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  • 1.
    Ahrén-Moonga, Jennie
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    af Klinteberg, Britt
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS). Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Koupil, Ilona
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Mothers’ social background and risk of eating disorders in daughters [abstract]2008Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, nr suppl. 1, s. 111-112Artikkel i tidsskrift (Fagfellevurdert)
  • 2.
    Allers, Katharina
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Carl von Ossietzky University of Oldenburg, Germany.
    Calderón-Larrañaga, Amaia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Fors, Stefan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Morin, Lucas
    Socioeconomic position and risk of unplanned hospitalization among nursing home residents: a nationwide cohort study2021Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, nr 3, s. 467-473Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Socioeconomic inequalities in health and healthcare use in old age have been on the rise during the past two decades. So far, it is unknown whether these inequalities have permeated the nursing home setting. This study aimed to assess whether the socioeconomic position of newly admitted nursing home residents had an influence on their risk of unplanned hospitalization. Methods: We identified older persons (similar to 75 years) who were newly admitted to a nursing home between March 2013 and December 2014 using a set of linked routinely collected administrative and healthcare data in Sweden. The number of unplanned hospitalizations for any cause and the cumulative length of stay were defined as primary outcomes. Unplanned hospitalizations for potentially avoidable causes (i.e. fall-related injuries, urinary tract infections, pneumonia and decubitus ulcers) were considered as our secondary outcome. Results: Among 40 545 newly admitted nursing home residents (mean age 86.8 years), the incidence rate of unplanned hospitalization ranged from 53.9 per 100 person-years among residents with tertiary education up to 55.1 among those with primary education. After adjusting for relevant confounders, we observed no meaningful difference in the risk of unplanned hospitalization according to the education level of nursing home residents (IRR for tertiary vs. primary education: 0.96, 95% CI 0.92-1.00) or to their level of income (IRR for highest vs. lowest quartile of income: 0.98, 0.95-1.02). There were also no differences in the cumulative length of hospital stays or in the risk of experiencing unplanned hospitalizations for potentially avoidable causes. Conclusions: In sum, in this large cohort of newly admitted nursing home residents, we found no evidence of socioeconomic inequalities in the risk of unplanned hospitalization.

  • 3.
    Almquist B., Ylva
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Landstedt, Evelina
    Hammarström, Anne
    Associations between social support and depressive symptoms: social causation or social selection – or both?2017Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr 1, s. 84-89Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Numerous studies have demonstrated an association between social support and health, almost regardless of how social support and health have been conceptualised or measured. Even so, the issue of causality has not yet been sufficiently addressed. This issue is particularly challenging for mental health problems such as depressive symptoms. The aim of the present study is to longitudinally assess structural and functional aspects of social support in relation to depressive symptoms in men and women, through a series of competing causal models that, in contrast to many other statistical methods, allow for bi-directional effects. Methods: Questionnaire data from the Northern Swedish Cohort (n = 1001) were utilised for the years 1995 (age 30) and 2007 (age 42). Associations were analysed by means of gender-specific structural equation modelling, with structural and functional support modelled separately. Results: Both structural and functional support were associated with depressive symptoms at ages 30 and 42, for men and women alike. A higher level of support, particularly functional support, was associated with a decrease in depressive symptoms over time among men. Among women, there were bi-directional effects of social support and depressive symptoms over time. Conclusion: Concerning social support and health, the social causation hypothesis seems relevant for men whereas, for women, the associations appear to be more complex. We conclude that preventive and health promoting work may need to consider that the presence of depressive symptoms in itself impedes on women’s capability to increase their levels of social support.

  • 4.
    Almquist, Ylva B.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Högnäs, Robin S.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Modin, Bitte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Only the lonely? All-cause mortality among children without siblings and children without friends2017Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr Suppl. 3Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: In childhood, relations with siblings and friends lie at the core of social interaction. Lacking either type of relationship may reflect lower levels of social support. While social support is known to be negatively associated with premature death, there are still no long-term follow-ups of mortality risks among children without siblings (‘only-children’) and children without friends (‘lonely-children’). The aim of the present study was therefore to examine and compare all-cause mortality in these two groups.

    Methods: Cox regression analysis was based on a Stockholm cohort born in 1953 (n = 15,117). Individuals were identified as only-children if there were no records of siblings before age 18. Derived from sociometric data collected at age 13, lonely-children were defined as not being nominated by classmates as one of three best friends. The follow-up of all-cause mortality covered ages 20-56.

    Results: Both only-children and lonely-children had increased risks of premature mortality. When adjusted for a wide range of family-related and individual factors, the risk ratio for only-children increased in strength whereas the risk ratio for lonely-children was reduced. The former finding may be explained by suppressor effects: for example, both only-children and those whose parents had alcohol problems had higher mortality risks but only-children were less likely to have parents with alcohol problems. The latter finding was primarily due to adjustment for scholastic ability.

    Conclusions: It is concluded that while only-children and lonely-children have similar risks of all-cause mortality, the processes leading up to premature death appear to be rather different. Yet, interventions targeted at improving social learning experiences may be beneficial for both groups.

    Key messages:

    • Only-children have higher risks of premature mortality but the mechanisms remain unclear.

    • Lonely-children are at risk of premature mortality primarily due to poorer scholastic ability.

  • 5.
    Almquist, Ylva B
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Landstedt, E.
    Jackisch, Josephine
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rajaleid, Kristiina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Westerlund, Hugo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Hammarström, A.
    Growing through asphalt: What counteracts the long-term negative health impact of youth adversity?2017Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr Suppl. 3Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Adversity in the family of origin tends to translate into poor health development. Yet, the fact that this is not the always the case has been seen an indicator of resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status.

    Methods

    The study was based on the Northern Swedish Cohort born in 1965 (n = 1,001). Measures of social and material adversity, health, and protective factors related to school, peers, and spare time, were derived from questionnaires distributed to the cohort members and their teachers at age 16. Self-rated health was measured at age 43. The main associations were examined by means of ordinal regression analysis, with the role of the protective factors being assessed through interaction analysis.

    Results

    Social and material adversity in youth was associated with poorer self-rated health in midlife among males and females alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time – particularly in terms of being seen as having good educational and work prospects, as well as a high-quality spare time – appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health.

    Conclusions

    There are several factors outside the context of the family that seemingly have the potential to buffer against the negative health consequences stemming from having experienced a disadvantaged upbringing. Initiatives targeted at increasing academic motivation and commitment as well as social capital and relationships in youth, may here be of particular relevance.

    Key messages:

    • While the experience of disadvantageous living conditions in adolescence tends to translate into poor health development across the life course, this is not always the case.

    • Advantages related to school, peers, and spare time have the potential of counteracting the negative health impact of an adverse family context.

  • 6.
    Almquist, Ylva B
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Östberg, Viveca
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Modin, Bitte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Is there a peer status gradient in mortality? Findings from a Swedish cohort born in 1953 and followed to age 672023Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, nr 2, s. 184-189Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Similar to having a less advantaged socioeconomic position, children in lower peer status positions typically experience a situation characterized by less power, influence and command over resources, followed by worse health outcomes. The aim of this study was to examine whether peer status position is further associated with increased risks for premature all-cause mortality. Methods Data were drawn from a 1953 cohort born in Stockholm, Sweden. Peer status positions were established through survey data on peer nominations within the school class at age 13, whereas national registers were used to identify all-cause mortality across ages 14-67. Differences in hazard rates and median survival time, according to peer status position, were estimated with Cox regression and Laplace regression, respectively. Results Although differences in hazard rates were not large, they were consistent and clear, also after taking childhood socioeconomic status into account. Regarding median survival time, the number of years lost increased gradually as peer status decreased, with a difference of almost 6 years when comparing individuals in the lowest and highest positions. Conclusions Children's positions in the peer status hierarchy play a role for their chances of health and survival, pointing to the relevance of addressing opportunities for positive peer interaction and mitigating any adverse consequences that may stem from negative experiences within the peer context.

  • 7.
    Almquist, Ylva M.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Childhood friendships and adult health: Findings from the Aberdeen Children of the 1950s Cohort study2012Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, nr 3, s. 378-383Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Social relations are known to influence morbidity and mortality but few have studied this association from a life-course perspective specifically targeting the importance of social relations in childhood for adult health. In childhood, a key aspect of children’s relationships is the number of friendships a child has in the school class, i.e. friendship quantity. The overall aim of this study was to examine the association between childhood friendships and adult self-rated health. Data from a longitudinal study of children born in Aberdeen, Scotland, between 1950 and 1956 was used. Information on friendship quantity (1964) was derived from sociometric nominations among classmates and defined as mutual choices. The health outcome was based on self-ratings derived from a questionnaire in 2001-2003. The study included various childhood and adult circumstances as possible explanatory factors. The analysis was based on ordinal logistic regression, producing odds ratios (n=5,814). The results demonstrated a gradient in women’s self-rated health according to the number of friendships in the school class. A number of circumstances in childhood and adulthood were partial explanations. For men, only those without friends reported poorer self-rated health in adulthood. This finding was explained by adult socioeconomic status. It is concluded that childhood friendships are linked to health disparities in middle age, underlining the importance of such relationships and the need for a life-course perspective on health that integrates a variety of mechanisms as they interact across life.

  • 8. Almroth, Melody
    et al.
    Hemmingsson, Tomas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Karolinska Institutet, Sweden.
    Sörberg Wallin, Alma
    Kjellberg, Katarina
    Falkstedt, Daniel
    Psychosocial workplace factors and alcohol-related morbidity: a prospective study of 3 million Swedish workers2022Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, nr 3, s. 366-371Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 9. Axelsson Fisk, Sten
    et al.
    Alex-Petersen, Jesper
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Liu, Can
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Juárez, Sol Pia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (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 2024Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 34, nr 1, s. 22-28Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 10. Bean, Christopher G.
    et al.
    Virtanen, Marianna
    Westerlund, Hugo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Berg, Noora
    Hallqvist, Johan
    Hammarström, Anne
    Group activity participation at age 21 and depressive symptoms during boom and recession in Sweden: a 20-year follow-up2019Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr 3, s. 475-481Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Organized group activities (e.g. sports or arts clubs) have long been noted as important developmental settings for youth, yet previous studies on the relationships between participation and mental health outcomes have focused on short-term effects among school-aged adolescents. The subsequent period of life, emerging adulthood, has been largely overlooked despite being another important life stage where individuals face new existential challenges and may benefit from group activity participation. The potential for macroeconomic conditions to modify these relationships has also not been considered. Methods: Participants (n = 1654) comprise two cohorts, born in either 1965 (n = 968) or 1973 (n = 686), from the same middle-sized industrial town in Northern Sweden. Both cohorts completed detailed questionnaires at age 21 (macroeconomic boom for Cohort 65, recession for Cohort 73) and approximately 20 years follow-up (age 43 for Cohort 65, age 39 for Cohort 73). General linear models were used to assess concurrent and prospective associations between regular group activity participation and depressive symptoms, as well as the potential interaction with boom/recession. Results: After controlling for sociodemographic factors, regular group activity participation at age 21 was associated with lower depressive symptoms, both concurrently and at follow-up. Those exposed to recession at age 21 reported higher depressive symptoms at the time but there was no interaction between cohort (boom/recession) and group activity participation. Conclusions: Regular group activity participation during emerging adulthood is associated with lower depressive symptoms uniformly in times of boom and recession. Beneficial effects of such participation may contribute to better mental health over 20 years.

  • 11. Benson, Rebecca
    et al.
    Glaser, Karen
    Corna, Laurie M.
    Platts, Loretta G.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Di Gessa, Giorgio
    Worts, Diana
    Price, Debora
    McDonough, Peggy
    Sacker, Amanda
    Do work and family care histories predict health in older women?2017Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr 6, s. 1010-1015Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health.

    Methods: We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours.

    Results: Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories.

    Conclusion: Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

  • 12. Berg, Noora
    et al.
    Nummi, Tapio
    Bean, Christopher G.
    Westerlund, Hugo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Stressforskningsinstitutet.
    Virtanen, Pekka
    Hammarström, Anne
    Risk factors in adolescence as predictors of trajectories of somatic symptoms over 27 years2022Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, nr 5, s. 696-702Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Somatic symptoms among adolescents are common, yet little is known about long-term trajectories of somatic symptoms and the factors in adolescence that shape them. We examined individual, family and schoolbased factors at age 16 as predictors of trajectories of somatic symptoms over 27 years. Methods: Participants from the Northern Swedish Cohort (n ¼ 1001) responded to questions about individual factors (e.g. health behaviours), family factors (e.g. contact with parents, social and material adversity) and school satisfaction at age 16; as well as 10 somatic symptoms at ages 16, 18, 21, 30 and 43. Teacher assessments at age 16 included overall ability at school and peer relations. Age 16 predictors of somatic symptom trajectory group membership were analysed using multinomial logistic regression. Results: Poor contact with mother and poor school satisfaction were significant predictors of adverse symptom trajectories among both men and women. Low birth weight and low parental academic involvement were contributing factors for women, while smoking and social adversity were more relevant factors for men. Conclusions: Our findings emphasize the importance of a holistic approach that considers the unique contributions of individual, family and school-based factors in the development of trajectories of somatic symptoms from adolescence to middle age.

  • 13. Berg, Noora
    et al.
    Virtanen, Marianna
    Lintonen, Tomi
    Hammarström, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Stressforskningsinstitutet. Uppsala University, Sweden.
    The contribution of drinking culture at comprehensive school to heavy episodic drinking from adolescence to midlife2020Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, nr 2, s. 357-363Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The school context is associated with adolescent alcohol use, but it is not clear whether this association continues into adulthood. This study examined whether exposure to drunkenness oriented drinking culture in 9th grade school class is associated with individuals' heavy episodic drinking (HED) from adolescence to midlife. Methods: Participants in the 'Northern Swedish Cohort' study aged 16 years in 1981 were followed-up when aged 18, 21, 30 and 43 (N = 1080). Individual-level factors were HED, positive attitudes towards drunkenness, early initiation of HED and peer-oriented spare-time. School class-level drinking culture was measured as classmate reported HED, positive attitudes, early initiation of HED and peer-oriented spare time. Multilevel log-binomial regression analyses were adjusted for gender, parental socioeconomic background, family structure and HED at age 16. Results:After adjustment for sociodemographic factors several cross-sectional and longitudinal associations were found between class-level indicators of drinking culture and individual HED. After additional adjustment for age 16 HED, most associations attenuated. The risk ratio (95% confidence interval) for engaging in HED at age 43 was 1.58 (1.03-2.42) times higher for those who at age 16 had many classmates reporting positive attitude towards drunkenness. Conclusions: These findings suggest that drinking culture in school may have a long-lasting impact on drinking habits in adulthood. The associations with HED at follow-ups are likely mediated by HED in adolescence. Studies on alcohol use would benefit from taking into account both individual and contextual factors in a life course perspective.

  • 14. Björkenstam, Emma
    et al.
    Burström, Bo
    Hjern, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Karolinska Institutet, Sweden.
    Kosidou, Kyriaki
    Berg, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Cumulative childhood adversity, adolescent psychiatric disorder and violent offending in young adulthood2019Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr 5, s. 855-861Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Childhood adversity (CA) is a risk indicator for psychiatric morbidity. Although CA has been linked to violent offending, limited research has considered adolescent psychiatric disorder as a mediating factor. The current study examined whether adolescent psychiatric disorder mediates the association between CA and violent offending.

    Methods

    We used a cohort of 476 103 individuals born in 1984–1988 in Sweden. Register-based CAs included parental death, substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance, child welfare intervention and residential instability. Adolescent psychiatric disorder was defined as being treated with a psychiatric diagnosis prior to age 20. Estimates of risk of violent offending after age 20 were calculated as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). Mediation was tested with the bootstrap method.

    Results

    Exposure to CA was positively associated with violent offending, especially when accumulated. Individuals exposed to 4+ CAs who were also treated for psychiatric disorder had a 12-fold elevated risk for violent offending (adjusted IRR 12.2, 95% CI 10.6–14.0). Corresponding IRR among 4+ CA youth with no psychiatric disorder was 5.1 (95% CI 4.5–5.6). Psychiatric disorder mediated the association between CA and violent offending.

    Conclusion

    CA is associated with elevated risk for violent offending in early adulthood, and the association is partly mediated by adolescent psychiatric disorder. Individuals exposed to cumulative CA who also develop adolescent psychopathology should be regarded as a high-risk group for violent offending, by professionals in social and health services that come into contact with this group.

  • 15. Björkenstam, Emma
    et al.
    Helgesson, Magnus
    Gustafsson, Klas
    Virtanen, Marianna
    Magnusson Hanson, Linda L.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Stressforskningsinstitutet.
    Mittendorfer-Rutz, Ellenor
    Occupational class and employment sector differences in common mental disorders: a longitudinal Swedish cohort study2021Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, nr 4, s. 809-815Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Recent increases in common mental disorders (CMDs) among young adults are of great concern although studies of CMDs in young employees are sparse. This study investigated the independent and interacting effects of sector of employment, occupational class and CMDs. Additionally, associations between type of employment branch and CMDs within each sector were examined.

    Methods This population-based longitudinal cohort study included 665 138 employees, 19–29 years, residing in Sweden in 2009. Employment sector (i.e. private/public) and occupational class (non-manual/manual workers) were measured in 2009. Risk estimates of CMDs, measured as new prescription of antidepressants and/or psychiatric care with a diagnosis of CMDs, between 2010 and 2016, were calculated as hazard ratios (HRs) with 95% confidence intervals (CIs), using Cox multivariable regression analysis.

    Results Public sector employees (whereof 60% manual workers) had an elevated risk for CMDs compared to private sector employees [adjusted HR: 1.14 (95% CI 1.12–1.16)]. Within each sector, manual workers were at increased risk of CMDs compared to non-manual workers. There was an interaction between sector of employment and occupational class; manual workers in the public sector had the highest CMD risk [adjusted synergy index: 1.51 (95% CI 1.29–1.76)]. The most elevated risk for CMDs was observed in those employed in health and social services and the lowest risk among construction workers.

    Conclusion Sector of employment and occupational class play a role in CMDs in young employees. These findings should be taken into account in the attempts to reduce CMDs in the young working population.

  • 16. Björkenstam, Emma
    et al.
    Hjern, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Adverse childhood experiences and disability pension in early midlife: results from a Swedish National Cohort Study2017Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr 3, s. 472-477Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Few studies have examined the association between adverse childhood experiences (ACEs) and disability pension (DP). The current study aimed to investigate the relationship between different ACEs, cumulative ACEs, and DP, and the mediating role of school performance. Methods: We used a Swedish cohort of 522 880 individuals born between 1973 and 1978. ACEs included parental death, parental substance abuse and psychiatric disorder, substantial parental criminality, household public assistance, parental DP and child welfare intervention. Estimates of risk of DP in 2008 were calculated as odds ratios (OR) with 95% confidence intervals (CIs). Results: A total of 2.3% (3.0% females, 1.7% males) received DP in 2008. All studied ACEs increased the odds for DP, particularly child welfare intervention and household public assistance. Cumulative ACEs increased the odds of DP in a graded manner. Females exposed to 4+ ACEs had a 4-fold odds (OR: 4.0, 95% CI 3.5-4.5) and males a 7-fold odds (OR: 7.1, 95% CI: 6.2-8.1). School performance mediated the ACEs-DP association. Conclusion: This study provides evidence that ACEs is associated with increased odds of DP, particularly when accumulated. The effects of ACEs should be taken into account when considering the determinants of DP, and when identifying high-risk populations.

  • 17. Blomqvist, Ida
    et al.
    Henje Blom, Eva
    Hägglöf, Bruno
    Hammarström, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Uppsala University, Sweden.
    Increase of internalized mental health symptoms among adolescents during the last three decades2019Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr 5, s. 925-931Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous studies suggest an overall increase of adolescent mental health symptoms globally since the 1980s until today, especially an increase of internalizing symptoms in girls. Due to methodological limitations of these studies, further studies are warranted to obtain a more solid knowledgebase. Methods: This study was cross-sectional and compared two separate but geographically identical groups of adolescents in a middle-sized industrial municipality in Northern Sweden at two time-points [(i) 1981, n = 1083, (505 girls, 577 boys), response rate 99.7%; (ii) 2014, n = 682, (338 girls, 344 boys), response rate 98.3%]. All students in their last year of compulsory school were included. The same self-report questionnaire, consisting of four sub-scales (functional somatic-, anxiety-, depressive symptoms and conduct problems), was used at both occasions. Data were analyzed with descriptive statistics, two-way ANOVA and general linear model. Results: Symptoms of anxiety and depression and functional somatic symptoms, increased among both boys and girls from 1981 until 2014 (P < 0.001 for all subscales), and the increase of these symptoms was higher in girls. Conduct problems were significantly higher in boys in 1981 and decreased over time so that in 2014 there was no longer a significant difference between boys and girls regarding conduct problems (P = 0.286). Conclusion: In this population-based study spanning over 30 years, both girls and boys showed increasing internalizing problems, while conduct problems decreased. To halt this trend, we need a deeper understanding of the impact of the major societal changes that have occurred during the last three decades.

  • 18. Bohman, H
    et al.
    Brolin Låftman, Sara
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Päären, A
    Jonsson, U
    Somatic symptoms in adolescence as a predictor of in-patient care for mental disorders in adulthood2016Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, nr 1Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background

    Somatic symptoms such as headache, abdominal pain and dizziness, are common among young people and often associated with poor everyday functioning and concurrent mental disorders. Yet, relatively few studies have examined the long-term consequences of such symptoms. The aim of the study was to investigate if somatic symptoms in adolescence predict adulthood hospital based care for mental disorders.

    Methods

    The total school population of 16-17-year olds, in the city of Uppsala, Sweden, was screened for depression in 1991-1993. Adolescents with positive screening and the same number of healthy controls took part in a semi-structured diagnostic interview of mental disorders. In addition, 21 different self-rated functional somatic symptoms were assessed. The participants were followed up in the national patients register about 20 years later (n = 337). The associations between somatic symptoms in adolescence and in-patient care and out-patient hospital based mental health care in adulthood were analysed using binary logistic regression analysis.

    Results

    Adolescents with somatic symptoms had an excess risk of later psychiatric hospital based health care. The presence of multiple somatic symptoms (≥5) in adolescence was associated with psychiatric hospital based care in adulthood also when controlling for depression and anxiety in adolescence as well as sex and potential psychosocial confounders (OR 3.29, p = 0.046). The presence of just any somatic symptom (≥1) in adolescence predicted later hospital based mental health care for mood disorders (OR 8.49, p = 0.041) whereas adolescent depression, anxiety and sex did not, when mutually adjusted for.

    Conclusions

    Somatic symptoms in adolescence are a strong independent predictor of severe mental health problems in adulthood. The link between adolescent somatic symptoms and adult mood disorders are particularly strong even when somatic symptoms are compared head to head with concurrent depression and anxiety.

  • 19.
    Brolin Låftman, Sara
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Bjereld, Y.
    Modin, Bitte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Löfstedt, P.
    Sexual harassment and psychological complaints: Student- and class-level associations2020Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, nr Suppl 5, s. v881-v881, artikkel-id ckaa166.944Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Students who are subjected to sexual harassment at school report lower psychological well-being than those who are not exposed. Yet, it is possible that the occurrence of sexual harassment in the school class is stressful also for those who are not directly targeted, with potential negative effects on well-being for all students. The aim was to examine whether sexual harassment at the student- and at the class-level was associated with students' psychological complaints.

    Methods

    Data from the Swedish Health Behaviour in School-aged Children (HBSC) of 2017/18 was used, with information from students aged 11, 13 and 15 years (n = 3,720 distributed across 209 classes). Psychological complaints were constructed as a summative index of four items capturing how often the student had felt low, felt irritable or bad tempered, felt nervous, or had difficulties to fall asleep, during the past six months (Cronbach's alpha=0.78). Sexual harassment at the student-level was measured by one item concerning bullying at school: “Other students have exposed me to sexual jokes”. Students who reported that this had happened at least “2 or 3 times a month” were classified as exposed to sexual harassment at school. Sexual harassment at the class-level was defined as the school class proportion of students exposed to sexual harassment, reported in per cent. Two-level linear regression analysis was applied.

    Results

    Students who had been exposed to sexual harassment had higher levels of psychological complaints (b = 2.74, p < 0.001). The proportion of students in the school class who had been exposed to sexual harassment was also associated with higher levels of psychological complaints, even when adjusting for sexual harassment at the student-level, gender and grade (b = 0.03, p = 0.015).

    Conclusions

    Sexual harassment is harmful for those who are exposed, but may also affect other students negatively. Thus, a school climate free from sexual harassment will profit all students.

    Key messages 

    • Using data collected among students aged 11, 13 and 15 years, this study showed that sexual harassment at the student- and class-level was associated with higher levels of psychological complaints.
    • Sexual harassment is harmful for those who are exposed, but may also affect other students negatively. Thus, a school climate free from sexual harassment will profit all students.
  • 20.
    Brolin Låftman, Sara
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Fransson, Emma
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Östberg, Viveca
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Sociodemographic inequalities in adolescents’ health-related behaviours: The case of Sweden2016Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Earlier research suggests that socioeconomic inequalities in health-related behaviours exist among young people, but with less clearcut patterns than among adults. The aim of the study is to examine to what extent sociodemographic inequalities in health behaviours in terms of alcohol use, smoking, physical inactivity, and regularly skipping breakfast and lunch, exist among adolescents in Sweden.

    Methods

    The data were obtained from the Swedish Living Conditions Survey (ULF) and its child supplements (Child-ULF) from 2008-2011 (n = 4001). Health-related behaviours were reported by adolescents aged 10-18 years and information on sociodemographic characteristics was derived from parents and from official registers. Binary logistic regression analyses were conducted.

    Results

    Clear sociodemographic inequalities in health-related behaviours were shown. Compared with their peers with parents in upper non-manual occupations, adolescents in working-class households were more likely to smoke (OR 1.53, p = 0.033), to be physically inactive (OR 1.54, p = 0.004), and to regularly skip breakfast (OR 1.78, p = 0.000) and lunch (OR 1.42, p = 0.011). Adolescents in households lacking a cash margin were more inclined to smoke (OR 1.47, p = 0.033) and to skip breakfast (OR 1.62, p = 0.000) as well as to skip lunch (OR 1.31, p = 0.041) than those in better off households. Not living in a nuclear family was linked with a higher risk of drinking alcohol (OR 1.57, p = 0.002), smoking (OR 2.32, p = 0.000), and skipping breakfast (OR 1.54, p = 0.000) and lunch (OR 1.55, p = 0.000). Adolescents with foreign-born parents were more likely to be physically inactive (OR 1.67, p = 0.001) and to regularly skip breakfast (OR 1.55, p = 0.002) compared with those whose parents were born in Sweden.

    Conclusions

    Sociodemographic inequalities in health-related behaviours clearly exist among adolescents in Sweden, along lines of household social class, financial strain, family structure and parental country of birth.

  • 21.
    Brolin Låftman, Sara
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Ramberg, Joacim
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Specialpedagogiska institutionen.
    Modin, Bitte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    School ethos and recurring sickness absence: A multilevel study of ninth grade students in Stockholm2019Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr supplement 4, artikkel-id ckz187.052Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 22.
    Brolin Låftman, Sara
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Östberg, Viveca
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Psychological complaints in adolescence: do they track into young adulthood?2017Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr Suppl. 3Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Psychological complaints, such as feeling sad or nervous, are common among adolescents, especially girls. The prevalence also appears to have risen during the last decades in Sweden, in particular among girls. Yet, knowledge about whether there are long-term associations with adverse health outcomes later in life is scarce. The aim of the current study is to assess to what extent psychological complaints in adolescence track into young adulthood, and whether there are gender differences.

    Methods

    The data used were derived from the Swedish Young-LNU, which is a prospective study based on a nationally representative sample with survey information from adolescents aged 10-18 years in 2000 and from the same individuals at ages 20-28 years in 2010 (n = 792). Information on household characteristics at baseline was provided by parents. Psychological complaints in adolescence were measured by self-reported items on feeling sad and down, tense and nervous, and grouchy and irritated. Psychological complaints in young adulthood were measured by self-reported items on anxiety and depression. The statistical method used was binary logistic regression.

    Results

    Psychological complaints in adolescence were associated with an excess risk of psychological complaints in young adulthood (OR = 2.08, p = 0.003) also when adjusting for sex, age group, and family structure and household social class at baseline. Gender-separate analyses revealed that the association was statistically significant for females (OR = 2.22, p = 0.007) but not for males (OR = 1.83, p = 0.148).

    Conclusions

    For females, psychological complaints in adolescence predicted psychological complaints in young adulthood. This underlines the importance that adolescents who suffer from this type of health problems should be identified and provided support, for instance through the school health services.

  • 23.
    Brännström, Lars
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Bo, Vinnerljung
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Hjern, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Child welfare clients have higher risks for teenage childbirths: which are the major confounders?2016Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, nr 4, s. 592-597Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Aiming to support effective social intervention strategies targeting high-risk groups for teenage motherhood, this study examined to what extent the elevated crude risks of teenage childbirth among child welfare groups were attributable to the uneven distribution of adverse individual and family background factors. Methods: Comprehensive longitudinal register data for more than 700 000 Swedish females born 1973–1989 (including around 29 000 child welfare clients) were analysed by means of binary logistic regression. The Karlson/Holm/Breen-method was used to decompose each confounding factor’s relative contribution to the difference between crude and adjusted odds ratios (ORs). Results: Elevated crude risks for teenage childbirth are to a large extent attributable to selection on observables. Girls’ school failure was the most potent confounder, accounting for 28–35% of the difference between crude and adjusted ORs. Conclusion: As in majority populations, girls’ school failure was a strong risk factor for teenage childbirth among former child welfare children. At least among pre-adolescents, promoting school performance among children in the child welfare system seems to be a viable intervention path.

  • 24.
    Burström, Bo
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Öberg, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Smedman, Lars
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Policy measures and the survival of foster infants in Stockholm 1878-19252012Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, nr 1, s. 56-60Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: At the end of the 19th century, infant mortality was high in urban and rural areas in Sweden. In Stockholm, the mortality rate was particularly high among foster children. This study addresses the importance for health of targeted public policies and their local implementation in the reduction of excess mortality among foster children in Stockholm at the turn of the 19th century. In response to public concern, a law was passed in 1902 on inspections of foster homes. Stockholm city employed a handful of inspectors who visited foster homes and advised parents on child care and feeding. Methods: Analysis of historical records from the City of Stockholm was combined with epidemiological analysis of mortality rates and hazard ratios on individual-level data for 112 746 children aged < 1 year residing in one part of Stockholm between 1878 and 1925. Hazard ratios of mortality were calculated using Cox' regression analysis. Results: Mortality rates of foster infants exceeded 300/1000 before 1903. Ten years later the mortality rates among foster children had declined and were similar to other children born in and out of wedlock. Historical accounts and epidemiological analysis of individual-level data over a longer time period showed similar results. Conclusions: Targeted policy measures to foster children may have potentiated the positive health effects of other universal policies, such as improved living conditions, clean water and sanitation for the whole population in the city, contributing to an equalization of mortality rates between different groups.

  • 25.
    Dunlavy, Andrea C.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Juárez, Sol
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Employment status and risk of all-cause mortality among native- and foreign-origin persons in Sweden2018Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, nr 5, s. 891-897Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 26.
    Dunlavy, Andrea
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Cederström, Agneta
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Katikireddi, Srinivasa Vittal
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Glasgow, Scotland.
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Juárez, Sol P.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Investigating the salmon bias effect among international immigrants in Sweden: a register-based open cohort study2022Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, nr 2, s. 226-232Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 27.
    Dunlavy, Andrea
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Juárez, Sol
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (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 Sweden2018Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, s. 182-182Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 28.
    Dunlavy, Andrea
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Juárez, Sol
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Toivanen, Susanna
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Migration background characteristics and the association between unemployment and suicide2017Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr Suppl. 3Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 29. Einiö, Elina
    et al.
    Metsä-Simola, Niina
    Saarioja, Saska
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Korhonen, Kaarina
    Is impending or actual death of a spouse with dementia bad for mental health? Antidepressant use surrounding widowhood2020Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, nr 5, s. 953-957Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous studies have shown that the risk of death is elevated after the death of a spouse. Limited evidence is available on changes in mental health before and after bereavement among individuals whose spouse dies of dementia. Methods: We analyzed changes in the 3-month prevalence of antidepressant use for 5 years before and 3 years after widowhood for individuals whose spouses died of either dementia or other causes. The study used data of 41 855 widowed individuals and repeated-measures logistic regression analyses. Antidepressant use was based on the prescription register of Finland in 1995-2007. Results: Five years before widowhood, the 3-month prevalence for antidepressant use was 4% among widowing men and 6-7% among widowing women, regardless of whether the spouse died of dementia or other causes. Further changes in antidepressant use depended on a spouse's cause of death. Women whose spouses died of dementia experienced large increase in antidepressant use starting from 3 to 4 years prior to widowhood, whereas other widows did not experience large increase until after widowhood. The trajectories for men were similar. Antidepressant use following the death of a spouse with dementia stayed at a new heightened level after widowhood. Conclusions: The trajectories of antidepressant use indicate that the process of losing a spouse to dementia is bad for mental health, already a few years prior to widowhood. There are no clear improvements in mental health after the death of a spouse with dementia. Support services for individuals whose spouses' dementia progresses are needed.

  • 30. Ekeus, Cecilia
    et al.
    Cnattingius, Sven
    Essen, Birgitta
    Hjern, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Stillbirth among foreign-born women in Sweden2011Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 21, nr 6, s. 788-792Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    The aims of this study were: (i) to investigate stillbirth risk in offspring to foreign-born

    women by region of birth; (ii) if disparities in risks can be explained by socio-economic factors,

    pregnancy complications or maternal morbidity; and (iii) if the risk varies by time since immigration.

    Methods:

    This was a population-based register study with data from the Swedish Medical Birth Register

    and socio-economic variables from national income and population registers. We studied single births

    from 1992 to 2005, and included 219 832 births to foreign-born women and 1 094 146 births to

    Swedish-born women. Logistic regression analysis was used to calculate odds ratios (ORs), using 95%

    confidence intervals (CIs).

    Results:

    In all, 4104 antepartal and 255 intrapartal stillbirths occurred.

    Compared with births to Swedish women, the OR of stillbirth was 2.27 (95% CI 1.84–2.80) for births

    to women from Africa and 1.41 (95% CI 1.22–1.64) for births to women from Middle East, after

    adjustment for confounding factors. The risk of stillbirth was higher in immigrants who had been in

    Sweden for a short time period (<5 years) compared with those who had been in Sweden for a longer

    period, OR 1.21 (95% CI 1.05–1.40).

    Conclusions:

    The risk of stillbirth in immigrant women varies

    by region of birth and time since immigration, being highest in women from Africa and the Middle

    East, and the recently settled. Further studies are needed to identify the mechanisms behind

    these patterns.

     

  • 31.
    Engdahl, Barbro
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD).
    Ramstedt, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD).
    Is the population level link between drinking and harm similar for women and men?: a time series analysis with focus on gender-specific drinking and alcohol-related hospitalizations in Sweden2011Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 21, nr 4, s. 432-437Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A question that has not been addressed in the literature is whether the population level association between alcohol and harm differs between men and women. The main aim of this article is to fill this gap by analysing recently collected time series data of male and female self-reported drinking in relation to gender-specific harm indicators in Sweden. Methods: Male and female per capita and risk consumption was estimated on the basis of self-reported data from monthly alcohol surveys for the period 2002-07. Overall per capita consumption including recorded sales and estimates of unrecorded consumption were also collected for the same period. Alcohol-related hospitalizations were used as indicators of alcohol-related harm. Data were aggregated into quarterly observations and analysed by means of time series analyses (ARIMA-modelling). Results: Overall per capita consumption was significantly related to both male and female alcohol-related hospitalizations. Male per capita consumption and risk consumption were also significantly related to alcohol-related hospitalizations among men. Female per capita consumption and risk consumption had also a positive association with alcohol-related hospitalizations but statistical significance was only reached for alcohol poisonings where the association was even stronger than for men. Conclusions: Changes in alcohol consumption in Sweden was associated with changes in male and female alcohol-related hospitalizations also in analyses based on gender-specific consumption measures. There was no clear evidence that the population level association between alcohol and harm differed between men and women.

  • 32. Engström, K.
    et al.
    Johnson, C.
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Can social capital explain mental health inequalities between immigrant groups?2014Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, s. 57-58Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background

    Nearly 15% of Sweden’s population are immigrants and research has shown them to be one of the most susceptible groups to mental ill-health. The variance in mental health status can to a large extent be explained by different post-migrant factors. Social capital has been suggested to partly explain health inequalities between social groups and may be specifically important with regard to health inequalities between immigrant groups, due to its affinity with the concept of integration. This study aims to explore to what extent social capital can help to explain mental health inequalities between Swedish born and different immigrant groups.

    Methods

    The project is based on data from the Stockholm Public Health Cohort (SPHC). The SPHC combines information from repeated self-administered questionnaires, 2002 an onwards, with information from national and regional registers on a randomized sample of the adult population in Stockholm County. We employed a cross-sectional design using baseline data from 51,715 individuals from the SPHC. Mental health was measured using the 12-item General Health Questionnaire. Social capital was measured using indicators of bonding, bridging, and linking social capital. Immigrant status was decided depending on reason for immigration (refugee/labor). Mediation was tested using step-wise logistic regression.

    Results

    The results show that refugees had greater risk of mental ill-health than labor immigrants. Among men both refugees and labor immigrants had greater risk of mental ill-health than Swedish born, which was true only for refugees among women. No significant differences in mental ill-health between Swedish born, labor immigrants and refugees remained after adjusting for social capital indicators.

    Conclusions

    Immigrants in Sweden have greater risk of mental ill-health than Swedish born, both among men and women. Social capital seemed to explain most of the differences in mental ill-health between Swedish born and different immigrant groups. Increased knowledge of how social capital might mediate the effect of immigration status on mental health may be of significance for a variety of policy measures taken in the public-health arena and a step towards identifying elements of improvement of the integration process.

  • 33.
    Erikson, Robert
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutet för social forskning (SOFI).
    Torssander, Jenny
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutet för social forskning (SOFI).
    Social class and cause of death2008Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, nr 5, s. 473-478Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous studies have shown that causes of death differ in their relationship to social class, but we lack a more comprehensive description of this variation. The present study provides a detailed and extensive list of social class differences for a large number of specific causes of death.

    Methods: All deaths between 1991 and 2003 in Sweden were linked with information on household social class from 1990. Relative death risks and excess mortality in groups of causes according to the European shortlist were estimated separately for men and women in eight classes using Cox Regression.

    Results: A clear mortality gradient among employees was found for the majority of causes, from low-relative death risks among higher managerial and professional occupations to relatively high risks for the unskilled working class. There is considerable variation in the strength of the association, from causes such as malignant melanoma, breast cancer and transport accidents among women, where no clear class differences were found. At the other extreme, mental and behavioural disorders, endocrine, nutritional and metabolic diseases and diseases of the respiratory system all show steep slopes for both men and women. Circulatory diseases and cancer together account for 15–20% of excess mortality.

    Conclusions: Exceptions to the general pattern—causes of death in which higher social classes are exposed to greater death risks or in which there is no mortality gradient—are practically non-existent. There is nevertheless significant variation in the strength of the class differences in specific causes.

  • 34.
    Fallesen, Peter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutet för social forskning (SOFI). ROCKWOOL Foundation, Denmark.
    The association between type of conception through medically assisted reproduction and childhood cognition: a Danish population-wide cohort study 2023Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, nr 6, s. 1020-1026Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous research has indicated that children conceived through medically assisted reproduction (MAR) generally have cognitive outcomes comparable to or better than naturally conceived children. However, previous studies have been limited in their ability to examine this relationship at a population level and consider variations across different types of MAR. Methods: This study utilizes data from all live births in Denmark between 2006 and 2009 (n = 259 608), including a subset of births resulting from MAR conceptions (n = 13 566). The dependent variable is the standardized test scores obtained in the second and third grades of primary schools. A comparison is made between the test scores of children spontaneously conceived (SC) and those conceived through intrauterine insemination (IUI) and assisted reproductive technologies (ART). Ordinary least squares regressions are employed, with a baseline model adjusted only for birth year, as well as models that additionally account for conception-related confounders and sociodemographic family characteristics. Results: In the baseline analysis, ART- and IUI-conceived children displayed better test scores compared with their SC peers. However, after adjusting for relevant factors, ART-conceived children performed worse than SC peers, while IUI-conceived children performed equally well as SC peers and better than ART-conceived children. Conclusions: These results likely reflect differences in the selection process of potential parents into the type of MAR, as well as the consequences of variations in fecundability. Nevertheless, the differences observed across conception types were overshadowed by test score disparities in socioeconomic background.

  • 35. Floderus, Birgitta
    et al.
    Hagman, Maud
    Aronsson, Gunnar
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Marklund, Staffan
    Wikman, Anders
    Medically certified sickness absence with insurance benefits in women with and without children2012Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, nr 1, s. 85-92Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Sickness absence in Sweden is high, particularly in young women and the reasons are unclear. Many Swedish women combine parenthood and work and are facing demands that may contribute to impaired health and well-being. We compared mothers and women without children under different conditions, assuming increased sickness absence in mothers, due to time-based stress and psychological strain. Methods: All women born in 1960-79 (1.2 million) were followed from 1993 to 2003. Information on children in the home for each year was related to medically certified sickness absence with insurance benefits the year after. We used age and time-stratified proportional hazard regression models accounting for the individual's changes on study variables over time. Data were retrieved from national administrative registers. Results: Sickness absence was higher in mothers than in women without children, the relative risks decreased by age, with no effect after the age of 35 years. An effect appeared in lonely women irrespective of age, while in cohabiting women only for the ages 20-25 years. Mothers showed increased sickness absence in all subgroups of country of birth, education, income, sector of employment and place of residence. The relation between number of children and sickness absence was nonlinear, with the highest relative risks for mothers of one child. The upward trend of sickness absence at the end of 1990s was steeper for mothers compared to women without children. Conclusion: Despite the well-developed social security system and child care services in Sweden, parenthood predicts increased sickness absence, particularly in young and in lone women.

  • 36.
    Fors, Stefan
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Lennartsson, Carin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Lundberg, Olle
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Health inequalities among older adults in Sweden 1991–20022008Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, nr 2, s. 138-143Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Current research has shown a decline in health amongolder adults in Sweden. This study examines health inequalitiesamong older adults in Sweden in 1991–1992 and 2000–2002and explores the development of these inequalities during thisperiod.

    Methods: A data set was constructed out of four levelsof living surveys, comprising 4085 individuals aged 55 and above.Multivariate logistic regressions were used to assess the associationbetween social class, sex, age and four different domains ofself-reported health: global self-rated health, impaired mobility,musculoskeletal pain and psychological distress. Adjustmentswere made for period of interview. Interaction terms were alsoused to assess change over time. Levin's attributable risk wasused to assess the magnitude of the health inequalities.

    Results:The results indicate an increase in reports of all specifichealth problems, but not in the global health measure duringthe period. Significant sex differences and a clear social gradientin health were discernible during both periods. Women were morelikely than men to report problems with impaired mobility, painand psychological distress. Manual workers were significantlymore likely than non-manuals to report problems in all fourdomains of health. However, both the sex differences and thesocial gradient seemed to remain constant during the period.

    Conclusion: Although it seems there are significant differencesin health depending on sex and social class among older adultsin Sweden, these inequalities appear to be unaffected by thegeneral increase in ill health that has been observed in thesegroups over the last decade.

  • 37.
    Gauffin, Karl
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Östergren, Olof
    Department of Public Health Sciences, Stockholm University , Stockholm, Sweden;Aging Research Center (ARC), Karolinska Institutet , Solna, Sweden.
    Cederström, Agneta
    Department of Public Health Sciences, Stockholm University , Stockholm, Sweden.
    Waves of inequality: income differences in intensive care due to Covid-19 in Sweden2023Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, nr 4, s. 574-579Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Socioeconomically vulnerable groups were overall more likely to develop severe Covid-19, but specific conditions in terms of preparedness, knowledge and the properties of the virus itself changed during the course of the pandemic. Inequalities in Covid-19 may therefore shift over time. This study examines the relationship between income and intensive care (ICU) episodes due to Covid-19 in Sweden during three distinct waves.

    Methods: This study uses Swedish register data on the total adult population and estimates the relative risk (RR) of ICU episodes due to Covid-19 by income quartile for each month between March 2020 and May 2022, and for each wave, using Poisson regression analyses.

    Results: The first wave had modest income-related inequalities, while the second wave had a clear income gradient, with the lowest income quartile having an increased risk compared to the high-income group [RR: 1.55 (1.36–1.77)]. In the third wave, the overall need for ICU decreased, but RRs increased, particularly in the lowest income quartile [RR: 3.72 (3.50–3.96)]. Inequalities in the third wave were partly explained by differential vaccination coverage by income quartile, although substantial inequalities remained after adjustment for vaccination status [RR: 2.39 (2.20–2.59)].

    Conclusions: The study highlights the importance of considering the changing mechanisms that connect income and health during a novel pandemic. The finding that health inequalities increased as the aetiology of Covid-19 became better understood could be interpreted through the lens of adapted fundamental cause theory.

    Fulltekst (pdf)
    Gauffin et al 2023
  • 38.
    Goodman, Anna
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS). London School of Hygiene and Tropical Medicine, United Kingdom.
    Heshmati, Amy
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Koupil, Ilona
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Family history of education predicts eating disorders across multiple generations: a study of one million Swedish females born 1973-19982013Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, s. 108-108Artikkel i tidsskrift (Annet vitenskapelig)
  • 39.
    Goodman, Anna
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS). London School of Hygiene and Tropical Medicine, United Kingdom.
    Heshmati, Amy
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Malki, N.
    Koupil, Ilona
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Associations between birth characteristics and eating disorders across the life course: findings from 2 million Swedish males and females born 1975-19982013Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, s. 108-109Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction

    Results on developmental origins of eating disorders (ED) have been conflicting, with low power in many studies. We studied the effect of birth characteristics including twin/triplet status; gestational age; birthweight; birthlength; delivery method; Apgar score; birth traumas; mother’s smoking and weight gain during pregnancy.

    Methods

    From a total population data, we created a cohort of 2,011,908 males and females born to Swedish-born mothers in Sweden 1975-1998. We adjusted for multiple family and social characteristics, and conducted within-family analyses to test for family-level confounding. Outcomes were hospitalisation for anorexia, bulimia or ‘eating disorder not-otherwise-specified’ after age 12, with follow-up to end 2010.

    Results

    Anorexia was independently predicted by multiple birth (adjusted hazard ratio (HR) 1.33 (95%CI 1.15-1.53) for twin/triplet vs. singleton) and by lower gestational age (HR 0.96 (0.95-0.98) per extra week of gestation). These associations were specific to anorexia, and were only seen in the cohort members affected – within-family analyses revealed that the maternal siblings of twins or preterm individuals showed no increased risk. Higher birthweight for gestational age showed a strong association with bulimia (HR 1.15 (1.09-1.22) per sex-standardised standard deviation increase). This association was specific to bulimia and within-family analyses provided no evidence of residual family-level confounding.

    Discussion

    Our findings are consistent with a causal role of earlier gestational age upon anorexia and higher birthweight upon bulimia. Further research is needed to elucidate the mechanisms, but the dose-response nature of these associations indicates that they do not simply reflect pathological responses at the extremes of the distribution. The strong association with multiple births is noteworthy as many of the best population-based studies of ED prevalence have been conducted in twins and might thus have overestimated ED prevalence.

    Key messages

    • Our findings are consistent with a causal role of earlier gestational age upon anorexia and higher birthweight upon bulimia.

    • Anorexia was independently predicted by multiple birth.

  • 40.
    Hagqvist, Emma
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Stressforskningsinstitutet. Karolinska Institutet, Sweden.
    Lidwall, Ulrik
    Leineweber, Constanze
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Stressforskningsinstitutet.
    Is work-life interference a risk factor for sickness absence? A longitudinal study of the Swedish working population2022Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, nr 3, s. 398-401Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: While there is increasing literature on the health effects of work–life interference, few studies have investigated the relationship between a direct measure of work–life interference and objective sickness absence measures. The aim of this study is to investigate whether work–life interference is a risk factor for subsequent long-term sickness absence (LTSA). Methods: Data were derived from the Swedish Longitudinal Occupational Survey of Health 2010, 2012, 2014 and 2016. Data were linked to register data on LTSA (having at least one continuous period of medically certified sick leave exceeding 14 days) the following 2 years after each data collection wave. We applied generalized estimating equations, odds ratios (ORs) and 95% confidence intervals (CIs). The sample included 15 244 individuals (43.1% men and 56.9% women). Nearly a fifth of the sample (18.7%, n = 1110) started at least one period of LTSA at any point between 2010 and 2018. Results: Work–life interference was found to be a risk factor for subsequent LTSA (OR = 1.55; 95% CI = 1.44–1.67) even when adjusting for relevant factors including general health (OR = 1.39; 95% CI = 1.29–1.51). We found no significant moderating effect of gender. Conclusion: The results of this study indicate that work–life interference is a risk factor for subsequent LTSA for working men and women in Sweden.

  • 41.
    Halonen, Jaana
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Stressforskningsinstitutet.
    Chandola, Tarani
    Hyde, Martin
    Leinonen, Taina
    Westerlund, Hugo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Stressforskningsinstitutet.
    Aalto, Ville
    Pentti, Jaana
    Laaksonen, Mikko
    Stenholm, Sari
    Mänty, Minna
    Vahtera, Jussi
    Oksanen, Tuula
    Kivimäki, Mika
    Virtanen, Marianna
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Stressforskningsinstitutet.
    Lallukka, Tea
    Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress2020Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, nr 1, s. 158-163Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Retirement has been associated with improved mental health, but it is unclear how much this is due to the removal of work-related stressors. We examined rates of psychotropic medication use before and after the transition to disability retirement due to mental, musculoskeletal and other causes by pre-retirement levels of perceived work stress (effort-reward imbalance, ERI). Methods: Register-based date and diagnosis of disability retirement of 2766 participants of the Finnish Public Sector study cohort were linked to survey data on ERI, socialand health-related covariates, and to national records on prescribed reimbursed psychotropic medication, measured as defined daily doses (DDDs). Follow-up for DDDs was 2–5 years before and after disability retirement. We assessed differences in the levels of DDDs before and after retirement among those with high vs. low level of pre-retirement ERI with repeated measures regression. Results: Those with high (vs. low) levels of ERI used slightly more psychotropic medication before disability retirement due to mental disorders [rate ratio (RR) 1.14, 95% confidence intervals (CI) 0.94–1.37], but after retirement this difference attenuated (RR 0.94, 95% CI 0.80–1.10, P for interaction 0.02). Such a change was not observed for the other causes of disability retirement. Conclusions: The level of psychotropic medication use over the transition to disability retirement due to mental, but not musculoskeletal or other, causes was modified by pre-retirement perceived work-related stress. This suggests that among people retiring due to mental disorders those who had stressful jobs benefit from retirement more than those with low levels of work-related stress.

  • 42. Head, Jenny
    et al.
    Chungkham, Holendro Singh
    Hyde, Martin
    Zaninotto, Paola
    Alexanderson, Kristina
    Stenholm, Sari
    Salo, Paula
    Kivimäki, Mika
    Goldberg, Marcel
    Zins, Marie
    Vahtera, Jussi
    Westerlund, Hugo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Socioeconomic differences in healthy and disease-free life expectancy between ages 50 and 75: a multi-cohort study2019Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr 2, s. 267-272Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There are striking socioeconomic differences in life expectancy, but less is known about inequalities in healthy life expectancy and disease-free life expectancy. We estimated socioeconomic differences in health expectancies in four studies in England, Finland, France and Sweden. Methods: We estimated socioeconomic differences in health expectancies using data drawn from repeated waves of the four cohorts for two indicators: (i) self-rated health and (ii) chronic diseases (cardiovascular, cancer, respiratory and diabetes). Socioeconomic position was measured by occupational position. Multistate life table models were used to estimate healthy and chronic disease-free life expectancy from ages 50 to 75. Results: In all cohorts, we found inequalities in healthy life expectancy according to socioeconomic position. In England, both women and men in the higher positions could expect 82-83% of their life between ages 50 and 75 to be in good health compared to 68% for those in lower positions. The figures were 75% compared to 47-50% for Finland; 85-87% compared to 77-79% for France and 80-83% compared to 72-75% for Sweden. Those in higher occupational positions could expect more years in good health (2.1-6.8 years) and without chronic diseases (0.5-2.3 years) from ages 50 to 75. Conclusion: There are inequalities in healthy life expectancy between ages 50 and 75 according to occupational position. These results suggest that reducing socioeconomic inequalities would make an important contribution to extending healthy life expectancy and disease-free life expectancy.

  • 43. Hedna, Khedidja
    et al.
    Hensing, Gunnel
    Skoog, Ingmar
    Fastbom, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Waern, Margda
    Sociodemographic and gender determinants of late-life suicide in users and non-users of antidepressants2020Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, nr 5, s. 958-964Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The treatment of depression is a main strategy for suicide prevention in older adults. Our aim was to examine factors related to suicide in older adults (75+) with and without antidepressant (AD) therapy. Methods: A national population-based register study, including all Swedish residents aged >= 75 years between 2006 and 2014 (N = 1 413 806). A nested case-control design was used to investigate sociodemographic factors associated with suicide among users and non-users of ADs. Risk estimates were calculated in adjusted conditional logistic regression models for the entire cohort and by gender. Results: In all, 1305 individuals died by suicide (70% men). The suicide rate in men who used ADs was over four times higher than women with such treatment. Being unmarried was a risk factor for suicide in men but not in women. Being born outside of Nordic countries was associated with increased suicide risk; a 3-fold risk increase was observed in non-Nordic women without AD treatment. Lower suicide risk was observed in blue-collar women who used ADs, whereas a higher risk was found in blue-collar men who did not. Conclusions: Our differential findings on factors associated with suicide can offer clues for gender-specific preventive strategies that go beyond the healthcare sphere.

  • 44. Helgadóttir, Björg
    et al.
    Svedberg, Pia
    Mather, Lisa
    Lindfors, Petra
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Arbets- och organisationspsykologi.
    Bergström, Gunnar
    Blom, Victoria
    The association between part-time and temporary employment and sickness absence: A prospective Swedish twin study2019Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr 1, s. 147-153Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Sickness absence (SA) is becoming a major economic problem in many countries. Our aim was to investigate whether type of employment, including temporary employment or part-time employment, is associated with SA while controlling for familial factors (genetic and shared environment). Differences between men and women and across employment sectors were explored.

    Methods: This is a prospective twin study based on 21 105 twins born in Sweden 1959–85. The participants completed a survey in 2005 with follow-up of SA (≥15 days), using register data, until end of 2013. The data were analyzed with logistic regression, with results presented as odds ratios (OR) with 95% confidence intervals (CI).

    Results: Temporary employment involved higher odds of SA (OR=1.21 95% CI=1.04–1.40) compared to full-time employment. Both part-time workers (OR=0.84 95% CI=0.74–0.95) and the self-employed (OR=0.77 95%CI=0.62–0.94) had lower odds of SA. Stratifying by sex showed lower odds for part-timers (OR=0.82 95% CI=0.73–0.94) and self-employed women (OR=0.65 95% CI=0.47–0.90), but higher odds for men in temporary employment (OR=1.33 95% CI=1.03–1.72). Temporary employees in county councils (OR=1.73 95% CI=1.01–2.99) and municipalities (OR=1.41 95% CI=1.02–1.96) had higher odds while part-timers employed in the private sector had lower odds (OR=0.77 95% CI=0.64–0.93). Familial factors did not confound the association between employment type and SA.

    Conclusions: Employment type is associated with SA, with temporary employment involving a higher risk compared to permanent full-time employment while both part-time employment and self-employment involved a lower risk. The associations vary between women and men and across sectors.

  • 45.
    Hjern, Anders
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rajmil, Luis
    Bergström, Malin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Berlin, Marie
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen. National Board of Health and Welfare .
    Gustafsson, Per A.
    Modin, Bitte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Migrant density and well-being - A national school survey of 15-year-olds in Sweden2013Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, nr 5, s. 823-828Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The aim of this study was to investigate the impact of migrant density in school on the well-being of pupils with a migrant origin in first as well as second generation. Methods: Cross-sectional analysis of data from a national classroom survey of 15-year-old Swedish schoolchildren. The study population included 76 229 pupils (86.5% participation) with complete data set from 1352 schools. Six dimensions of well-being from the KIDSCREEN were analysed in two-level linear regression models to assess the influence of migrant origin at individual level and percentage of students with a migrant origin at school level, as well as interaction terms between them. Z-scores were used to equalize scales. Results: A high density (>50%) of pupils with a migrant origin in first or second generation was associated with positive well-being on all six scales for foreign-born pupils originating in Africa or Asia compared with schools with low (<10%) migrant density. The effect sizes were 0.56 for boys and 0.29 for girls on the comprehensive KIDSCREEN 10-index (P<0.001) and 0.61 and 0.34, respectively, for psychological well-being (P<0.001). Of the boys and girls born in Africa or Asia, 31.6% and 34.6%, respectively, reported being bullied during the past week in schools with low (<10%) migrant density. Conclusions: Pupils born in Africa or Asia are at high risk for being bullied and having impaired well-being in schools with few other migrant children. School interventions to improve peer relations and prevent bullying are needed to promote well-being in non-European migrant children.                 

  • 46.
    Holowko, Natalie
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Mishra, G.
    Koupil, Ilona
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Social differences in pre-pregnancy body mass index (BMI) and gestational weight gain: an opportunity to reduce long-lasting inequality in maternal and offspring health2012Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, s. 43-43Artikkel i tidsskrift (Annet vitenskapelig)
  • 47.
    Honkaniemi, Helena
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Juárez, Sol Pia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Mental health by native-immigrant intermarriage in Sweden: a register-based retrospective cohort study2022Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, nr 6, s. 877-883Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 48. Hossin, Muhammad Zakir
    et al.
    Heshmati, Amy
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Karolinska Institute, Sweden.
    Koupil, Ilona
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Karolinska Institute, Sweden.
    Goodman, Anna
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. The University of Queensland, Australia.
    Mishra, Gita D.
    Latent class trajectories of socioeconomic position over four time points and mortality: the Uppsala Birth Cohort Study2022Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, nr 4, s. 522-527Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The study assessed socioeconomic position (SEP) over four time points and employed a latent class analysis (LCA) to explore the associations between longitudinal SEP trajectories and late-life mortality. Methods: We analyzed a cohort of 11 336 members born at the Uppsala University Hospital, Sweden during 1915–29 and followed up for mortality during 1980–2008. SEP was measured at birth, age 10, mid-adulthood and late adulthood. LCA was used to identify SEP trajectories, which were linked to all-cause and cause-specific mortality through Cox proportional hazard regression models. Results: The age and birth cohort adjusted hazard ratio (HR) of all-cause mortality among the upwardly mobile from middle vs. stable low SEP was 28% lower in men [HR: 0.72; 95% confidence interval (95% CI): 0.65, 0.81] and 30% lower in women (HR: 0.70; 95% CI: 0.62, 0.78). The corresponding HR of cardiovascular mortality was 30% lower in men (HR: 0.70; 95% CI: 0.60, 0.82) and 31% lower in women (HR: 0.69; 95% CI: 0.58, 0.83). Upward mobility was also associated with decreased HR of mortality from respiratory diseases and injuries among men and from cancer, respiratory diseases, injuries and mental disorders among women. The upwardly mobile were similar to the stable high group in terms of their HRs of mortality from all-causes and cardiovascular, cancer and mental diseases. Conclusions: Upward mobility appeared to be protective of mortality from a wide range of causes. Interventions aiming to prevent deaths can benefit from creating optimal conditions earlier in the life course, letting disadvantaged children maximize their socioeconomic and health potentials.

  • 49. Jansson, B.
    et al.
    Stenbacka, M.
    Leifman, A.
    Romelsjö, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD).
    A small fraction of patients with repetitive injuries account for a large proportion of medical costs2004Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 14, nr 2, s. 161-167Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    The phenomenon of repetitive injuries has been judged to be of limited importance in the public health context. A study was therefore initiated in order to analyse all types of single and repetitive injuries using a longitudinal approach.

    METHODS:

    Hospital care, medical costs and risk factors were examined for single and repetitive severe injuries. A cross-sectional survey with a 12-year follow-up was performed. Questionnaire information from a survey of a random sample of the adult population 20-89 years old in 1984 in Stockholm County were linked to the Swedish national inpatient and cause-of-death register up to 1996, inclusive.

    RESULTS:

    During the study period 13% of males and 15% of females were hospitalized or deceased as a result of injuries. Persons with three or more injuries comprise 19% of the injuries, but account for 63% of the total number of days of hospital care and medical costs. Injuries related to falls were most common among patients requiring hospital care. Factors such as high age, living alone, stroke earlier, and use of hypnotics and sedatives were especially associated with repetitive injuries. The risk factors for single and repetitive injuries covariate, but the size of the risk is overrepresented for stroke, drugs, self-reported injuries and living alone for two or more injuries.

    CONCLUSION:

    These results indicate that subjects with repetitive injuries, and with the observed risk factors for such injuries, should be given extra attention, both in policy and prevention, but also in integrated treatment programmes.

  • 50.
    Juárez, Sol
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Honkaniemi, Helena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Dunlavy, Andrea
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Aldridge, Robert
    Barreto, Mauricio
    Katikireddi, Srinivasa
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    A systematic review of evaluations of the health impacts of migration-oriented public policies2018Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, s. 24-24Artikkel i tidsskrift (Fagfellevurdert)
    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.

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