and the exposures were age, maternal educational level, dichotomous migration status and civil status. Thirty-six possible combinations of these factors constituted the exposure in an intersectional model. We present odds ratios (ORs) with 95% confidence intervals (95% CIs) and the area under the receiver operating characteristic curve (AUC)—a measurement of discriminatory accuracy (i.e. the ability to discriminate the babies born SGA from those who are not).

    Results: Women with low education and women born outside Sweden had ORs of 1.46 (95% CI 1.38–1.54) and 1.50 (95% CI 1.43–1.56) in unidimensional analyses, respectively. Among women aged under 25 with low education who were born outside Sweden and unmarried, the highest OR was 3.06 (2.59–3.63). The discriminatory accuracy was low for both the unidimensional model that included all sociodemographic factors (AUC 0. 563) and the intersectional model (AUC 0.571).

    Conclusions: The intersectional approach revealed a complex sociodemographic pattern of SGA risk. Sociodemographic factors have a low accuracy in identifying SGA at the individual level, even when quantifying their multi-dimensional intersections. This cautions against interventions targeted to individuals belonging to socially defined groups to reduce social inequalities in SGA risk.

  • 4.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juarez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Health risk behaviours among migrants by duration of residence: protocol for a systematic review and meta-analysis2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 10, article id e038388Article, review/survey (Refereed)
    Abstract [en]

    Introduction International migrants’ health has often been found to deteriorate in new countries, partly due to changes in health risk behaviours such as alcohol consumption, tobacco use, physical inactivity, and poor dietary habits. However, limited efforts have been made to comprehensively evaluate the extent to which migrants adopt unhealthy risk behaviours with longer duration of residence. This systematic review and meta-analysis will summarise evidence on international migrants’ behavioural patterns by duration of residence in multiple country contexts.

    Methods and analysis PubMed/MEDLINE, Web of Science and ProQuest databases will be searched for quantitative or mixed-method observational studies published in peer-reviewed scientific journals between 1 January 2000 and 31 December 2019. Studies comparing foreign-born individuals by duration of residence will be included. Information on study characteristics, descriptive statistics and measures of effect will be extracted. All included studies will be quality assessed using a modified Newcastle-Ottawa scale. The review will include narrative synthesis and, if sufficient and comparable data are available, random effects meta-analyses. The review will be conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

    Ethics and dissemination Ethical approval is not required since previously published information from peer-reviewed studies will be assessed. The results of this review will be published in peer-reviewed journals and presented at scientific conferences. Other forms of dissemination will include communication to broader audiences using well-established channels, including through university-based press releases. Progress will be regularly updated on the International Prospective Register of Systematic Reviews to ensure full transparency.

  • 5. Dribe, Martin
    et al.
    Juárez, Sol Pía
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Lund University, Sweden.
    Scalone, Francesco
    Is It Who You Are or Where You Live? Community Effects on Net Fertility at the Onset of Fertility Decline: A Multilevel Analysis Using Swedish Micro-Census Data2017In: Population, Space and Place, ISSN 1544-8444, E-ISSN 1544-8452, Vol. 23, no 2, article id e1987Article in journal (Refereed)
    Abstract [en]

    This paper studies contextual effects on fertility at the onset of fertility decline in Sweden. We argue that the community exerts an influence on fertility when individuals belonging to a certain community are more similar to one another (within-area) in their reproductive behaviour than individuals living in another community (between-area). Our hypotheses are that community had a strong influence in the past but that it decreased over time as more individualistic values grew in importance. We expect that the community exerted a greater impact in the low socioeconomic groups as the elite were less constrained by proximity and, therefore, more exposed to new ideas crossing community borders. Using micro-census data from 1880, 1890, and 1900, we use multilevel analysis to estimate measures of intra-class correlation within areas. We measure net fertility by the number of own children under five living in the household to currently married women with their spouses present. Parish is used as proxy for community. Our results indicate that despite average differences in fertility across parishes, the correlation between individuals belonging to the same community is less than 2.5%, that is, only a negligible share of the number of children observed is attributable to true community effects. Contrary to our expectation, we do not find any substantial change over time. However, as expected, community has a greater impact in the low socioeconomic groups. Our findings suggest that it is who you are rather than where you live which explains fertility behaviour during the initial stages of the transition.

  • 6.
    Dunlavy, Andrea C.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Employment status and risk of all-cause mortality among native- and foreign-origin persons in Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 5, p. 891-897Article in journal (Refereed)
    Abstract [en]

    Background: The association between exposure to unemployment and increased risk of mortality is well established. Yet migrants and their children often experience a number of stressors in the country of residence which could exacerbate the negative effects of job loss or unemployment. This study examined the extent to which region of origin and generational status modified associations between employment status and risk of all-cause mortality.

    Methods: Using population-based registers, an open cohort of 2 178 321 individuals aged 25-64 years was followed from 1993 to 2008. Hazard ratios for mortality were calculated using Cox regression. Employment status and socio-demographic covariates were included as time-varying variables in all models.

    Results: Relative to employed native-origin Swedes, excess risk of mortality was found among most groups of unemployed persons. The excess risk of mortality found among African women exposed to long-term unemployment (HR = 3.26, 95% CI: 2.30-4.63), Finnish men exposed to short-and long-term unemployment (HR = 2.74, 95% CI: 2.32-3.24 and HR = 2.39, 95% CI: 2.12-2.69), and second generation Swedish men exposed to short-term unemployment (HR = 2.34, 95% CI: 2.06-2.64) was significantly greater (P < 0.05) than that found among their unemployed native-origin counterparts. Excess risk of mortality among the unemployed in other foreign-origin groups was of a similar or lower magnitude to that found in unemployed native-origin Swedes. A decreased risk of mortality was observed among the employed in nearly all foreign-origin groups.

    Conclusions: With some exceptions, mortality risk in foreign-origin individuals across all categories of employment status was generally similar to or lower than the risk observed in native-origin Swedes.

  • 7.
    Dunlavy, Andrea C.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Suicide risk among native- and foreign-origin persons in Sweden: a longitudinal examination of the role of unemployment status2019In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 54, no 5, p. 579-590Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Prior research has documented an association between unemployment and elevated suicide risk. Yet, few Swedish studies have explicitly considered how such risk may vary by different migration background characteristics among persons of foreign-origin, who often experience diverse forms of labor market marginalization. This study examines the extent to which unemployment status may differentially influence suicide risk among the foreign-origin by generational status, region of origin, age at arrival, and duration of residence.

    METHODS: Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993 to 2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models.

    RESULTS: Elevated suicide risk observed among foreign-origin unemployed groups was generally of a similar or lower magnitude than that found in unemployed native-origin, although unemployed second-generation Swedish men demonstrated significantly greater (p < 0.05) excess risk of suicide than that observed among their native-origin counterparts. Unemployed foreign-born men with a younger age at arrival and longer duration of residence demonstrated an increased risk of suicide, while those who arrived as adults, and a shorter duration of residence did not show any increased risk. Among foreign-born women, excess suicide risk persisted regardless of age at arrival and duration of residence in the long-term unemployed.

    CONCLUSIONS: Multiple migration background characteristics should be considered when examining relationships between employment status and suicide among the foreign-origin.

  • 8.
    Dunlavy, Andrea
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Katikireddi, Srinivasa Vittal
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Glasgow, Scotland.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol P.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Investigating the salmon bias effect among international immigrants in Sweden: a register-based open cohort study2022In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 2, p. 226-232Article in journal (Refereed)
    Abstract [en]

    Background: Studies of migration and health have hypothesized that immigrants may emigrate when they develop poor health (salmon bias effect), which may partially explain the mortality advantage observed among immigrants in high-income countries. We evaluated the salmon bias effect by comparing the health of immigrants in Sweden who emigrated with those who remained, while also exploring potential variation by macro-economic conditions, duration of residence and region of origin. Methods: A longitudinal, open cohort study design was used to assess risk of emigration between 1992 and 2016 among all adult (18+ years) foreign-born persons who immigrated to Sweden between 1965 and 2012 (n = 1 765 459). The Charlson Comorbidity Index was used to measure health status, using information on hospitalizations from the Swedish National Patient Register. Poisson regression models were used to estimate incidence rate ratios (RRs) with 95% confidence intervals (CIs) for emigrating from Sweden. Results: Immigrants with low (RR = 0.83; 95% CI: 0.76-0.90) moderate (RR = 0.70; 95% CI: 0.62-0.80) and high (RR = 0.62; 95% CI: 0.48-0.82) levels of comorbidities had decreased risk of emigration relative to those with no comorbidities. There was no evidence of variation by health status in emigration during periods of economic recession or by duration of residence. Individuals with low to moderate levels of comorbidities from some regions of origin had an increased risk of emigration relative to those with no comorbidities. Conclusions: The study results do not support the existence of a salmon bias effect as a universal phenomenon among international immigrants in Sweden.

  • 9.
    Dunlavy, Andrea
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    The impact of migration background characteristics on the relationship between employment status and suicide: a longitudinal study of native- and foreign-origin persons in Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 182-182Article in journal (Refereed)
    Abstract [en]

    Background:

    Persons of foreign-origin have higher rates of unemployment than those of native-origin, yet few studies have explicitly assessed relationships between unemployment and mental health in persons of foreign-origin relative to those of native-origin. This study examines the extent to which generational status, region of origin, age at arrival, and duration of residence modify the relationship between employment status and suicide risk.

    Methods:

    Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993-2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox regression models.

    Results:

    Elevated hazard ratios for suicide were observed among the majority of foreign-origin persons exposed to unemployment. Second generation Swedish men exposed to unemployment demonstrated significantly greater (p < 0.05) excess risk of suicide (HR = 3.63, 95% CI: 2.90-4.54) than that observed among native-origin Swedish men exposed to unemployment (HR = 1.67, 95% CI: 1.29-2.16). In unemployed foreign-born men, younger age at arrival and longer duration of residence were associated with increased risk of suicide, whereas unemployed foreign-born men who arrived as adults and had a shorter duration of residence did not demonstrate excess suicide risk.

    Conclusions:

    Suicide risk in most foreign-origin groups exposed to unemployment was of a similar magnitude to that observed among their native-origin counterparts. Yet there were notable differences in patterns of association by generational status, region of origin, age at arrival, and duration of residence. The high excess risk observed in unemployed second generation men suggests that ensuring employment among this group may be of particular public health importance.

    Main messages:

    The mental health impact of unemployment varies by migration background characteristics.

    Unemployed second generation men had an elevated risk of suicide that was of a greater magnitude compared to the risk of suicide observed among unemployed native-origin men.

  • 10.
    Dunlavy, Andrea
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Unemployment status and risk of all-cause mortality among native- and foreign-origin persons in Sweden: An open cohort study from 1993-2008Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: The association between exposure to unemployment and increased risk of mortality is well established. Yet migrants and their children often experience a number of stressors in the country of residence which could exacerbate the negative effects of job loss or unemployment. This study examined the extent to which region of origin and generational status modified associations between employment status and risk of all-cause mortality.

    Methods: Using population-based registers, an open cohort study of 2,178,321 individuals aged 25-64 was followed from 1993-2008. Hazard ratios for mortality were calculated using Cox regression. Employment status and socio-demographic covariates were included as time-varying variables in all models.

    Results: Relative to employed native-origin Swedes, excess risk of mortality was found among most groups of foreign-origin persons exposed to unemployment. The excess risk of mortality found among African women exposed to long-term unemployment (HR=3.26, 95% CI: 2.30-4.63),  Finnish men exposed to short-and long-term unemployment (HR=2.74, 95% CI: 2.32-3.24 and HR=2.39, 95% CI: 2.12-2.69), and  second generation Swedish men exposed to short-term unemployment (HR=2.34, 95% CI: 2.06-2.64) was significantly greater (p<0.05) than that found among their unemployed native-origin counterparts. Decreased risk of mortality was observed among the employed in nearly all foreign-origin groups.

    Conclusions: Our findings suggest that the mortality health advantage often observed among foreign-origin groups is most evident among the employed, while the magnitude of excess risk for mortality in the foreign-origin exposed to unemployment varies by generational status and region of origin.

  • 11.
    Dunlavy, Andrea
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Migration background characteristics and the association between unemployment and suicide2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Persons of foreign-origin have higher rates of unemployment compared to those of native-origin, yet few studies have assessed relationships between unemployment and mental health in persons of foreign-origin relative to the native-origin. This study aims to examine the extent to which generational status, region of origin, age at arrival, and duration of residence modify the relationship between employment status and suicide risk.

    Methods

    Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993-2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models.

    Results

    Elevated hazard ratios for suicide were observed among the majority of foreign-origin persons exposed to unemployment. Second generation Swedish men exposed to unemployment demonstrated significantly greater (p < 0.05) excess risk of suicide (HR = 3.63, 95% CI: 2.90-4.54) than that observed among native-origin Swedish men exposed to unemployment (HR = 1.67, 95% CI: 1.29-2.16). In unemployed foreign-born men, younger age at arrival and longer duration of residence were associated with increased risk of suicide, whereas unemployed foreign-born men who arrived as adults and had a shorter duration of residence did not demonstrate excess suicide risk.

    Conclusions

    Analyses indicated that the majority of the foreign-origin exposed to unemployment demonstrated excess risk of suicide that was of a similar magnitude to that observed among their native-origin counterparts. Yet there were notable differences in patterns of association by generational status, region of origin, age at arrival, and duration of residence. The high excess risk observed in unemployed second generation men suggests that ensuring employment among this group may be of particular public health importance.

  • 12.
    Heshmati, Amy
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    The effect of parental leave on parents’ mental health: a systematic review2023In: The Lancet Public Health, ISSN 2468-2667, Vol. 8, no 1, p. e57-e75Article, review/survey (Refereed)
    Abstract [en]

    Mental health disorders during the post-partum period are a common morbidity, but parental leave might help alleviate symptoms by preventing or reducing stress. We aim to summarise available evidence on the effect of different types of parental leave on mental health outcomes among parents. For this systematic review, we searched Ovid MEDLINE, Web of Science, PsycINFO, CINAHL, and Scopus from database inception to Aug 29, 2022, for peer-reviewed, quantitative studies written in English. We included studies if the exposure was postnatal parental leave; a relevant comparison group was present (eg, paid vs unpaid leave); and if indicators related to general mental health, including depression, anxiety, stress, and suicide, for either parent were evaluated or recorded at any time after childbirth. The Review is registered with PROSPERO (registration number CRD42021227499). Of the 3441 records screened, 45 studies were narratively synthesised. Studies were done in high-income countries, and they examined generosity by any parental leave (n=5), benefit amount (n=13), and leave duration (n=31). 38 studies were of medium or high quality. Improved mental health was generally observed among women (referred to as mothers in this Review) with more generous parental leave policies (ie, leave duration and paid vs unpaid leave). For example, increased duration of leave was generally associated with reduced risk of poor maternal mental health, including depressive symptoms, psychological distress and burnout, and lower mental health-care uptake. However, the association between fathers’ leave and paternal mental health outcomes was less conclusive as was the indirect effect of parental leave use on partners’ mental health.

  • 13.
    Honkaniemi, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Alcohol-related morbidity and mortality by fathers' parental leave: A quasi-experimental study in Sweden2024In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 119, no 2, p. 301-310Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Fathers' parental leave has been associated with decreased risks of alcohol-related hospitalizations and mortality. Whether this is attributable to the health protections of parental leave itself (through stress reduction or behavioral changes) or to selection into leave uptake remains unclear, given that fathers are more likely to use leave if they are in better health. Using the quasi-experimental variation of a reform incentivizing fathers' leave uptake (the 1995 Father's quota reform), this study aimed to assess whether fathers' parental leave influences alcohol-related morbidity and mortality.

    Design: Quasi-experimental interrupted time series and instrumental variable analyses.

    Setting: Sweden.

    Participants: Fathers of singleton children born from January 1992 to December 1997 (n = 220 412).

    Measurements: Exposure was indicated by the child's birthdate before or after the reform and used to instrument fathers' 2- and 8-year parental leave uptake. Outcomes included fathers' hospitalization rates for acute alcohol-related (intoxication; mental and behavioral disorders) and chronic alcohol-related diagnoses (cardiovascular, stomach and other diseases; liver diseases), as well as alcohol-related mortality, up to 2, 8 and 18 years after the first child's birthdate.

    Findings: In interrupted time series analyses, fathers of children born after the reform exhibited immediate decreases in alcohol-related hospitalization rates up to 2 (incidence rate ratio [IRR] = 0.66, 95% confidence interval [CI] = 0.51–0.87), 8 (IRR = 0.74, 95% CI = 0.57–0.96) and 18 years after birth (IRR = 0.72, 95% CI = 0.54–0.96), particularly in acute alcohol-related hospitalization rates, compared with those with children born before. No changes were found for alcohol-related mortality. Instrumental variable results suggest that alcohol-related hospitalization decreases were driven by fathers' parental leave uptake (e.g. 2-year hospitalizations: IRR = 0.16, 95% CI = 0.03–0.84).

    Conclusions: In Sweden, a father's parental leave eligibility and uptake may protect against alcohol-related morbidity.

  • 14.
    Honkaniemi, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Mental health by native-immigrant intermarriage in Sweden: a register-based retrospective cohort study2022In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 6, p. 877-883Article in journal (Refereed)
    Abstract [en]

    Background: Native–immigrant intermarriage is often regarded as a proxy for integration, given that intermarried immigrants are more socioeconomically and culturally similar to natives than intramarried immigrants. This study aimed to assess whether integration affects mental health and care-seeking behaviours, examining prescription hazards for psychotropic medications by native–immigrant marital composition in Sweden.

    Methods: Total population register data were used to identify first-time married couples residing in Sweden between 31 December 2005 and 31 December 2016. Index persons were distinguished by gender and partners’ origin (native vs. immigrant), as well as by immigrants’ regions of origin, with intramarried natives as references. Using Cox regression, hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated for antidepressant and anxiolytic prescriptions and adjusted for socioeconomic factors, presence of children and length and quality of marriage.

    Results: Intramarried immigrant women had higher psychotropic prescription hazards than intramarried native references (HR 1.11, 95% CI 1.10–1.12), whereas intermarried immigrant women had equal hazards. Immigrant women’s hazards were lower than native references after adjustment. Intramarried immigrant men had the greatest prescription hazards (HR 1.33, 95% CI 1.32–1.34), and intermarried immigrant men slightly higher hazards (HR 1.11, 95% CI 1.10–1.13), than intramarried natives. All were partly attenuated after adjustment. Intermarriage hazards increased by similarities in regions of origin, especially among men.

    Conclusions: Integration indicated by intermarriage appears to be protective for the mental health of immigrants, especially for immigrant men. Future research should empirically disentangle the social, cultural and socioeconomic mechanisms underlying these health differences.

  • 15.
    Honkaniemi, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Psychiatric health by native-migrant intermarriage in Sweden: a register-based retrospective cohort studyManuscript (preprint) (Other academic)
  • 16.
    Honkaniemi, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol Pía
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Katikireddi, Srinivasa Vittal
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Psychological distress by age at migration and duration of residence in Sweden2020In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 250, article id 112869Article in journal (Refereed)
    Abstract [en]

    Migrants suffer from worse psychological health than natives in many countries, yet the extent to which this varies by age at migration and duration of residence in the receiving context remains unexplored in Sweden. Drawing on a life course approach, we investigate differences in psychological distress by age at migration and duration of residence in working-age migrants to Sweden, and examine the role of various social determinants of health in explaining these differences relative to Swedish-born.

    Using pooled cross-sectional data from the 2011/2015 Health on Equal Terms survey in Västra Götaland Region, Sweden (n = 58,428), we applied logistic regression analysis to calculate predicted probabilities and average marginal effects (AME) of migrant status, by age at migration and duration of residence, on psychological distress. Analyses were stratified by sex and region of origin and controlled for indicators of socioeconomic status (SES), social cohesion, and discrimination to assess their potential contribution to differences in migrants' and natives' psychological distress.

    All migrants except men from OECD-predominant regions had a greater probability of psychological distress than Swedish-born (ranging from AME 0.031 [95% Confidence Interval or CI 0.000–0.062] for OECD women to AME 0.115 [95% CI 0.074–0.156] for non-OECD men). Marginal effects of migration status on psychological distress probabilities generally increased with age at migration and duration of residence. Differences between migrants and natives were largely attenuated after controlling for social determinants, the greatest contribution coming from inequalities in social cohesion, followed by inequalities in discrimination and SES.

    Our results suggest a relative health advantage of early-life compared to later-life migration, albeit with worse outcomes with longer residence in Sweden. The predominance of integration opportunities in childhood strengthens calls for supportive policies to assist older migrants' integration directly upon arrival, which may ultimately improve their psychological wellbeing.

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  • 17.
    Honkaniemi, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Katikireddi, Srinivasa Vittal
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol P.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Psychiatric consequences of a father’s leave policy by nativity: a quasi-experimental study in Sweden2022In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 76, no 4, p. 367-373Article in journal (Refereed)
    Abstract [en]

    Background Parental leave use has been found to promote maternal and child health, with limited evidence of mental health impacts on fathers. How these effects vary for minority populations with poorer mental health and lower leave uptake, such as migrants, remains under-investigated. This study assessed the effects of a Swedish policy to encourage fathers’ leave, the 1995 Father’s quota, on Swedish-born and migrant fathers’ psychiatric hospitalisations.

    Methods We conducted an interrupted time series analysis using Swedish total population register data for first-time fathers of children born before (1992–1994) and after (1995–1997) the reform (n=198 589). Swedish-born and migrant fathers’ 3-year psychiatric hospitalisation rates were modelled using segmented negative binomial regression, adjusting for seasonality and autocorrelation, with stratified analyses by region of origin, duration of residence, and partners’ nativity.

    Results From immediately pre-reform to post-reform, the proportion of fathers using parental leave increased from 63.6% to 86.4% of native-born and 37.1% to 51.2% of migrants. Swedish-born fathers exhibited no changes in psychiatric hospitalisation rates post-reform, whereas migrants showed 36% decreased rates (incidence rate ratio (IRR) 0.64, 95% CI 0.47 to 0.86). Migrants from regions not predominantly consisting of Organisation for Economic Cooperation and Development countries (IRR 0.50, 95% CI 0.19 to 1.33), and those with migrant partners (IRR 0.23, 95% CI 0.14 to 0.38), experienced the greatest decreases in psychiatric hospitalisation rates.

    Conclusion The findings of this study suggest that policies oriented towards promoting father’s use of parental leave may help to reduce native–migrant health inequalities, with broader benefits for family well-being and child development.Data availability statement

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  • 18.
    Honkaniemi, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Katikireddi, Srinivasa Vittal
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Simultaneous parental leave and psychiatric health by nativity: a quasi-experimental study in SwedenManuscript (preprint) (Other academic)
  • 19.
    Honkaniemi, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Wimark, Thomas
    Stockholm University, Faculty of Social Sciences, Department of Human Geography.
    Juárez, Sol Pía
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lagerqvist, Maja
    Stockholm University, Faculty of Social Sciences, Department of Human Geography.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social hållbarhet i kollektivtrafiken2017In: Metoder och verktyg för sociala nyttoberäkningar i kollektivtrafiken / [ed] Thomas Wimark, Stockholm: Kulturgeografiska institutionen, Stockholms universitet , 2017, p. 9-53Chapter in book (Other academic)
    Abstract [sv]

    Med skärpt fokusering på hållbar utveckling blir såväl politiskt ansvariga som akademiker allt mer sysselsatta inte enbart med infrastrukturens inverkan på ekonomi och miljö utan även dess sociala inverkan. Denna breda litteraturstudie har undersökt den sociala hållbarhetens roll i kollektivtrafikens infrastruktur. Den har siktat på att urskilja de olika komponenter i social hållbarhet som ingår i denna kontext, kvalitativa respektive kvantitativa analytiska metoder och deras krav på data samt tillämpbarheten av dessa rön i den svenska kontexten. Översikten utfördes med hjälp av indexeringstjänsten Web of Science, en kombinerad snöbollsmetod samt interna rekommendationer och analyser med hjälp av ett teoretiskt ramverk för hållbarhet anpassat från United Nations Environment Programme. Rönen ådagalade många kvantitativa tillvägagångssätt, däribland kostnads-/nyttoanalys [cost-benefit analyses (CBA)], tillämpningar av geografiska informationssystem (GIS), och jämlikhetsanalyser m.fl. Variabler för kollektivtrafik såsom tillgänglighet och rörlighet behandlades oftast tillsammans med sociala bestämningsfaktorer, liksom sociala utfallsvariabler däribland socialt utanförskap och socialt kapital. Kvalitativa infallsvinklar används däremot mer sällan i den här kontexten trots deras betydelse för att hjälpa till att fånga in användares erfarenheter och att urskilja nya sociala variabler. Utifrån dessa resultat och den rådande preferensen för kvantitativa metoder i svenska analyser av kollektivtrafik rekommenderar författarna mera fokus på de sociala utfallen av kollektivtrafikens infrastruktur genom att använda en blandning av kvantitativa och kvalitativa infallsvinklar.

  • 20.
    Juárez, Sol
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    All-cause mortality, age at arrival, and duration of residence among adult migrants in Sweden: A population-based longitudinal study2018In: SSM - Population Health, ISSN 2352-8273, Vol. 6, p. 16-25Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 21.
    Juárez, Sol
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Aldridge, Robert
    Barreto, Mauricio
    Katikireddi, Srinivasa
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    A systematic review of evaluations of the health impacts of migration-oriented public policies2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 24-24Article in journal (Refereed)
    Abstract [en]

    Background:

    Government policies, including those outside healthcare, fundamentally shape both migration and health. Policies oriented toward migration begin with management of the arrival process (e.g. entry criteria), through to resettlement (e.g. dispersal) and short- and long-term integration (e.g. language classes and anti-discriminatory efforts). We aimed to systematically review the available evaluation evidence on the impacts of migration and integration policies at the supranational, national, and local levels on the health of international migrants, adopting a ‘health in all policies’ perspective.

    Methods:

    We searched the PubMed, Embase, and Web of Science databases from January 2000 to September 2017 for quantitative or mixed-method studies which compared the health impacts of public policies to that of a counterfactual. We excluded all health policies, defined as those primarily introduced to improve health. Two reviewers independently conducted screening and data extraction. Policies were grouped by migration stage and sector for narrative synthesis. Random-effects meta-analyses were conducted to estimate the effectiveness of specific policies.

    Results:

    Out of 31,528 hits, 296 full texts were included for screening. Preliminary narrative synthesis shows a predominance of US and Australian studies, with few studies in low- and middle-income settings. Greater enforcement of immigration laws may adversely impact health (e.g. implementation of US Section 287g has been linked to increased childhood food poverty and reduced healthcare access), while provision of legal protection for existing illegal immigrants (e.g. the Deferred Action for Childhood Arrivals) has been associated with improved health.

    Conclusions:

    Few studies evaluate the impact of migration policies on health beyond those specifically oriented towards improving health. Preliminary findings suggest health benefits of legal protection, whereas greater enforcement of immigration law undermines healthcare access.

    Main message:

    Public policies outside of the health sector can substantially impact the health of international migrants, yet remain under-investigated in most of the world.

  • 22.
    Juárez, Sol
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Mussino, Eleonora
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Being a refugee or having a refugee status? Birthweight and gestational age outcomes among offspring of immigrant mothers in Sweden2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 7, p. 730-734Article in journal (Refereed)
    Abstract [en]

    Aims: to evaluate whether the information on refugee status based on the residence permit is a useful source of information for perinatal health surveillance. Methods: using the Swedish population registers (1997-2012), we use multinomial regression models to assess the associations between migration status (refugee and non-refugee) and birth outcomes derived from birthweight and gestational age: low birthweight (lBW) (<2500 g), macrosomia (≥4000 g); preterm: (<37 w) and post-term (≥42 w). The Swedish-born population was used as a reference group. Results: Compared to the Swedish-born population, an increased OR (odds ratio) of lBW and post-term was found among migrants with and without refugee status (respectively: OR for refugees: 1.47 [95% CI: 1.33-1.63] and non-refugees:1.27 [95% CI: 1.18-1.38], for refugees: 1.41 [95% CI: 1.35-1.49] and non-refugees:1.04 [95% CI: 1.00-1.08]) with statistically significant differences between these two migrant categories. However, when looking at specific regions of origin, few regions show differences by refugee status. Compared to Swedes, lower or equal ORs of preterm and macrosomia are observed regardless of migratory status. Conclusions: Small or no differences were observed in birth outcomes among offspring of women coming from the same origin with different migratory status, compared to their Swedish counterparts. This suggests that information on migration status is not a relevant piece of information to identify immigrant women at higher risk of experiencing adverse reproductive outcomes. Our results however might be explained by the large proportion of women coming to Sweden for family reunification who are classified as non-refugee migrants.

  • 23.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Lund University, Sweden .
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of London, UK .
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden .
    From cradle to grave: tracking socioeconomic inequalities in mortality in a cohort of 11 868 men and women born in Uppsala, Sweden, 1915-19292016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 6, p. 569-575Article in journal (Refereed)
    Abstract [en]

    Background: Ample evidence has shown that early-life social conditions are associated with mortality later in life. However, little attention has been given to the strength of these effects across specific age intervals from birth to old age. In this paper, we study the effect of the family's socioeconomic position and mother's marital status at birth on all-cause mortality at different age intervals in a Swedish cohort of 11 868 individuals followed across their lifespan.

    Methods: Using the Uppsala Birth Cohort Multigenerational Study, we fitted Cox regression models to estimate age-varying HRs of all-cause mortality according to mother's marital status and family's socioeconomic position.

    Results: Mother's marital status and family's socioeconomic position at birth were associated with higher mortality rates throughout life (HR 1.18 (95% CI 1.12 to 1.26) for unmarried mothers; 1.19 (95% CI 1.12 to 1.25) for low socioeconomic position). While the effect of family's socioeconomic position showed little variation across different age groups, the effect of marital status was stronger for infant mortality (HR 1.47 (95% CI 1.23 to 1.76); p=0.04 for heterogeneity). The results remained robust when early life and adult mediator variables were included.

    Conclusions: Family's socioeconomic position and mother's marital status involve different dimensions of social stratification with independent effects on mortality throughout life. Our findings support the importance of improving early-life conditions in order to enhance healthy ageing.

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

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

  • 25.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis2022In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 67, article id 1604437Article, review/survey (Refereed)
    Abstract [en]

    Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence.

    Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence.

    Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I2 = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I2 = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I2 = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence.

    Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contex

  • 26.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Lund, Sweden.
    Ortiz-Barreda, Gaby
    Agudelo-Suárez, Andrés A.
    Ronda-Pérez, Elena
    Revisiting the Healthy Migrant Paradox in Perinatal Health Outcomes Through a Scoping Review in a Recent Host Country2017In: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 19, no 1, p. 205-214Article, review/survey (Refereed)
    Abstract [en]

    Ample evidence shows that, in many developed countries, immigrants have similar or better perinatal health outcomes than natives despite facing socioeconomic disadvantages in the host country (“healthy migrant paradox” –HMP). This scoping review aims to: (1) summarize the literature on perinatal health among immigrants and natives in Spain and (2) examine whether there is evidence of the HMP in a context of recent migration. A total of 25 articles published between 1998 and 2014 were reviewed. Overall, we found evidence of the HMP in low birthweight and to a lesser extent in preterm, though the patterns vary by origin, but not in macrosomia and post-term. The results are consistent across settings, levels of adjustment, and birth year. Policies should be oriented towards identifying the modifiable risk factors leading to a higher risk of macrosomia and post-term among immigrants.

  • 27.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Small, Rhonda
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Schytt, Erica
    Length of residence and caesarean section in migrant women in Sweden: a population-based study2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 6, p. 1073-1079Article in journal (Refereed)
    Abstract [en]

    Background: Prior studies have reported substantial differences in caesarean rates between migrant and non-migrant women. In this study we investigate whether the association between maternal country of birth and caesarean section is modified by length of residence in Sweden.Methods: Population-based register study. A total of 106 760 migrant and 473 881 Swedish-born women having singleton, first births were studied using multinomial multiple regression models to estimate odds ratios (OR) and 95% confidence intervals for mode of birth. Random effect meta-analyses were conducted to assess true heterogeneity between categories of length of residence.Results: Longer duration of residence was associated with an increased overall risk of both unplanned and planned caesarean section among migrant women. This pattern was more pronounced among countries grouped as having higher prevalence (compared to Swedes) of unplanned: OR≤1=1.41 (1.32–1.50); OR>1–<6=1.49 (1.42–1.57); OR6–<10=1.61 (1.50–1.72); OR≥10=1.71 (1.64–1.79) and planned caesarean section [OR≤1=1.14 (0.95–1.36); OR>1–<6=1.30 (1.13–1.51); OR6–<10=1.97 (1.64–2.37]; OR≥10=1.82 (1.67–1.98)]. The results were robust to social, obstetric and health adjustments. There were some country-of-origin-specific findings.Conclusions: The fact that the risk of unplanned and planned caesarean section tended to increase with length of residence, even with adjustment for social, obstetric and health factors, suggests that receiving country-specific factors are playing an important role in caesarean section.

  • 28.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Small, Ronda
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden.
    Schytt, Erica
    Caesarean Birth is Associated with Both Maternal and Paternal Origin in Immigrants in Sweden: a Population-Based Study2017In: Paediatric and Perinatal Epidemiology, ISSN 0269-5022, E-ISSN 1365-3016, Vol. 31, no 6, p. 509-521Article in journal (Refereed)
    Abstract [en]

    Background

    To investigate the association between maternal country of birth and father's origin and unplanned and planned caesarean birth in Sweden.

    Methods

    Population-based register study including all singleton births in Sweden between 1999 and 2012 (n = 1 311 885). Multinomial regression was conducted to estimate odds ratios (OR) for unplanned and planned caesarean with 95% confidence intervals for migrant compared with Swedish-born women. Analyses were stratified by parity.

    Results

    Women from Ethiopia, India, South Korea, Chile, Thailand, Iran, and Finland had statistically significantly higher odds of experiencing unplanned (primiparous OR 1.10–2.19; multiparous OR 1.13–2.02) and planned caesarean (primiparous OR 1.18–2.25; multiparous OR 1.13–2.46). Only women from Syria, the former Yugoslavia and Germany had consistently lower risk than Swedish-born mothers (unplanned: primiparous OR 0.76–0.86; multiparous OR 0.74–0.86. Planned; primiparous OR 0.75–0.82; multiparous OR 0.60–0.94). Women from Iraq and Turkey had higher odds of an unplanned caesarean but lower odds of a planned one (among multiparous). In most cases, these results remained after adjustment for available social characteristics, maternal health factors, and pregnancy complications. Both parents being foreign-born increased the odds of unplanned and planned caesarean in primiparous and multiparous women.

    Conclusions

    Unplanned and planned caesarean birth varied by women's country of birth, with both higher and lower rates compared with Swedish-born women, and the father's origin was also of importance. These variations were not explained by a wide range of social, health, or pregnancy factors.

  • 29.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Urquia, Marcelo L.
    Mussino, Eleonora
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Liu, Can
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Qiao, Yao
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Preterm disparities between foreign and Swedish born mothers depend on the method used to estimate gestational age. A Swedish population-based register study2021In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 2, article id e0247138Article in journal (Refereed)
    Abstract [en]

    This study aims to examine whether disparities in gestational age outcomes between foreign and Swedish-born mothers are contingent on the measure used to estimate gestational age and, if so, to identify which maternal factors are associated with the discrepancy. Using population register data, we studied all singleton live births in Sweden from 1992-2012 (n = 1,317,265). Multinomial logistic regression was performed to compare gestational age outcomes classified into very (<32 weeks) and late preterm (32-36 weeks), term and post-term derived from the last menstrual period (LMP) and ultrasound estimates in foreign- and Swedish-born women. Compared to Swedish-born women, foreign-born women had similar odds of very preterm birth (OR: 0.98 [95% CI: 0.98, 1.01]) and lower odds of moderately preterm birth (OR: 0.95 [95% CI: 0.92, 0.98]) based on ultrasound, while higher risks based on LMP (respectively, OR: 1.10 [95% CI: 1.07, 1.14] and 1.09 [95% CI: 1.06, 1.13]). Conclusions on disparities in gestational age-related outcomes by mother's country of origin depend on the method used to estimate gestational age. Except for very preterm, foreign-born women had a health advantage when gestational age is based on ultrasound, but a health disadvantage when based on LMP. Studies assessing disparities in very preterm birth by migration status are not affected by the estimation method but caution should be taken when interpreting disparities in moderately preterm and preterm birth rates.

  • 30.
    Juárez, Sol Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Aradhya, Siddartha
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Differences in hospitalizations associated with severe COVID-19 disease among foreign- and Swedish-born2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 3, p. 522-527Article in journal (Refereed)
    Abstract [en]

    Background Differences in pre-existing health conditions are hypothesized to explain immigrants' excess COVID-19 mortality compared to natives. In this study, we evaluate whether immigrants residing in Sweden before the outbreak were more likely to be hospitalized for conditions associated with severe COVID-19 disease. Methods A cohort study using population-register data was conducted with follow-up between 1 January 1997 and 31 December 2017. Poisson regression was fitted to estimate incidence rate ratio (RR) and 95% confident intervals (95% CI) for 10 causes of hospitalization. Results Compared to Swedish-born individuals, most immigrant groups showed a decreased risk of hospitalization for respiratory chronic conditions, CVD, cancer, chronic liver conditions and neurological problems. All immigrant groups had increased risk of hospitalization for tuberculosis [RR between 88.49 (95% CI 77.21; 101.40) for the Horn of Africa and 1.69 (95% CI 1.11; 2.58) for North America], HIV [RR between 33.23 (95% CI 25.17; 43.88) for the rest of Africa and 1.31 (95% CI 0.93; 1.83) for the Middle East] and, with a few exceptions, also for chronic kidney conditions, diabetes and thalassemia. Conclusions Foreign-born individuals-including origins with excess COVID-19 mortality in Sweden-did not show increased risk of hospitalizations for most causes associated with severe COVID-19 disease. However, all groups showed increased risks of hospitalization for tuberculosis and HIV and, with exceptions, for chronic kidney conditions, diabetes and thalassemia. Although studies should determine whether these health conditions explain the observed excess COVID-19 mortality, our study alerts to an increased risk of hospitalization that can be avoidable via treatment or preventive measures.

  • 31.
    Juárez, Sol Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Aradhya, Siddartha
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Debiasi, Enrico
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Katikireddi, Srinivasa Vittal
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Mussino, Eleonora
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Explaining COVID-19 mortality among immigrants in Sweden from a social determinants of health perspective (COVIS): protocol for a national register-based observational study2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 4, article id e070670Article in journal (Refereed)
    Abstract [en]

    Introduction Adopting a social determinants of health perspective, this project aims to study how disproportionate COVID-19 mortality among immigrants in Sweden is associated with social factors operating through differential exposure to the virus (eg, by being more likely to work in high-exposure occupations) and differential effects of infection arising from socially patterned, pre-existing health conditions, differential healthcare seeking and inequitable healthcare provision. Methods and analysis This observational study will use health (eg, hospitalisations, deaths) and sociodemographic information (eg, occupation, income, social benefits) from Swedish national registers linked using unique identity numbers. The study population includes all adults registered in Sweden in the year before the start of the pandemic (2019), as well as individuals who immigrated to Sweden or turned 18 years of age after the start of the pandemic (2020). Our analyses will primarily cover the period from 31 January 2020 to 31 December 2022, with updates depending on the progression of the pandemic. We will evaluate COVID-19 mortality differences between foreign-born and Swedish-born individuals by examining each mechanism (differential exposure and effects) separately, while considering potential effect modification by country of birth and socioeconomic factors. Planned statistical modelling techniques include mediation analyses, multilevel models, Poisson regression and event history analyses. Ethics and dissemination This project has been granted all necessary ethical permissions from the Swedish Ethical Review Authority (Dnr 2022-0048- 01) for accessing and analysing deidentified data. The final outputs will primarily be disseminated as scientific articles published in open-access peer-reviewed international journals, as well as press releases and policy briefs.

  • 32.
    Juárez, Sol Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Is duration of residence a proxy for acculturation? The case of health risk behaviors among international immigrants2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Aims: Among international immigrants, health changes by duration of residence are commonly interpreted as an expression of acculturation to the receiving country context. This study compares changes in immigrants’ health risk behaviors by duration of residence to changes by acculturation levels, in order to assess whether duration of residence can be regarded as a proxy for acculturation.

    Methods: Using data from a previous systematic review, we identified 17 quantitative studies examining changes in alcohol, tobacco and drug use, physical inactivity, and diet by both duration of residence and acculturation level in the same population. We compared the directionality and consistency of these associations through tabulation and vote counting.

    Results: The majority of studies reported no or inconsistent changes in health risk behaviors by duration of residence versus by acculturation, including with opposite directionality. Four studies reported significant estimates with consistent directionality, while five reported consistent, non-significant estimates.

    Conclusions: Our findings suggest that duration of residence should not be used as a proxy for acculturation when studying health risk behaviors among immigrants. Researchers should consider additional time-dependent factors to explain behavioral changes by duration of residence.

  • 33.
    Juárez, Sol Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Heshmati, Amy F.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Debiasi, Enrico
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Mussino, Eleonora
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Katikireddi, Srinivasa Vittal
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Glasgow, UK.
    Duvander, Ann-Zofie
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Mid University, Sweden.
    Unintended health consequences of Swedish parental leave policy (ParLeHealth): protocol for a quasiexperimental study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 6, article id e049682Article in journal (Refereed)
    Abstract [en]

    Introduction Sweden has long been praised for a generousparental leave policy oriented towards facilitating a genderequitable approach to work and parenting. Yet certain aspects of Swedish parental leave could also be responsible for the maintenance of (or even the increase in) health inequalities. Using a ‘Health in All Policies’ lens, this research project aims to assess the unintended health consequences of various components of Sweden’s parental leave policy, including eligibility for and uptake of earnings based benefits.

    Methods and analysis We will use individual-level data from multiple Swedish registers. Sociodemographic information, including parental leave use, will be retrieved from the total population register, Longitudinal Integration Database for Health Insurance and Labour Market Studies and Social Insurance Agency registers. Health information for parents and children will be retrieved from the patient, prescribed drug, cause of death, medical birth and children’s health registers. We will evaluate parents’ mental, mothers’ reproductive and children’s general health outcomes in relation to several policy reforms aiming to protect parental leave benefits in short birth spacing (the speed premium) and to promote father’s uptake (the father’s quota) and sharing of parental leave days (the double days reform). We will also examine effects of increases in basic parental leave benefit levels. Using quasi-experimental designs, we will compare health outcomes across these reforms and eligibility thresholds with interrupted time series, difference-in-difference and regression discontinuity approaches to reduce the risk of health selection and assess causality in the link between parental leave use and health.

    Ethics and dissemination This project has been granted allnecessary ethical permissions from the Stockholm Regional Ethical Review Board (Dnr 2019-04913) for accessing and analysing deidentified data. The final outputs will primarily be disseminated as scientific articles published in open-access,high-impact peer-reviewed international journals, as well as press releases and policy briefs.

  • 34.
    Juárez, Sol Pía
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Lund University, Sweden.
    Calidad de los datos del Instituto Nacional de Estadística para la elaboración de los indicadores de salud perinatal: pequeño y grande para su edad gestacional [Quality of the Spanish Vital Statistics to Estimate Perinatal Health Outcomes: Small and Large for Gestational Age]2015In: Revista Española de Salud Pública, ISSN 1135-5727, Vol. 89, no 1, p. 85-91Article in journal (Refereed)
    Abstract [en]

    Background: Relative measures of birthweight (small and large-for-gestational age, SGA-LGA) are increasingly preferred to absolute measures (low birthweight, macrosomia). In this study we assess whether the national vital statistics provided by the Spanish National Statistical Institute (INE) reliably estimate SGA and LGA. Also, we will assess whether missing data (selection) and misreported information (bias) are systematically associated with parental socioeconomic information. Methods: We linked the information on 6,339 births at the Hospital Clínico San Carlos of Madrid (2005-06) with the vital statistics records (successful for the 95% of the observation). Validity measures and concordance were estimated for low birthweight (LBW, <2500 gr), macrosomia (>4500 gr), SGA (<10th percentile) and LGA (>90 percentile). Logistic regressions were fitted. Results: The prevalence estimated with the hospital data were: LBW (6%), macrosomia (0.5%) SGA (1%) and LGA (15%) and, with the data from INE: 5% 0.5% 2% 12% respectively. Kappa statistics: LBW (83%), macrosomia (79%), PEG (24%) and LGA (82%). Missing and misreported data vary with parental nationality and their situation in the labor market (OR between 1.5 y 2.2). Conclusions: Vital statistics overestimate the prevalence of SGA and underestimate the prevalence of LGA. The concordance between the sources is very good for low birthweight, macrosomia and LGA, and moderately good for SGA. Both missing and misreported birthweight and gestational age are associated with parental socioeconomic characteristics.

  • 35.
    Juárez, Sol Pía
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Dunlavy, Andrea C.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Aldridge, Robert W.
    Barreto, Mauricio L.
    Katikireddi, Srinivasa Vittal
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis2019In: The Lancet Global Health, E-ISSN 2214-109X, Vol. 7, no 4, p. e420-e435Article, review/survey (Refereed)
    Abstract [en]

    Background

    Government policies can strongly influence migrants' health. Using a Health in All Policies approach, we systematically reviewed evidence on the impact of public policies outside of the health-care system on migrant health.

    Methods

    We searched the PubMed, Embase, and Web of Science databases from Jan 1, 2000, to Sept 1, 2017, for quantitative studies comparing the health effects of non-health-targeted public policies on migrants with those on a relevant comparison population. We searched for articles written in English, Swedish, Danish, Norwegian, Finnish, French, Spanish, or Portuguese. Qualitative studies and grey literature were excluded. We evaluated policy effects by migration stage (entry, integration, and exit) and by health outcome using narrative synthesis (all included studies) and random-effects meta-analysis (all studies whose results were amenable to statistical pooling). We summarised meta-analysis outcomes as standardised mean difference (SMD, 95% CI) or odds ratio (OR, 95% CI). To assess certainty, we created tables containing a summary of the findings according to the Grading of Recommendations Assessment, Development, and Evaluation. Our study was registered with PROSPERO, number CRD42017076104.

    Findings

    We identified 43 243 potentially eligible records. 46 articles were narratively synthesised and 19 contributed to the meta-analysis. All studies were published in high-income countries and examined policies of entry (nine articles) and integration (37 articles). Restrictive entry policies (eg, temporary visa status, detention) were associated with poor mental health (SMD 0·44, 95% CI 0·13–0·75; I2=92·1%). In the integration phase, restrictive policies in general, and specifically regarding welfare eligibility and documentation requirements, were found to increase odds of poor self-rated health (OR 1·67, 95% CI 1·35–1·98; I2=82·0%) and mortality (1·38, 1·10–1·65; I2=98·9%). Restricted eligibility for welfare support decreased the odds of general health-care service use (0·92, 0·85–0·98; I2=0·0%), but did not reduce public health insurance coverage (0·89, 0·71–1·07; I2=99·4%), nor markedly affect proportions of people without health insurance (1·06, 0·90–1·21; I2=54·9%).

    Interpretation

    Restrictive entry and integration policies are linked to poor migrant health outcomes in high-income countries. Efforts to improve the health of migrants would benefit from adopting a Health in All Policies perspective.

  • 36.
    Juárez, Sol Pía
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Restrictive Migration Policies have Adverse Effects on Migrant Health2019Other (Other academic)
    Abstract [en]

    Restrictive policies including those pertaining to temporary visas, detention and reduced access to welfare support are linked to a greater risk of poor general and mental health, as well as mortality among migrants, relative to native populations and migrants that did not experience such restrictions.

  • 37.
    Juárez, Sol Pía
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Lund University, Sweden.
    Revuelta-Eugercios, Bárbara A.
    Exploring the ‘Healthy Migrant Paradox’ in Sweden: A Cross Sectional Study Focused on Perinatal Outcomes2016In: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 18, no 1, p. 42-50Article in journal (Refereed)
    Abstract [en]

    Evidence shows that in some contexts immigrants have better health than natives in spite of coming from poorer socioeconomic contexts and of facing socioeconomic disadvantages in the host country. However, this is a country or origin- and outcome-specific phenomenon. This study compares different health outcomes derived from birthweight and gestational age among different migrant groups residing in Sweden. Cross-sectional study based on the Swedish Medical Birth Register for years 1987–1993. Multinomial regression models were performed to obtain crude and adjusted Odd Ratios and their 95 % Confidence Intervals. Overall, immigrants show a higher risk of LBW and preterm and a lower risk of macrosomia and post-term. Moreover, some groups performed worse than natives even in indicators at the two ends of the distribution. The healthy migrant paradox is also outcome-specific within different perinatal indicators and the selection explanation cannot fully account for this phenomenon.

  • 38.
    Juárez, Sol
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Non-European migrants often have similar or better health than natives2017In: Sociologisk forskning, ISSN 0038-0342, E-ISSN 2002-066X, Vol. 54, no 4, p. 323-327Article in journal (Refereed)
    Abstract [en]

    Sweden has experienced a sharp increase in migration flows in the last decades. Projections estimate that the migrant population rate will continue to grow in the near future. Given the centrality of health for the successful engagement of individuals in society, health aspects of migration have emerged as an important area of study. In this research note, we present a brief overview of current knowledge and argue in favour of developing a social determinants perspective on health in future research.

  • 39.
    Kanamori, Mariko
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Tokyo, Japan.
    Kondo, Naoki
    Juarez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Dunlavy, Andrea C.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rural life and suicide: Does the effect of the community context vary by country of birth? A Swedish registry-based multilevel cohort study2020In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 253, article id 112958Article in journal (Refereed)
    Abstract [en]

    Contextual factors varying by residence in rural or urban areas may have different effects on the suicide of residents by nativity, but evidence on the urban-rural gap in suicide according to nativity is lacking. This study aims to evaluate the effect of cross-level interaction between nativity and rurality of residence on suicide risk, at two levels of aggregation (municipalities/neighborhoods). Study design was nationwide register-based cohort study in Sweden, 2011-2016. Participants were all residents 20 years or older. We calculated Incidence Rate Ratios comparing suicide incidence by nativity using three-level (individuals, neighborhoods, and municipalities) Poisson regression, stratified by gender. Among men, suicide incidences were the highest among those born in other Nordic countries, followed by those born in Sweden, other European countries, Middle Eastern countries, and the rest of the world. Residing in rural areas was associated with high IRR of suicide regardless of nativity, compared to residing in urban areas. When evaluating rurality at municipality level, we observed an increased suicide risk from living in rural areas in men born in other European (rural-urban ratio of nativityspecific IRRs: 1.39) and other Nordic (1.37) countries, followed by native Swedes (1.22). When evaluating rurality at neighborhood level, rurality was associated with increased suicide risk in men for all nativities, with the foreign-born showing higher risk than the Swedish-born. Individual sociodemographic characteristics explained the excess suicide risk in rural municipalities, but not the excess risk in rural neighborhoods. Among women, urban residents showed higher suicide incidence than rural residents. We found no consistent patterning of interaction with nativities among women. Foreign-born individuals residing in rural municipalities may have less access to economic resources and employment opportunities. Furthermore, ethnic discrimination, stigma, and exclusion from social networks and community may be more common in rural neighborhood contexts, leading to an increased risk of suicide.

  • 40.
    Kanamori, Mariko
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. The University of Tokyo, Japan; Kyoto University, Japan.
    Kondo, Naoki
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Stickley, Andrew
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Does increased migration affect the rural-urban divide in suicide? A register-based repeated cohort study in Sweden from 1991 to 20152022In: Population, Space and Place, ISSN 1544-8444, E-ISSN 1544-8452, Vol. 28, no 1, article id e2503Article in journal (Refereed)
    Abstract [en]

    Some countries have high suicide rates in rural areas with a potentially stronger impact of rural context on foreign-born residents. In Sweden, where immigration has been increasing, dispersion policies have directed refugees/migrants to settle in rural areas. We examined whether trends in suicide mortality vary by nativity and rurality. A repeated cohort study was designed using Swedish national register data between 1991 and 2015. Our three-level analysis found that male suicide rates in rural areas were 1.2 times higher than in urban areas, with the rate decreasing over time in both urban and rural areas. We observed fluctuations in suicide mortality among foreign-born men residing in small rural communities, with high suicide rates in the 2000s. The proportion of unemployed was linked to the excess rate of suicide in rural municipalities. Dispersion policies moving migrants to rural areas should take into account the regional characteristics both within municipalities (e.g., income distribution) and between municipalities (e.g., labour market characteristics).

  • 41. Kjøllesdal, M. K. R.
    et al.
    Juárez, Sol P.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Aradhya, Siddartha
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Indseth, T.
    Understanding the excess COVID-19 burden among immigrants in Norway2022In: Journal of Public Health, ISSN 1741-3842, E-ISSN 1741-3850, Vol. 45, no 2, p. 277-286Article in journal (Refereed)
    Abstract [en]

    Background We aim to use intermarriage as a measure to disentangle the role of exposure to virus, susceptibility and care in differences in burden of COVID-19, by comparing rates of COVID-19 infections between immigrants married to a native and to another immigrant.

    Methods Using data from the Norwegian emergency preparedness, register participants (N=2 312 836) were linked with their registered partner and categorized based on own and partner's country of birth. From logistic regressions, odds ratios (OR) of COVID-19 infection (15 June 2020-01 June 2021) and related hospitalization were calculated adjusted for age, sex, municipality, medical risk, occupation, household income, education and crowded housing.

    Results Immigrants were at increased risk of COVID-19 and related hospitalization regardless of their partners being immigrant or not, but immigrants married to a Norwegian-born had lower risk than other immigrants. Compared with intramarried Norwegian-born, odds of COVID-19 infection was higher among persons in couples with one Norwegian-born and one immigrant from Europe/USA/Canada/Oceania (OR 1.42-1.46) or Africa/Asia/Latin-America (OR 1.91-2.01). Odds of infection among intramarried immigrants from Africa/Asia/Latin-America was 4.92. For hospitalization, the corresponding odds were slightly higher.

    Conclusion Our study suggests that the excess burden of COVID-19 among immigrants is explained by differences in exposure and care rather than susceptibility.

  • 42.
    Klöfvermark, Josefin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Acculturation or unequal assimilation? Smoking during pregnancy and duration of residence among migrants in Sweden2019In: SSM - Population Health, ISSN 2352-8273, Vol. 8, article id 100416Article in journal (Refereed)
    Abstract [en]

    A growing corpus of evidence reveals that smoking patterns of migrant women tend to converge with that of the host population over time (‘acculturation paradox’). In this paper we aim to adopt a health equity perspective by studying the extent to which this pattern reflects a convergence with the group of natives who are more socioeconomically disadvantaged. Using population-based registers, we study 1,194,296 women who gave birth in Sweden between 1991 and 2012. Using logistic regression, we estimated odds ratios to assess the effect of duration of residence on the association between smoking during pregnancy and women's origin (classified according to inequality-adjusted Human Development Index (iHDI) of the country of birth). Sibling information and multilevel models were used to assess the extent to which our results might be affected by the cross-sectional nature of the data. Smoking during pregnancy increases with duration of residence among migrants from all levels of iHDI to such an extent that they tend to converge or increase in relation to the levels of the Swedish population with low education and low income, leaving behind the native population with high education and income. The results are robust to possible selection bias related to the cross-sectional nature of the data. Our findings indicate the need of a health equity perspective and suggest the use of ‘unequal assimilation’ rather than ‘acculturation paradox’ as a more suitable framework to interpret these findings.

  • 43. Krarup Sørbye, Ingvil
    et al.
    Vangen, Siri
    Juarez, Sol P.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Bolumar Montrull, Francisco
    Morisaki, Naho
    Gissler, Mika
    Andersen, Anne-Marie N.
    Racape, Judith
    Small, Rhonda
    Wood, Rachael
    Urquia, Marcelo L.
    Birthweight of Babies Born to Migrant Mothers - What Role Do Integration Policies Play?2019In: SSM - Population Health, ISSN 2352-8273, Vol. 9, article id 100503Article in journal (Refereed)
    Abstract [en]

    Birthweights of babies born to migrant women are generally lower than those of babies born to native-born women. Favourable integration policies may improve migrants’ living conditions and contribute to higher birthweights. We aimed to explore associations between integration policies, captured by the Migrant Integration Policy Index (MIPEX), with offspring birthweight among migrants from various world regions. In this cross-country study we pooled 31 million term birth records between 1998 and 2014 from ten high-income countries: Australia, Belgium, Canada, Denmark, Finland, Japan, Norway, Spain, Sweden and United Kingdom (Scotland). Birthweight differences in grams (g) were analysed with regression analysis for aggregate data and random effects models.

    Proportion of births to migrant women varied from 2% in Japan to 28% in Australia. The MIPEX score was not associated with birthweight in most migrant groups, but was positively associated among native-born (mean birthweight difference associated with a 10-unit increase in MIPEX: 105 g; 95% CI: 24, 186). Birthweight among migrants was highest in the Nordic countries and lowest in Japan and Belgium. Migrants from a given origin had heavier newborns in countries where the mean birthweight of native-born was higher and vice versa. Mean birthweight differences between migrants from the same origin and the native-born varied substantially across destinations (70 g–285 g).

    Birthweight among migrants does not correlate with MIPEX scores. However, birthweight of migrant groups aligned better with that of the native-born in destination counties. Further studies may clarify which broader social policies support migrant women and have impacts on perinatal outcomes.

  • 44. Lind, Johannes
    et al.
    Schollin Ask, Lina
    Juarez, Sol
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Sachs’ Children and Youth Hospital, South General Hospital, Sweden; Karolinska Institutet, Sweden.
    Hospital care for viral gastroenteritis in socio-economic and geographical context in Sweden 2006-20132018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 11, p. 2011-2018Article in journal (Refereed)
    Abstract [en]

    AIM: We investigated socio-economic and geographical determinants of hospital care for viral gastroenteritis in young children.

    METHOD: This is a register-based study in a national birth cohort of 752 078 children 0-5 years of age in Sweden during 2006-2012. Hazard ratios (HR) of time to first admission and first episode of outpatient emergency department (ED) care with a diagnosis of viral gastroenteritis were estimated with Cox regression.

    RESULTS: The adjusted HRs for hospital admission with a diagnosis of viral gastroenteritis were increased when the mother was below 25 years at the birth of the child, 1.30 (95% CI: 1.24-1.35), had a short (<=9 years) education, 1.18 (95% CI: 1.12-1.23), a psychiatric disorder, 1.34 (95% CI: 1.30-1.39), and/or when parents were born outside Europe, 1.23 (95% CI: 1.18-1.29). In contrast, the disposable income of the family was only marginally associated with such hospital admissions. The pattern of HRs for outpatient ED hospital care was similar. Hospital care incidences for viral gastroenteritis differed considerably between Swedish counties.

    CONCLUSION: Parental indicators associated with a lower level of health literacy increase the risk for hospital care due to gastroenteritis in young children. Information about oral rehydration should be provided in ways that are accessible to these parents.

  • 45.
    Liu, Can
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Juarez, Sol
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Cnattingius, Sven
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Out-of-Home Care and Subsequent Preterm Delivery: An Intergenerational Cohort Study2018In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 142, no 2, article id e20172729Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Adverse early-life experience may affect preterm delivery later in life through priming of stress response. We aim to investigate the links between out-of-home care (OHC) experience in childhood, as a proxy of severe adversities, on subsequent risk of preterm delivery. METHODS: A register-based national cohort of all women born in Sweden between 1973 and 1977 (N = 175 821) was crosslinked with information on these women's subsequent deliveries as recorded in the Swedish medical birth register. During 1986-2012, 343 828 livebirths of these women were identified. The associations between women's OHC experience and her risk of preterm delivery were analyzed through logistic regression models, adjusting for women's own preterm birth, intrauterine growth, and childhood socioeconomic situation. RESULTS: Compared with women that never entered OHC, women with OHC experience up to and after age 10 were both associated with increased risks of preterm delivery (adjusted odds ratio [aOR] = 1.23 [95% confidence interval 1.08-1.40] and aOR = 1.29 [1.13-1.48], respectively). Women who experienced OHC before or at 10 years of age had increased risk of both spontaneous and medically indicated preterm delivery (aOR = 1.19 [1.03-1.38] and aOR = 1.27 [1.02-1.59], respectively). Women who experienced OHC after age 10 had a more pronounced risk of medically indicated preterm delivery (aOR = 1.76 [1.44-2.16]) than for spontaneous preterm delivery (aOR = 1.08 [0.92-1.27]). CONCLUSIONS: Women who were placed in OHC in childhood had increased risk of preterm delivery independent from their own perinatal history. Stress response, as 1 consequence of early life adversities, may take its toll on women's reproductive health and their offspring, calling for integrative efforts in preventing early life adversity.

  • 46. López-Borbón, Dilana
    et al.
    Löve, Jesper
    Juárez, Sol P.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Early pregnancy overweight/obesity and length of residence among immigrants in Sweden: a pooled analysis of Swedish population registers between 1992 and 20122021In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 24, no 5, p. 796-801Article in journal (Refereed)
    Abstract [en]

    Objective: To examine whether the association between women's origin and early pregnancy overweight and obesity (OW/OB) varies by length of residence in Sweden.

    Design: This cross-sectional observational study used pooled Swedish population register data from 1992 to 2012. Logistic regression models were run to estimate odds ratios (OR) of early pregnancy OW/OB and 95 % confidence intervals (95 % CI), comparing Swedish-born and immigrants by length-of-residence categories while adjusting for covariates.

    Setting: Sweden.

    Participants: In total, 1 771 821 pregnant women, 315 992 of whom were immigrants.

    Results: With longer residence in Sweden, more immigrant women from various origins exhibited higher odds of experiencing early OW/OB compared with Swedish-born women. Findings specifically showed increased odds of early pregnancy OW/OB with increasing length of residence for women born in Latin America, Europe-27 and Southeast Asia. For example, immigrant women from Latin America residing in Sweden for < 6 years showed similar odds as Swedish-born (OR <= 5 years 0 center dot 92, 95 % CI 0 center dot 87, 0 center dot 98), while their longer residing counterparts showed higher odds than Swedish-born women (OR(6-15 years)1 center dot 21, 95 % CI 1 center dot 14, 1 center dot 28 and OR >= 16 years 1 center dot 68, 95 % CI 1 center dot 59, 1 center dot 78). Mixed results were found for other origins.

    Conclusions: The current study suggests that host country conditions might play an important role in explaining OW/OB among some groups of immigrant women. Although further studies are needed to disentangle the mechanisms that generate these health inequalities, policy efforts should focus on immigrant reception and early integration to prevent pregnancy-related OW/OB.

  • 47. Mattsson, Kristina
    et al.
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Malmqvist, Ebba
    Influence of Socio-Economic Factors and Region of Birth on the Risk of Preeclampsia in Sweden2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 7, article id 4080Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the association between socio-economic factors and the risk of preeclampsia in Sweden, specifically investigating if this relationship is confounded by maternal region of birth. Study design: All singleton births between 1999 and 2009 in an ethnically diverse area in southern Sweden, totaling 46,618 pregnancies, were included in this study. The data on maternal pregnancy outcomes were retrieved from a regional birth register and socio-economic variables from Statistics Sweden. The risk ratios for preeclampsia were calculated for educational level and household disposable income, adjusting for maternal region of birth, maternal age, body mass index, parity, and smoking. Results: Low income levels were associated with a higher risk for preeclampsia, adjusted risk ratio (aRR) = 1.25 (95% confidence interval [CI]: 0.99, 1.59) and aRR = 1.36 (95% CI: 1.10, 1.68) for the two lowest quintiles, respectively, compared to the highest. There was an educational gradient in preeclampsia risk, although not all categories reached statistical significance: aRR = 1.16, (95% CI: 0.89–1.50) for low educational attainment and aRR = 1.23 (95% CI: 1.08, 1.41) for intermediate educational attainment compared to women with highest education. The socio-economic gradient remained after adjusting for region of birth. There was a lower risk for preeclampsia for women born in Asia, aRR = 0.60 (95% CI: 0.47, 0.75), regardless of socio-economic position. Conclusion: An increased risk for preeclampsia was seen for women with measures of lower socio-economic position, even in a universal, government-funded healthcare setting. The relationship was not explained by region of birth, indicating that the excess risk is not due to ethnically differential genetic pre-disposition but rather due to modifiable factors.

  • 48.
    Miething, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Income mortality paradox by immigrants' duration of residence in Sweden: a population register-based study2023In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 78, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Studies have shown that, compared with the general native population, immigrants display weaker or absent income gradients in mortality. The aim of this study is to examine the extent to which the income gradient is modified by immigrants' duration of residence in Sweden.

    Methods: Swedish register data from 2004 to 2016 were used to study the association between individual income and all-cause mortality among foreign-born and Swedish-born individuals at ages 25-64 years. Based on relative indices of inequality (RIIs) and slope indices of inequality (SIIs) derived from Poisson regressions, we measured relative and absolute mortality differentials between the least and most advantaged income ranks. The analyses were stratified by sex, immigrants' European or non-European origin, and immigrants' duration of residence in Sweden.ResultsThe relative income inequality in mortality among immigrant men was less than half (RII: 2.32; 95% CI: 2.15 to 2.50) than that of Swedish-born men (RII: 6.25; 95% CI: 6.06 to 6.44). The corresponding RII among immigrant women was 1.23 (95% CI: 1.13 to 1.34) compared with an RII of 2.75 (95% CI: 2.65 to 2.86) among Swedish-born women. Inequalities in mortality were lowest among immigrants who resided for less than 10 years in Sweden, and most pronounced among immigrants who resided for more than 20 years in the country. Corresponding analyses of absolute income inequalities in mortality based on the SII were largely consistent with the observed relative inequalities in mortality.

    Conclusions: Income inequalities in mortality among immigrants differ by duration of residence in Sweden, suggesting that health inequalities develop in the receiving context.

  • 49. Mulinari, Shai
    et al.
    Juarez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Lund University, Sweden.
    Wagner, Philippe
    Merlo, Juan
    Does Maternal Country of Birth Matter for Understanding Offspring's Birthweight? A Multilevel Analysis of Individual Heterogeneity in Sweden2015In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 5, article id e0129362Article in journal (Refereed)
    Abstract [en]

    Background Many public health and epidemiological studies have found differences between populations (e.g. maternal countries of birth) in average values of a health indicator (e.g. mean offspring birthweight). However, the approach based solely on population-level averages compromises our understanding of variability in individuals' health around the averages. If this variability is high, the exclusive study of averages may give misleading information. This idea is relevant when investigating country of birth differences in health. Methods and Results To exemplify this concept, we use information from the Swedish Medical Birth Register (2002-2010) and apply multilevel regression analysis of birthweight, with babies (n = 811,329) at the first, mothers (n = 571,876) at the second, and maternal countries of birth (n = 109) at the third level. We disentangle offspring, maternal and maternal country of birth components of the total offspring heterogeneity in birthweight for babies born within the normal timespan (37-42 weeks). We found that of such birthweight variation about 50% was at the baby level, 47% at the maternal level and only 3% at the maternal countries of birth level. Conclusion In spite of seemingly large differences in average birthweight among maternal countries of birth (range 3290-3677g), knowledge of the maternal country of birth does not provide accurate information for ascertaining individual offspring birthweight because of the high inter-offspring heterogeneity around country averages. Our study exemplifies the need for a better understanding of individual health diversity for which group averages may provide insufficient and even misleading information. The analytical approach we outline is therefore relevant to investigations of country of birth (and ethnic) differences in health in general.

  • 50.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wallace, Matthew
    Aradhya, Siddartha
    Ahrne, Malin
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Inequalities in COVID-19 severe morbidity and mortality by country of birth in Sweden2023In: Nature Communications, E-ISSN 2041-1723, Vol. 14, no 1, article id 4919Article in journal (Refereed)
    Abstract [en]

    Migrants have been more affected by the COVID-19 pandemic. Whether this has varied over the course of the pandemic remains unknown. We examined how inequalities in intensive care unit (ICU) admission and death related to COVID-19 by country of birth have evolved over the course of the pandemic, while considering the contribution of social conditions and vaccination uptake. A population-based cohort study was conducted including adults living in Sweden between March 1, 2020 and June 1, 2022 (n = 7,870,441). Poisson regressions found that migrants from Africa, Middle East, Asia and European countries without EU28/EEA, UK and Switzerland had higher risk of COVID-19 mortality and ICU admission than Swedish-born. High risks of COVID-19 ICU admission was also found in migrants from South America. Inequalities were generally reduced through subsequent waves of the pandemic. In many migrant groups socioeconomic status and living conditions contributed to the disparities while vaccination campaigns were decisive when such became available.

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