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  • 101.
    Wastesson, Jonas W.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Ringbäck Weitoft, Gunilla
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Socioeconomic inequalities in access to specialized psychotropic prescribing among older Swedes: a register-based study2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 6, p. 991-996Article in journal (Refereed)
    Abstract [en]

    Background: Mental disorders among older adults are mainly treated with psychotropic drugs. Few of these drugs are, however, prescribed by specialized geriatricians or psychiatrists, but rather from general practitioners (GPs). Socioeconomic inequalities in access to specialist prescribing have been found in younger age groups. Hence, we aimed to investigate whether there are socioeconomic differences in access to geriatrician and psychiatrist prescribing of psychotropic drugs among older adults. Methods: By record-linkage of The Swedish Prescribed Drug Register and The Swedish Education Register, we obtained information for persons aged 75-89 years who had filled a prescription for psychotropic drugs (antipsychotics, anxiolytics, hypnotic/sedatives or antidepressants) with information on prescriber specialty from July to October 2005 (n = 221 579). Multinomial regression analysis was used to investigate whether education was associated with geriatrician and psychiatrist prescribing of psychotropic drugs. Results: The vast majority of the psychotropic drugs were prescribed by 'GPs and other specialists' (similar to 95% GPs). Older adults with higher educational level were more likely to be prescribed psychotropic drugs from psychiatrists and geriatricians. However, after adjustment for place of residence, the association between patient's education and prescription by a geriatrician disappeared, whereas the association with seeing a psychiatrist was only attenuated. Conclusion: Access to specialized prescribing of psychotropics is unequally distributed between socioeconomic groups of older adults in Sweden. This finding was partially confounded by place of residence for geriatrician but not for psychiatrist prescribing. Further research should examine if inequalities in specialized psychotropic prescribing translate into worse outcomes for socioeconomically deprived and non-metropolitan-living older individuals.

  • 102. Yao, Honghui
    et al.
    Junna, Liina
    Hu, Yaoyue
    Sha, Xinping
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Helsinki, Finland; The Max Planck Institute for Demographic Research, Rostock, Germany.
    The relationship of income on stroke incidence in Finland and China2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 3, p. 360-365Article in journal (Refereed)
    Abstract [en]

    Background: Stroke incidence has continued to increase recently in most countries. The roles of individual-level income on the incidence of overall stroke and its subtypes are still unknown, especially in low- and middle-income countries and the cross-national evidence is also limited. We explored the association between individual-level income and stroke incidence in Finland and China. Methods: Changde Social Health Insurance Database (N=571 843) and Finnish population register (N=4 046 205) data were used to calculate standard stroke incidence rates, which were employed to assess the absolute incidence difference between income quintiles. Cox regression was used to compare income differences in first-ever stroke incidence. Results: The highest income quintile had lower overall and subtype stroke incidence when compared to lower-income quintiles. The relative difference was more evident in hemorrhagic stroke incidence. After adjusting for age and employment status, the disparity of stroke incidence between the lowest and highest income quintiles was high among both men and women and in Finland and China. The disparity was particularly notable among men: in Finland, the hazard ratio (HR) for hemorrhagic stroke was 0.633 [95% confidence interval (95% CI) 0.576–0.696] and HR 0.572 (95% CI 0.540–0.606) for ischemic stroke. The respective figures were HR 0.452 (95% CI 0.276–0.739) and HR 0.633 (95% CI 0.406–0.708) for China. Conclusions: Individual-level income is related to overall and subtype stroke incidence. Future studies should explore the causal relationship between individual-level income and stroke incidence.

  • 103.
    Åberg Yngwe, Monica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The family's economic resources and adolescents' health complaints - do adolescents' own economic resources matter? 2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 1, p. 24-29Article in journal (Refereed)
    Abstract [en]

    Background: The present study focuses on the relevance of economic resources to psychological and psychosomatic health complaints during adolescence. It explores the link between the family's and the adolescent's economic resources and investigates whether or not differences in health complaints by the family's financial situation can be explained by adolescents' own economic resources. Methods: Drawing on data from two Swedish surveys on living conditions during adolescence (in the age group 10-18 years) conducted in 2002-03, logistic regressions were used to assess the associations between adolescents' own and household economic resources on two measures of health complaints. Results: The association between family economic hardship (i.e. lack of cash margin) and adolescents' health complaints largely disappeared when controlling for adolescents' own economic resources. Three measures of own absolute and relative economic resources were used. Out of these, the ability (or not) to buy things that others have was connected with both psychological [Odds ratio (OR) 2.16, 95% confidence interval (95% CI) 1.6-2.9] and psychosomatic complaints (OR 1.67, 95% CI 1.3-2.1), irrespective of age and gender. The importance of lacking a personal cash margin or not being able to join friends seemed to differ between age groups and genders. Conclusions: The importance of different aspects of economic resources seems to vary across age groups and gender. However, not being able to buy things that others have was clearly associated with health complaints irrespective of age and gender. Family economic hardship was associated with adolescents' health complaints, and this association was largely explained by adolescents' own economic resources.

  • 104.
    Östberg, Viveca
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Folkesson, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Triangulation of stress in adolescence2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no supplement 2, p. 220-220Article in journal (Refereed)
    Abstract [en]

    Large scale surveys show that perceived stress and stress-related complaints are common among young people. Perceived stress increase with age and are more common in girls than boys, resulting in late adolescent girls reporting the highest frequencies. The knowledge is however more limited regarding other measurements and meanings of stress. The purpose of this study is to use a small-scale multiple methods data collection to perform an empirical triangulation of stress in the age group 14–15 years, i.e. to analyse stress, and gender differences in stress, as it appears in questionnaires, biomarkers and interviews within the same population. The study population includes all pupils in the 8th and 9th grades (ages 14–16 years) in two elementary schools in Stockholm, Sweden (n = 545). The data collection was divided into three parts where information was gathered through class room questionnaires (n = 413), saliva sampling (5 time points during the day, number of students delivering complete samples = 190) and semi-structured qualitative interviews (49 pupils in grade 8, mean length 50 minutes).

    In the questionnaires, girls consistently report higher levels of perceived stress. This is true for the activation scale (mean value boys = 2.51, girls = 3.11, p < 0.00) and the pressure scale (boys = 2.62, girls = 3.33, p < 0.00). According to the saliva sampling, girls have higher cortisol concentration both at awakening and 30 minutes later (p < 0.00). According to the qualitative interviews, no distinct differences in boys’ and girls’ associations with the word “stress” were found. However, both male and female interviewees had a perception of girls being more stressed about schoolwork than boys. Many times they linked this to girls way of thinking or coping with life demands, including worries about the future. In conclusion, the picture of adolescent girls being more stressed than boys is largely confirmed by all methods used here.

  • 105.
    Östberg, Viveca
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Låftman Brolin, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Inequalities in subjective health complaints in Swedish adolescents: An intersectional approach2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1Article in journal (Other academic)
    Abstract [en]

    Background

    Health inequality has been defined as the association between individuals’ health and their position in societal hierarchies. Such associations can be used as a starting-point in the search for social determinants of health. With regard to subjective health complaints among adolescents the evidence of socio-economic inequalities has been inconclusive. Inequalities by gender are, in contrast, clear and a female excess emerge or increase during adolescence. The aim of this study is to apply an intersectional approach and analyse differences in health complaints by parental education among girls and boys, taking age into account. Furthermore, data with information from both adolescents and their parents will be used which is ideal since adolescents seldom have correct information on parental education.

    Methods

    The data was obtained from a Swedish nationally representative survey (ULF) and its child supplement (Child-ULF) from the years 2007-2011 (n = 5280). Subjective health complaints were reported by adolescents (aged 10-18) and measures indicating psychological (e.g. feeling sad) and somatic complaints (i.e. head- and stomach ache) calculated. Information on education was obtained for one parent and five educational groups distinguished. Binary logistic regression was used and odds ratios with 95% confidence limits computed.

    Results

    Among girls, a clear gradient was found. From higher to lower level of parental education the odds ratios for psychological complaints were; 1.00 (ref); 1.07 (0.7-1.6); 1.38 (1.0-2.0); 1.73 (1.3-2.4); 2.05 (1.3-3.3); and for somatic complaints; 1.00 (ref); 1.27 (0.8-1.9); 1.55 (1.1-2.3); 1.69 (1.2-2.4); 2.82 (1.8-4.5). No association was found among boys. Gender differences per se were pervasive and, in ages where female excess is present, substantial within all educational groups.

    Conclusions

    The higher burden of subjective health complain

  • 106.
    Östberg, Viveca
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Wells, Laura
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Inequalities in young adult frequency and quantity of alcohol use in a longitudinal Swedish sample2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Alcohol-related mortality is more prevalent in disadvantaged socioeconomic groups. Yet the relationship between socioeconomic position and alcohol use in young adulthood, when alcohol is often consumed in high quantities, is not well understood and findings are inconclusive. In this study, our aim was to examine whether two often-conflated dimensions of alcohol use (i.e., frequency and quantity) in young adulthood associate with parental educational attainment. We also explored whether parental alcohol use (same two dimensions) or young adult educational attainment may help explain this association.

    Methods

    Data was collected from two waves (2000 & 2010) of the Swedish Level of Living Survey, with parents surveyed ten years before the young adults. Young adults’ (N = 803) risk of daily/weekly and monthly drinking, relative to less frequent drinking, was analysed by multinomial logistic regression and estimated as relative risk ratios (RR); episodic heavy drinking was assessed through binary logistic regression and estimated as odds ratios (OR).

    Results

    Young adults whose parents held a compulsory (versus tertiary) degree were less likely to drink daily/weekly (RR = 0.18, 95% CI [0.07, 0.47]) but more likely to drink heavily (OR = 2.67, 95% CI [1.17, 6.06]). The same dimensions of alcohol use were associated across generations but did not explain inequalities by parental educational attainment. Accounting for young adult educational attainment left an independent effect of parental compulsory education (RR = 0.27, 95% CI [0.10, 0.73]) on young adult daily/weekly drinking.

    Conclusions

    Parental educational attainment can be viewed as an early-life structural factor that confers differential risk for young adult alcohol use, depending on the dimension of use: high educational attainment is a risk factor for frequent drinking while low educational attainment is a risk factor for episodic heavy drinking.

  • 107.
    Östergren, Olof
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Korhonen, Kaarina
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Home and away: mortality among Finnish-born migrants in Sweden compared to native Swedes and Finns residing in Finland2021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no 2, p. 321-325Article in journal (Refereed)
    Abstract [en]

    Background: Most first-generation migrants have lower mortality compared to the native population. Finnish-born migrants in Sweden instead have higher mortality; possibly because of health behaviours established before migration. To increase our understanding of this excess mortality, we compared the cause-specific mortality of Finnish migrants in Sweden to both the native population of Sweden and the native Finnish population residing in Finland.

    Methods: We used Swedish and Finnish register data, applying propensity score matching techniques to account for differences in sociodemographic characteristics between the migrants, Swedes and Finns. The index population were Finnish migrants aged 40–60, residing in Sweden in 1995. We compared patterns of all-cause, alcohol- and smoking-related, and cardiovascular disease mortality across the groups in the period 1996–2007.

    Results: Finnish migrant men in Sweden had lower all-cause mortality compared to Finnish men but higher mortality compared to the Swedish men. The same patterns were observed for alcohol-related, smoking-related and cardiovascular disease mortality. Among women, all three groups had similar levels of all-cause mortality. However, Finnish migrant women had higher alcohol-related mortality than Swedish women, similar to Finnish women. Conversely, migrant women had similar levels of smoking-related mortality to Swedish women, lower than Finnish women.

    Conclusions: Finnish-born migrants residing in Sweden have mortality patterns that are typically in between the mortality patterns of the native populations in their country of origin and destination. Both the country of origin and destination need to be considered in order to better understand migrant health.

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  • 108.
    Östergren, Olof
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rehnberg, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Miething, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Disruption and selection: the income gradient in mortality among natives and migrants in Sweden2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 3, p. 372-377Article in journal (Refereed)
    Abstract [en]

    Background 

    The income gradient in mortality is generated through an interplay between socio-economic processes and health over the life course. International migration entails the displacement of an individual from one context to another and may disrupt these processes. Furthermore, migrants are a selected group that may adopt distinct strategies and face discrimination in the labour market. These factors may have implications for the income gradient in mortality. We investigate whether the income gradient in mortality differs by migrant status and by individual-level factors surrounding the migration event.

    Methods

    We use administrative register data comprising the total resident population in Sweden aged between 30 and 79 in 2015 (n = 5.7 million) and follow them for mortality during 2015-17. We estimate the income gradient in mortality by migrant status, region of origin, age at migration and country of education using locally estimated scatterplot smoothing and Poisson regression.

    Results

    The income gradient in mortality is less steep among migrants compared with natives. This pattern is driven by lower mortality among migrants at lower levels of income. The gradient is less steep among distant migrants than among close migrants, migrants that arrived as adults compared with children and migrants that received their education in Sweden as opposed to abroad.

    Conclusions

    Our results are consistent with the notion that income inequalities in mortality are generated through life-course processes that may be disrupted by migration. Data restrictions prevent us from disentangling life-course disruption from selection into migration, discrimination and labour market strategies.

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