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  • 151. Bråbäck, L.
    et al.
    Vogt, H.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Migration and asthma medication in international adoptees and immigrant families in Sweden2011In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 41, no 8, p. 1108-1115Article in journal (Refereed)
    Abstract [en]

    Background Studies of asthma in migrant populations illustrate the effects of environmental changes.

    Objective In this register study we investigated the importance of exposure to a western lifestyle in different phases of development in Swedish residents with an origin in regions in the world where asthma usually is less prevalent.

    Methods The study population comprised 24 252 international adoptees, 47 986 foreign-born and 40 971 Swedish-born with foreign-born parents and 1 770 092 Swedish-born residents with Swedish-born parents (age 6–25 years). Purchased prescribed inhaled corticosteroids (ICS) during 2006 were used as an indicator of asthma.

    Results International adoptees and children born in Sweden by foreign-born parents had three- to fourfold higher rates of asthma medication compared with foreign-born children. The odds ratios (ORs) of asthma medication declined persistently with age at immigration. For adoptees the ORs compared with infant adoptees were 0.78 [95% confidence interval (CI) 0.71–0.85] for those adopted at 1–2 years, 0.51 (0.42–0.61) at 3–4 years and 0.35 (0.27–0.44) after 5 or more years of age. Corresponding ORs for foreign-born children with foreign-born parents immigrating at 0–4 years, at 5–9 years, at 10–14 years and at 15 years or more were 0.73 (0.63–0.86), 0.56 (CI 0.46–0.68) and 0.35 (CI 0.28–0.43), respectively. The ORs were only marginally affected by adjustment for region of birth and socio-economic indicators.

    Conclusions and Clinical Relevance Age at immigration is a more important determinant of purchased ICS than population of origin. This indicates the importance of environmental factors for asthma in schoolchildren and young adults.

  • 152. Bråbäck, Lennart
    et al.
    Ekéus, Cecilia
    Lowe, Adrian J
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Confounding with familial determinants affects the association between mode of delivery and childhood asthma medication - a national cohort study2013In: Allergy, Asthma & Clinical Immunology, ISSN 1710-1484, E-ISSN 1710-1492, Vol. 9, no 14Article in journal (Refereed)
    Abstract [en]

    Background: Mode of delivery may affect the risk of asthma but the findings have not been consistent and factors shared by siblings may confound the associations in previous studies.

    Methods: The association between mode of delivery and dispensed inhaled corticosteroid (ICS) (a marker of asthma) was examined in a register based national cohort (n=199 837). A cohort analysis of all first born children aged 2-5 and 6-9 years was performed. An age-matched sibling-pair analysis was also performed to account for shared genetic and environmental risk factors.

    Results: Analyses of first-borns demonstrated that elective caesarean section was associated with an increased risk of dispensed ICS in both 2-5 (adjusted odds ratio (aOR)=1.19, 95% confidence interval (CI) 1.09-1.29) and 6-9 (aOR=1.21, 1.09-1.34) age groups. In the sibling-pair analysis, the increased risk associated with elective caesarean section was confirmed in 2-5 year olds (aOR=1.22, 1.05-1.43) but not in 6-9 year olds (aOR=1.06, 0.78-1.44). Emergency caesarean section and vacuum extraction had some association with dispensed ICS in the analyses of first-borns but these associations were not confirmed in the sibling-pair analyses.

    Conclusions: Confounding by familial factors affects the association between mode of delivery and dispensed ICS. Despite this confounding, there was some evidence that elective caesarean section contributed to a modestly increased risk of dispensed ICS but only up to five years of age.

  • 153. Bråbäck, Lennart
    et al.
    Lowe, Adrian
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Elective cesarean section and childhood asthma2013In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 209, no 5, p. 496-496Article in journal (Other academic)
  • 154. Bures, J.
    et al.
    Kopacova, M.
    Koupil, I.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vorisek, V.
    Rejchrt, S.
    Beranek, M.
    Seifert, B.
    Pozler, O.
    Zivny, P.
    Douda, T.
    Kolesarova, M.
    Pinter, M.
    Palicka, V.
    Holcik, J.
    the European Society for Primary Care Gastroenterology, and
    Epidemiology of Helicobacter pylori infection in the Czech Republic2006In: Helicobacter, Vol. 1, no 11, p. 56-65Article in journal (Refereed)
  • 155. Bures, J.
    et al.
    Kopacova, M.
    Koupil, I.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vorisek, V.
    Rejchrt, S.
    Beranek, M.
    Seifert, B.
    Pozler, O.
    Zivny, P.
    Douda, T.
    Kolesarova, M.
    Pinter, M.
    Palicka, V.
    Holcik, J.
    the European Society for Primary Care Gastroenterology, and
    Social determinants of Helicobacter Pylori infection: Czech Republic in the context of Europe [abstract]2005In: European Journal of Public Health, Vol. 15, no Suppl 1, p. 28-29Article in journal (Refereed)
  • 156. Bureš, J.
    et al.
    Kopáčová, M.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Seifert, B.
    Škodová Fendrichová, M.
    Špirková, J.
    Voříšek, V.
    Rejchrt, S.
    Douda, T.
    Král, N.
    Tachecí, I.
    Significant decrease in prevalence of Helicobacter pylori in the Czech Republic2012In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 18, no 32, p. 4412-4418Article in journal (Refereed)
    Abstract [en]

    METHODS: A total of 22 centres entered the study. The catchment areas of these centres covered cities and towns with more than 20 000 inhabitants, smaller towns (<= 20 000 inhabitants) with surrounding villages and rural areas, and were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1 837 subjects (aged 5-98 years) took part in the study, randomly selected out of 38 147 people from the general population. H. pylori infection was investigated by means of a C-13-urea breath test. Breath samples in duplicates were analysed using isotope ratio mass spectrometry. The cut-off point was 3.5. Social and demographic characteristics were based on data from self-completed questionnaires. RESULTS: The overall prevalence of H. pylori infection was 23.5% (430/1826), and 4.8% (20/420) in children aged 15 or less. There was no statistically significant difference in prevalence between males (24.3%; 208/857) and females (22.9%, 222/969, P = 0.494). H. pylon infection was strongly associated with higher age, among subjects aged 55+ years, prevalence of H. pylori infection was 39.8% (252/633, P < 0.001). The highest prevalence of H. pylori infection was found among persons aged 55-64 years (43.9%, 97/221) and 75+ years (37.9%, 58/153). Among study subjects aged 15+ years, prevalence of H. pylori infection was significantly increased in those with lowest education (odds risk 3.19, 95% CI 1.87-5.47). Compared to never married (14.1%), the prevalence of H. pylori infection was statistically significantly higher among married (35.4%, 246/694, P < 0.001), divorced (36.8%, 49/133, P < 0.001) and widowed study subjects (40.2%, 45/112, P < 0.001), both in minimally and fully adjusted analysis. There was no significant difference in the prevalence of H. pylori infection between married and widowed subjects (35.4%, 246/694 vs 40.2%, 45/112, P = 0.389). There was little variation in smoking prevalence across categories of smoking and there was no evidence of an increased risk of H. pylon infection among current or past smokers in our data (odds risk 1.04 with 95% CI 0.78-1.40 for current smokers; odds ratio 0.83 with 95% CI 0.60-1.16 for former smokers). The current prevalence of H. pylori in 2011 was significantly lower compared to the prevalence reported from identical geographical areas in 2001 (23.5% vs 41.7%, P < 0.001). CONCLUSION: The overall prevalence of H. pylon infection in the general population has fallen substantially in the Czech Republic over the past 10 years.

  • 157.
    Burström, Bo
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Öberg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Smedman, Lars
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Policy measures and the survival of foster infants in Stockholm 1878-19252012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no 1, p. 56-60Article in journal (Refereed)
    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.

  • 158.
    Busch, Hillevi
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Montgomery, William
    Melin, Bo
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Visuospatial and verbal memory in chronic pain patients: an explorative study.2006In: Pain Practice, ISSN 1530-7085, Vol. 6, no 3, p. 179-185Article in journal (Refereed)
    Abstract [en]

    Cognitive bias, such as selective memory for pain-related information, is frequently observed in chronic pain patients and is assessed mostly using verbal material. Beside word lists, the current study used photographs of people presenting pain behaviours to assess memory bias in chronic pain patients. Chronic pain patients were hypothesized to show better recall of pain-related words and pictures as compared to pain-free controls. Twenty-eight female chronic neck patients and 28 pain-free female controls completed two computerized pictorial memory games and two word recall tasks. Patients and controls performed equally well in the neutral memory game. In the pain-related game, patients performed significantly worse than did controls. No significant differences were found in the word recall task. The result is discussed in terms of cognitive avoidance.

  • 159. Byberg, Liisa
    et al.
    Michaëlsson, Karl
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, United Kingdom.
    Zethelius, Björn
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Birth Weight is not Associated with Risk of Fracture: Results From Two Swedish Cohort Studies2014In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 29, no 10, p. 2152-2160Article in journal (Refereed)
    Abstract [en]

    Development and growth in utero has been suggested to influence bone health. However, the relationship with risk of fracture in old age is largely unknown. Using Cox proportional hazards regression, we studied the association between birth weight and fractures at ages 50-94 among 10,893 men and women (48% women) from the Uppsala Birth Cohort Study (UBCoS, born 1915-29) and 1,334 men from the Uppsala Longitudinal Study of Adult Men (ULSAM, born 1920-24). Measured birth weight was collected from hospital or midwives' records and fractures from the Swedish National Patient Register. We observed 2,796 fractures (717 of these were hip fractures) in UBCoS and 335 fractures (102 hip fractures) in ULSAM. In UBCoS, the hazard ratio (HR) per 1 kg increase in birth weight, adjusted for sex and socioeconomic status at birth, was 1.01 (95% confidence interval [CI], 0.94-1.09) for any fracture and 1.06 (95% CI, 0.91-1.23) for hip fracture. Estimates in ULSAM were similar. We did not observe a differential association of birth weight with fractures occurring before age 70 or after age 70 years. Neither birth weight standardized for gestational age nor gestational duration was associated with fracture rate. In linear regression, birth weight was not associated with bone mineral density among 303 82-year-old men in ULSAM but showed positive associations with total body bone mineral content (β per kg increase in birth weight, adjusted for social class and age, 133; 95% CI, 30-227). This association was attenuated after further adjustment for body mass index and height (β, 41; 95% CI, -43 to 126). We conclude that birth weight is associated with bone mineral content but this association does not translate into an association with risk of fracture in men and women aged 50-94 years.

  • 160. Bäckman, O.
    et al.
    Bryngelson, A.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, O.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Den ojämlika sjukfrånvaron. Klass- och könsskillnader i sjukfrånvaro på 1990- och 2000-talet2007In: Socialvetenskaplig Tidskrift, Vol. 14, no 2-3Article in journal (Refereed)
  • 161. Bäckman, O.
    et al.
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hälsa - en fördelningsfråga2008In: Framtider, Vol. 1, p. 18-23Article in journal (Other (popular science, discussion, etc.))
  • 162.
    Bäckman, Olof
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Nilsson, Anders
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Marginalisering och uppväxtvillkor2008In: Framtider, ISSN 0281-0492, no 4, p. 21-23Article in journal (Other (popular science, discussion, etc.))
  • 163. Canivet, Catarina
    et al.
    Bodin, Theo
    Emmelin, Maria
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Moghaddassi, Mahnaz
    Östergren, Per-Olof
    Precarious employment is a risk factor for poor mental health in young individuals in Sweden: a cohort study with multiple follow-ups2016In: BMC Public Health, E-ISSN 1471-2458, Vol. 16, article id 687Article in journal (Refereed)
    Abstract [en]

    Background

    The globalisation of the economy and the labour markets has resulted in a growing proportion of individuals who find themselves in a precarious labour market situation, especially among the young. This pertains also to the Nordic countries, despite their characterisation as well developed welfare states with active labour market policies. This should be viewed against the background of a number of studies, which have shown that several aspects of precarious employment are detrimental to mental health. However, longitudinal studies from the Nordic region that examine the impact of precarious labour market conditions on mental health in young individuals are currently lacking. The present study aims to examine this impact in a general cohort of Swedish young people.

    Methods

    Postal questionnaires were sent out in 1999/2000 to a stratified random sample of the Scania population, Sweden; the response rate was 58 %. All of those who responded at baseline were invited to follow-ups after 5 and 10 years. Employment precariousness was determined based on detailed questions about present employment, previous unemployment, and self-rated risk of future unemployment. Mental health was assessed by GHQ-12. For this study individuals in the age range of 18–34 years at baseline, who were active in the labour market (employed or seeking job) and had submitted complete data from 1999/2000, 2005, and 2010 on employment precariousness and mental health status, were selected (N = 1135).

    Results

    Forty-two percent of the participants had a precarious employment situation at baseline. Labour market trajectories that included precarious employment in 1999/2000 or 2005 predicted poor mental health in 2010: the incidence ratio ratio was 1.4 (95 % CI: 1.1–2.0) when excluding all individuals with mental health problems at baseline and adjusting for age, gender, social support, social capital, and economic difficulties in childhood. The population attributable fraction regarding poor mental health in the studied age group was 18 %.

    Conclusions

    This study supported the hypothesis that precarious employment should be regarded as an important social determinant for subsequent development of mental health problems in previously mentally healthy young people.

  • 164. Carlson, Per
    et al.
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Are area-level effects just a proxy for school-level effects? Socioeconomic differences in alcohol consumption patterns among Swedish adolescents2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 166, p. 243-248Article in journal (Refereed)
    Abstract [en]

    Aims

    Although recent studies have found significant variations in adolescent alcohol consumption across neighbourhoods, these investigations did not address another important context in adolescents’ lives: schools. The purpose of this study was to not only simultaneously assess variations in adolescent alcohol use and binge drinking at the city district level and the school level but also analyse whether any such variations could be ascribed to the socioeconomic characteristics of the examined city districts, schools, and students.

    Design

    Cross-sectional study.

    Setting

    Stockholm, Sweden.

    Participants

    Ninth-grade students (n = 4349) attending schools (n = 75) located in the city districts of the Stockholm municipality (n = 14).

    Measurements

    Two measures based on information regarding alcohol consumption were constructed: alcohol use (no or yes) and binge drinking among alcohol users (ranging from “very seldom” to “a few times a week”). A wide range of socioeconomic characteristics was included at the city district, school, and student levels. Alcohol use was analysed using mixed-effects logistic regression, whereas binge drinking among users was modelled using mixed-effects ordered logistic regression.

    Findings

    The results indicated that the school was more important than the city district in assessments of contextual variations in adolescent alcohol use in general and binge drinking in particular. Moreover, proportions of well-educated parents and high-performing students accounted for part of the school-level variation in alcohol use but not binge drinking.

    Conclusions

    Failure to account for the school context may have caused past research to overestimate city district differences in alcohol consumption among adolescents.

  • 165. Carlsson, Sofia
    et al.
    Andersson, Tomas
    Michaëlsson, Karl
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ahlbom, Anders
    Late retirement is not associated with increased mortality, results based on all Swedish retirements 1991-20072012In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 27, no 6, p. 483-486Article in journal (Other academic)
    Abstract [en]

    In their recent paper based on German old-age pensioners, Kühntopf and Tivig [1] show that early retirement is associated with considerably higher mortality in men. This is in line with previous reports from British, Danish, US, German and Greek populations showing an increased mortality risk related to retirement, especially in the case of early retirement [2–6]. As pointed out by Kühntopf and Tivig, interpretation of these results is complicated, since a “Healthy worker selection effect” may be operating. To reduce this bias, they used information on credited periods of disease in the public insurance system [1]. Other strategies include adjustment for baseline medical problems [2, 6], using a time lag during follow up [5] or exclusion of subjects retiring for health reasons [3, 4]. It is however questionable, whether these strategies have been sufficient to eliminate the effect of health on retirement.

  • 166. Celeste, R. K.
    et al.
    Nadanovsky, P.
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Trends in socioeconomic disparities in oral health in Brazil and Sweden2011In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 39, no 3, p. 204-212Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe the dynamics of trends in socioeconomic disparities in oral health in Brazil and Sweden among adults, to assess whether trends follow expected patterns according to the inverse equity hypothesis.

    Methods:  In Sweden, we obtained nationally representative data for the years 1968, 1974, 1981, 1991 and 2000, and in Brazil, for 16 state capitals in 1986 and in 2002. Trends in the prevalence of ‘edentulism’ and of ‘teeth in good conditions’ were described in two groups aged 35–44 with lower and higher economic standards, respectively.

    Results:  There was an annual decline in disparities in ‘edentulism’ of 0.4 percentage points (pp) (95% CI = 0.2–0.7) in Brazil and 0.7pp (95% CI = 0.5–0.9) in Sweden, as a result of improvements in both income groups. Concerning ‘teeth in good conditions’, in Brazil, there was improvement only in the higher income group and absolute disparities have increased (0.5pp annually), while in Sweden, there was a nonsignificant decrease (0.3pp annually) with improvements in both groups. Since 1991 in Sweden and in 2002 in Brazil, our measures of socioeconomic disparities in ‘edentulism’ were not statistically significant. Trends did not differ by sex or dental visit.

    Conclusions:  Despite improvements in both income groups and a decrease in disparities in ‘edentulism’, the poorer group in Brazil has seen no improvement in ‘teeth in good conditions’ and disparities have increased. It appears that Brazil and Sweden reflect different stages of trend for ‘teeth in good conditions’ and the same stages for ‘edentulism’, represented by the inverse equity hypothesis.

  • 167. Celeste, R. K.
    et al.
    Nadanovsky, P.
    Ponce de Leon, A.
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 69, no 10, p. 1468-1475Article in journal (Refereed)
    Abstract [en]

    We evaluate the association between incomeinequality (Gini index) and oralhealth and in particular the role of alternative models in explaining this association. We also studied whether or not income at the individual level modifies the Gini effect. We used data from an oralhealth survey in Brazil in 2002–2003. Our analysis included 23,568 15–19 and 22,839 35–44 year-olds nested in 330 municipalities. Different models were fitted using multilevel analysis. The outcomes analysed were the number of untreated dental caries (count), having at least one missing tooth (dichotomous) and being edentulous (dichotomous). To assess interaction as a departure from additivity we used the Synergy Index. For this, we dichotomized the Gini coefficient (high vs low inequality) by the median value across municipalities and the individualincome in the point beyond which it showed roughly no association with oralhealth. Adjusted rate ratio of mean untreated dental caries, respectively for the 15–19 and 35–44 age groups, was 1.12 and 1.16 for each 10 points increase in Gini scale. Adjusted odds ratio of a 15–19 year-old having at least one missing tooth or a 35–44 year-old being edentulous was, respectively, 1.19 and 1.01. High incomeinequality had no statistically significant synergistic effect with being poor or living in a poor municipality. Higher levels of incomeinequality at the municipal level were associated with worse oralhealth and there was an unexplained residual effect after controlling for potential confoundings and mediators. Municipal level incomeinequality had a similar, detrimental effect, among individuals with lower or higher income.

  • 168. Celeste, Roger Keller
    et al.
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Nadanovsky, Paulo
    The relationship between levels of income inequality and dental caries and periodontal diseases2011In: Cadernos de Saúde Pública, ISSN 0102-311X, E-ISSN 1678-4464, Vol. 27, no 6, p. 1111-1120Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to evaluate the association between income inequality at a lagged time of 2 and 11 years with two short latency outcomes (untreated dental caries and gingivitis) and two long latency outcomes (edentulism and periodontal attachment loss > 8mm). We used data from the Brazilian oral health survey in 2002-2003. Our analysis included 13,405 subjects aged 35-44 years. Different lagged Gini at municipal level were fitted using logistic and negative binomial multilevel analyses. Covariates included municipal per capita income, equivalized income, age, sex, time since last dental visit and place of residence (rural versus urban). Crude estimates showed that only untreated dental caries was associated with current and lagged Gini, but in adjusted models only current Gini remained significant with a ratio of 1.19 (95%CI: 1.09-1.30) for every ten-point increase in the Gini coefficient We conclude that lagged Gini showed no association with oral health; and current income Gini was associated with current dental caries hut not with periodontal disease.

  • 169. Celeste, Roger Keller
    et al.
    Nadanovsky, Paulo
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Trends in socioeconomic disparities in the utilization of dental care in Brazil and Sweden2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 6, p. 640-648Article in journal (Refereed)
    Abstract [en]

    Aims: To describe trends in socioeconomic disparities in utilization of dental care. Methods: We obtained cross-sectional data from Sweden in the period 1968-2000 and from Brazil in 1986 and 2002 for 16 state capitals. The outcome was the percentage of people who reported that they had visited the dentist in the last 12 months, calculated for a higher and a lower income group and stratified by sex, age (two groups: young and adults) and dental status. Adjusted prevalence differences and prevalence ratios were produced using Poisson regression. Results: In Brazil, there was a decline in use of dental care among the 15-19 year olds in the period 1986-2002, but not among the 35-44 year olds. In Sweden, there was a decline among the young and adults between 1991 and 2000. Overall, socioeconomic disparities in use of dental services between the higher and the lower economic groups showed a decline in both countries. The reduction in disparities among young Brazilians was 1.1 percentage points per year (p < 0.01), but among the other age groups the decline was not significant (p>0.01). In the last surveys, the gap remained in both countries and age groups (p < 0.01). Conclusions: The recent decline in utilization of dental care and in the socioeconomic gap may mirror improvements in oral health. However, there are still relevant and persistent disparities in utilization of dental care in both countries, with a higher proportion of people of higher socioeconomic status visiting the dentist.

  • 170.
    Chaparro, M. Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of California, USA.
    Bernabe-Ortiz, Antonio
    Harrison, Gail G.
    Association between food assistance program participation and overweight2014In: Revista de Saude Publica, ISSN 0034-8910, E-ISSN 1518-8787, Vol. 48, no 6, p. 889-898Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS: A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS: Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06; 1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS: Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.

  • 171.
    Chaparro, M. Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    De Luna, Xavier
    Haggstrom, Jenny
    Ivarsson, Anneli
    Lindgren, Urban
    Nilsson, Karina
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Childhood family structure and women's adult overweight risk: A longitudinal study2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 5, p. 511-519Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate whether women's adult overweight and obesity risk was associated with their childhood family structure, measured as their mothers' marital status history, during the women's first 18 years of life. Methods: Using linked register data, we analyzed 30,584 primiparous women born in Sweden in 1975 who were between 19-35 years of age when their height and pre-pregnancy weight was recorded. The outcomes were women's overweight/ obesity (body mass index (BMI) >= 25 kg/m(2)) and obesity (BMI >= 30 kg/m(2)) and the predictor was mothers' marital status history, which was summarized using sequence analysis. We carried out nested logistic regression models adjusting for women's age and maternal sociodemographic characteristics. Results: Mothers' marital status history was summarized into six clusters: stable marriage, stable cohabitation, married then divorcing, cohabiting then separating, varied transitions, and not with father. In fully adjusted models and compared with women whose mothers belonged to the stable marriage cluster: (1) women whose mothers belonged to the other marital status clusters had higher odds of overweight/obesity (odds ratio (OR) ranging 1.15-1.19; p < 0.05); and (2) women whose mothers belonged to the stable cohabitation (OR = 1.31; 95% confidence interval (CI) = 1.14-1.52), cohabiting then separating (OR = 1.23; 95% CI = 1.01-1.49), varied transitions (OR = 1.24; 95% CI = 1.11-1.39), and not with father (OR = 1.24; 95% CI = 1.00-1.54) clusters had higher odds of obesity. Conclusions: Women whose mothers were not in stable marriage relationships had higher odds of being overweight or obese in adulthood. The finding that even women raised in the context of stable cohabitation had higher odds of being overweight or obese is intriguing as these relationships are socially accepted in Sweden.

  • 172. Chaparro, M. Pia
    et al.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Byberg, Liisa
    Maternal pre-pregnancy BMI and offspring body composition in young adulthood: the modifying role of offspring sex and birth order2017In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 20, no 17, p. 3084-3089Article in journal (Refereed)
    Abstract [en]

    To investigate if the association between maternal pre-pregnancy BMI and offspring’s body composition in late adolescence and young adulthood varies by offspring birth order and sex.

    Family cohort study, with data from registers, questionnaires and physical examinations. The main outcome under study was offspring body composition (percentage fat mass (%FM), percentage lean mass (%LM)) measured by dual-energy X-ray absorptiometry.

    Uppsala, Sweden.

    Two hundred and twenty-six siblings (first-born v. second-born; average age 19 and 21 years) and their mothers.

    In multivariable linear regression models, maternal pre-pregnancy BMI was positively associated with daughter’s %FM, with stronger estimates for first-born (β=0·97, 95 % CI 0·14, 1·80) v. second-born daughters (β=0·64, 95 % CI 0·08, 1·20). Mother’s BMI before her first pregnancy was associated with her second-born daughter’s body composition (β=1·05, 95 % CI 0·31, 1·79 (%FM)) Similar results albeit in the opposite direction were observed for %LM. No significant associations were found between pre-pregnancy BMI and %FM (β=0·59, 95 % CI−0·27, 1·44 first-born; β=−0·13, 95 % CI−0·77, 0·52 second-born) or %LM (β=−0·54, 95 % CI−1·37, 0·28 first-born; β=0·11, 95 % CI−0·52, 0·74 second-born) for sons.

    A higher pre-pregnancy BMI was associated with higher offspring %FM and lower offspring %LM in late adolescence and young adulthood, with stronger associations for first-born daughters. Preventing obesity at the start of women’s reproductive life might reduce the risk of obesity in her offspring, particularly for daughters.

  • 173.
    Chaparro, M. Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden; UCLA Fielding School of Public Health, USA.
    Whaley, Shannon E.
    Crespi, Catherine M.
    Koleilat, Maria
    Nobari, Tabashir Z.
    Seto, Edmund
    Wang, May C.
    Influences of the neighbourhood food environment on adiposity of low-income preschool-aged children in Los Angeles County: a longitudinal study2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 11, p. 1027-1033Article in journal (Refereed)
    Abstract [en]

    Background Few studies have examined the association between the food environment and adiposity in early childhood, a critical time for obesity prevention. The objective of this study was to examine the longitudinal association between neighbourhood food environment and adiposity among low-income preschool-aged children in a major metropolitan region in the USA. Methods The study sample was 32 172 low-income preschool-aged children in Los Angeles County who had repeated weight and height measurements collected between ages 2 and 5 years through a federal nutrition assistance programme. We conducted multilevel longitudinal analyses to examine how spatial densities of healthy and unhealthy retail food outlets in the children's neighbourhoods were related to adiposity, as measured by weight-for-height z-score (WHZ), while controlling for neighbourhood-level income and education, family income, maternal education, and child's gender and race/ethnicity. Results Density of healthy food outlets was associated with mean WHZ at age 3 in a non-linear fashion, with mean WHZ being lowest for those exposed to approximately 0.7 healthy food outlets per square mile and higher for lesser and greater densities. Density of unhealthy food outlets was not associated with child WHZ. Conclusions We found a non-linear relationship between WHZ and density of healthy food outlets. Research aiming to understand the sociobehavioural mechanisms by which the retail food environment influences early childhood obesity development is complex and must consider contextual settings.

  • 174.
    Chaparro, M. Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Whaley, Shannon E.
    Crespi, Catherine M.
    Koleilat, Maria
    Nobari, Tabashir Z.
    Seto, Edmund
    Wang, May C.
    Response to Letter to the Editor by Joe Brew, Department of Epidemiology, University of Florida2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 8, p. 817-817Article in journal (Other academic)
  • 175.
    Chaparro, Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ivarsson, A.
    Koupil, Illona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Nilsson, K.
    Häggström, J.
    de Luna, X.
    Lindgren, U.
    Regional inequalities in pre-pregnancy overweight and obesity in Sweden, 1992, 2000, and 20102015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 5, p. 534-539Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate regional differences and time trends in women's overweight and obesity in Sweden. Methods: Using data from the Swedish Medical Birth Register (women aged 18 years, first pregnancy only) and the Total Population Register accessed through the Umea SIMSAM Lab, age-standardized prevalence of pre-pregnancy overweight/obesity (BMI 25 kg/m(2)) and obesity (BMI 30 kg/m(2)) were estimated by county for the years 1992, 2000, and 2010. Maps were created using ArcMap v10.2.2 to display regional variations over time and logistic regression analyses were used to assess if the observed trends were significant. Results: The prevalence of pre-pregnancy overweight/obesity and obesity increased significantly in all Swedish counties between 1992, and 2010. In 2010, Sodermanland and Gotland exhibited the highest age-standardized overweight/obesity (39.7%) and obesity (15.1%) prevalence, respectively. The sharpest increases between 1992 and 2010 were observed in Vasterbotten for overweight/obesity (75% increase) and in Gotland for obesity (233% increase). Across the years, Stockholm had the lowest prevalence of overweight/obesity (26.3% in 2010) and obesity (7.3% in 2010) and one of the least steep increases in prevalence of both between 1992 and 2010. Conclusions: Substantial regional differences in pre-pregnancy overweight and obesity prevalence are apparent in Sweden. Further research should elucidate the mechanisms causing these differences.

  • 176.
    Chaparro, Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Illona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The impact of parental educational trajectories on their adult offspring's overweight/obesity status: a study of three generations of Swedish men and women2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 120, p. 199-207Article in journal (Refereed)
  • 177. Chen, Tian-Jiao
    et al.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ji, Cheng-Ye
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Regional, socioeconomic and urban-rural disparities in child and adolescent obesity in China: a multilevel analysis2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 12, p. 1583-1589Article in journal (Refereed)
    Abstract [en]

    Aim:  To study socio-demographic patterns of obesity in Chinese children and adolescents. Methods:  Data came from the 2005 cycle of the Chinese National Survey on Student's Constitution and Health. In all, 231 326 subjects aged 7-18 years, distributed across 622 schools and 30 provinces, were analysed. Multilevel modelling was used to estimate variations at individual, school area and province levels. Results:  The prevalence of obesity varied enormously across different areas. Young people living in high socioeconomic and urban areas had higher body mass index (BMI) and higher odds of overweight and obesity than those living in lower socioeconomic and rural areas. Subjects living in provinces with a higher standard of living, as indicated by less perinatal mortality, lower Engel coefficient, and higher personal expenditure on health had higher BMI and higher odds of overweight and obesity than those living in less affluent provinces. An interaction between gender and urbanicity revealed that boys in urban areas were especially prone to obesity. Conclusion:  In contrast to most present-day high income countries, obesity among young people in China is associated with affluence and urban residence. Intervention and strategy for obesity prevention should be targeting high socioeconomic families in urban areas, perhaps with particular focus on boys.

  • 178.
    Chiesa, Flaminia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Effect of parental social class on alcohol related mortality in adulthood and old age.2009In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 24, no Suppl1, p. 36-Article in journal (Refereed)
  • 179. Contreras, Mariela
    et al.
    Blandon, Elmer Zelaya
    Persson, Lars-Åke
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ekström, Eva-Charlotte
    Socio-economic resources, young child feeding practices, consumption of highly processed snacks and sugar-sweetened beverages: a population-based survey in rural northwestern Nicaragua2015In: BMC Public Health, E-ISSN 1471-2458, Vol. 15, article id 25Article in journal (Refereed)
    Abstract [en]

    Background: Socio-economic resources may be associated with infant feeding in complex patterns in societies undergoing a nutrition transition. This study evaluates associations of housing quality, food security and maternal education to the World Health Organization (WHO) feeding recommendations and to consumption of highly processed snacks (HP snacks) and sugar-sweetened beverages (SSBs) in rural Nicaragua. Methods: Data were collected from May to November 2009, with mothers of 0- to 35-month-olds being asked about young child feeding using a food frequency questionnaire. A validated questionnaire was used to assess household food insecurity and data were collected on maternal education and housing quality. Pearson's chi-squared test was used to compare proportions and determine associations between the resources and young child feeding. The three socio-economic resources and other confounders were introduced to multivariate logistic regression analyses to assess the independent contribution of the resources to the feeding practices and consumption of HP snacks and SSBs. Results: Mothers with the lowest education level were more likely to be exclusively breastfeeding (EBF) their infants (OR not EBF: 0.19; 95% CI: 0.07, 0.51), whilst mothers of 6- to 35-month-olds in the lowest education category had more inadequate dietary diversity (DD) (OR for not meet DD: 2.04; 95% CI: 1.36, 3.08), were less likely to consume HP snacks (OR for HP snacks: 0.47; 95% CI: 0.32, 0.68) and SSBs (OR for SSBs: 0.68; 95% CI: 0.46, 0.98), compared to mothers with the highest level of education. Similarly, children residing in households with the highest food insecurity were also more prone to have inadequate dietary diversity (OR for not meet DD: 1.47; 95% CI: 1.05, 2.05). The odds for double burden of suboptimal feeding (concurrent inadequate diet and consumption of HP snacks/SSBs) were significantly lower in children of least educated mothers (OR: 0.64; 95% CI: 0.44, 0.92). Conclusions: Higher level of education was associated with both more and less adherence to the WHO recommended feeding practices as well as with more consumption of HP snacks and SSBs. Regardless of educational strata, the children in the community were exposed to suboptimal feeding practices conducive to both under-as well as overnutrition.

  • 180.
    Cárdenas, Camila
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The Association Between Level of Religiousness and Subjective General Health in Europe: Subjective measurements at four different European countries2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Studies linking religion and its impact on humans have increased over time with health being the most studied outcome in statistical analysis. Even so, the use of variables, models and approaches has been homogenous being applied among similar groups and places. The aim of the thesis is for that reason to investigate to what extent there is an association between religiousness and health in Cyprus (n=3 355), Finland (n=4 058), Norway (n=4 691) and Ireland (n=6 869) adjusting for potential confounders age, gender and education. Logistic regression analyses were applied, including subjective level of religiousness as predictor and good subjective general health as outcome in conjunction with the Theory of Attachment. The data is collected from The European Social Survey from 2008, 2010 and 2012. Middle religious have significant higher odds of good health than individuals that categorized by themselves as Not at all religious in Cyprus, Norway and Ireland while adjusting for age and education. Low, Middle and High religious are significantly associated with good health in Finland compared to Not at all religious. There is an association between religiousness and health in the four European countries while age and education potentially confound the relationship in Norway and Ireland.

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    Cárdenas, C: The Association Between Level of Religiousness and Subjective General Health in Europe
  • 181.
    Dahlqvist, Mattias
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Is family structure associated with the psychological behavior of young people?: The Strengths and Difficulties Questionnaire in a population sample2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Differences in family structure have been linked to several mental health outcomes, where children living in a nuclear family setting are best-off, while children in joint physical custody are second best followed by those living mostly and only with one parent. One of the biggest changes in recent years is that joint physical custody is growing more common. The dependent variables in this thesis were three dimensions of mental health from the Strengths and Difficulties Questionnaire. Data from 6th and 9th graders in the entire Sweden 2009 was used. Regression modelling showed differences in mental health between the family structures throughout, although children in  joint physical custody was not significantly different from those in nuclear families (reference category) in half of the models. Children living mostly with one parent reported the third worst levels of problematic behaviour and prevalence of low prosocial behaviour while those living with just one parent were worst off. Stratifying by gender did reveal small coefficient differences and so did controls for birth region. This thesis, although in a line of other publications based on this study can help shape future guidelines for e.g. social workers.

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  • 182. Danielsson, Maria
    et al.
    Heimerson, Inger
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Stefansson, Claes-Göran
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Psychosocial stress and health problems: Health in Sweden: The National Public Health Report 2012. Chapter 62012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 9, p. 121-134Article in journal (Refereed)
    Abstract [en]

    Stress can be defined as an imbalance between demands placed on us and our ability to manage them. The body’s stress system is adapted to confront sudden physical threats. Today, however, we are increasingly exposed to prolonged mental and psychosocial stress. Prolonged stress can give rise to a range of problems: poor performance, chronic fatigue, disinterest, dejection, memory disturbances, sleep problems, numbness and diffuse muscle pains. These symptoms may eventually be followed by depression, post-traumatic stress disorder and chronic fatigue syndrome, and ultimately chronic pain conditions, cardiovascular disease and diabetes. Sleep is a vital counterbalance to stress as it enables the body to recover properly. Good sleep is thus essential to our ability to cope with stress and stay healthy.

    The decline in the mental wellbeing of the population since the 1980s has been accompanied by a rise in the number of pain complaints. A similar development in respect of symptoms such as anxiousness, nervousness and anxiety, constant fatigue and neck and shoulder pain and sleeping problems has been observed in the population. This increase, which continued throughout the 1990s and culminated in 2001, was followed by a slight fall. However, there was no decline among young people in the early 2000s. Rather, the number of complaints continued to increase.

    Since the mid-1990s, the proportion of people suffering from stress symptoms has risen and fallen in step with employment levels. Since the beginning of the 1980s, growing numbers of people in gainful employment have experienced their work as hectic and mentally taxing. This may indicate that the balance between healthy and unhealthy factors impacting the actively employed has tilted towards less favourable conditions. Mental stress at work has increased among women and men, particularly among county council employees. Repeated organisational restructuring may explain why hectic and mentally taxing work has become more commonplace. Mental ill-health along with musculoskeletal disorders are the most frequent diagnoses in connection with newly granted disability pensions. Sickness absence trends largely reflect the trend in stress symptoms.

  • 183. Danziger, P. D.
    et al.
    Silverwood, R.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fetal growth, early life circumstances, and risk of suicide in late adulthood2011In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 26, no 7, p. 571-581Article in journal (Refereed)
    Abstract [en]

    Recent studies in Sweden and Scotland have found early life conditions to be associated with increased risk of attempted and completed suicide in adolescence and young adulthood. It is not known, however, whether early life conditions affect suicide risk throughout the life course, from adulthood into old age. We examined the effects of early life conditions, including markers of fetal growth, and social and economic characteristics in adulthood, on risk of suicide by violent and non-violent methods in women and men aged 31–87 years using Cox regression. 11,650 women and men born at the Uppsala University Hospital in Sweden between 1915 and 1929 were followed from 1960 until 2002 using linked records from obstetric archives, Census, population and mortality registries. During 435,039 person-years of follow-up 161 completed suicides (104 in males, 57 in females) were observed. An inverse association was found between lower birthweight-for-gestational age and risk of violent suicide in females, although the association did not reach the conventional level of statistical significance (minimally adjusted HR 2.02, 95% CI (0.88–4.63); Table 4). Being male, unmarried, and in the “other or unknown” social class category in adulthood were independently associated with increased rates of suicide. There was a weak association between higher maternal parity and suicide rates. Our findings suggest differences in effects of fetal growth patterns and perinatal circumstances on suicide risk later in life, and suggest that suicide in adults and in the elderly may be influenced by a different combination of factors than those that influence suicide in adolescence and young adulthood.

  • 184. Daud, Atia
    et al.
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rydelius, Per-Anders
    Resilience and vulnerability among refugee children of traumatized and non-traumatized parents2008In: Child and Adolescent Psychiatry and Mental Health, E-ISSN 1753-2000, Vol. 2, no 7Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the study was to explore resilience among refugee children whose parents had been traumatized and were suffering from Post-Traumatic Stress Disorder (PTSD).

    Methods: The study comprised 80 refugee children (40 boys and 40 girls, age range 6–17 yrs), divided into two groups. The test group consisted of 40 refugee children whose parents had been tortured in Iraq before coming to Sweden. In accordance with DSM-IV criteria, these children were further divided in two sub-groups, those who were assessed as having PTSD-related symptoms (n = 31) and those who did not have PTSD-related symptoms (n = 9). The comparison group consisted of 40 children from Egypt, Syria and Morocco whose parents had not been tortured. Wechsler Intelligence Scale for Children, 3rd edn. (WISC-III), Diagnostic Interview for Children and Adolescents- Revised (DICA-R), Post-Traumatic Stress Symptoms checklist (PTSS), "I Think I am" (ITIA) and Strengths and Difficulties Questionnaire (SDQ) were used to assess IQ; PTSD-related symptoms; self-esteem; possible resilience and vulnerability.

    Results: Children without PTSD/PTSS in the traumatized parents group had more favorable values (ITIA and SDQ) with respect to <i>total scores, emotionality, relation to family, peer relations</i> and <i>prosocial behavior</i> than the children in the same group with PTSD/PTSS and these values were similar to those the children in the comparison group (the non-traumatized parents group). The children in the non-traumatized parents group scored significantly higher on the IQ test than the children with traumatized parents, both the children with PTSD-related symptoms and those without PTSD-related symptoms.

    Conclusion: Adequate emotional expression, supportive family relations, good peer relations, and prosociality constituted the main indicators of resilience. Further investigation is needed to explore the possible effects of these factors and the effects of IQ. The findings of this study are useful for treatment design in a holistic perspective, especially in planning the treatment for refugee children, adolescents and their families.

  • 185. Daud, Atia
    et al.
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rydelius, Per-Anders
    Trauma, PTSD and personality: the relationship between prolonged traumatisation and personality impairment2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 3, p. 331-340Article in journal (Refereed)
    Abstract [en]

    Objective: Chronic post-traumatic stress disorder (PTSD) has been associated with personality impairments involving externalized and internalized psychopathology. This study has explored the association between PTSD symptoms as consequences of prolonged torture experiences or early childhood trauma exposure and personality traits.

    Method: One hundred and sixty-one men were included: 36 Iraqi men refugees (mean age = 43.9, SD = 8.7) who had longstanding torture experiences as adults; 42 Swedish prisoners (mean age = 33.8, SD = 7), with early childhood trauma exposure; 31 Arab men refugees (mean age = 41.8, SD = 8.9) without self-reported torture or violence experiences; 52 non-traumatized Swedish males (mean age = 39.3, SD = 5.5). They were assessed for symptoms of PTSD or PTSD hypothetical clusters. Personality profile was assessed by the Karolinska Scales of Personality (KSP). Factor analysis with varimax rotation was conducted and yielded three factors: externalized, internalized and avoidance domains.

    Results: Individuals who suffered prolonged torture experiences or had early childhood trauma exposure showed impaired personality profiles in internalized and externalized domains. Individuals with or without PTSD showed significant differences p < 0.05 concerning: internalized, externalized and avoidance. anova and post-hoc analysis according to Scheffé showed that the prolonged torture group > early childhood trauma exposure > nontraumatized group.

    Conclusion: Prolonged torture experiences or early trauma exposure may impair personality formation by enhancing the effects of cognitive, affective and behavioural vulnerabilities.

  • 186. De Stavola, B. L.
    et al.
    Leon, D. A.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Intergenerational correlations in size at birth and the contribution of environmental factors: The Uppsala Birth Cohort Multigenerational Study, Sweden, 1915-20022011In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 174, no 1, p. 52-62Article in journal (Refereed)
    Abstract [en]

    Data indicate an inverse association between dietary calcium and magnesium intakes and blood pressure (BP); however, much less is known about associations between urinary calcium and magnesium excretion and BP in general populations. The authors assessed the relation of BP to 24-hour excretion of calcium and magnesium in 2 cross-sectional studies. The International Study of Macro- and Micro-Nutrients and Blood Pressure (INTERMAP) comprised 4,679 persons aged 40–59 years from 17 population samples in China, Japan, the United Kingdom, and the United States, and the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) comprised 10,067 persons aged 20–59 years from 52 samples around the world. Timed 24-hour urine collections, BP measurements, and nutrient data from four 24-hour dietary recalls (INTERMAP) were collected. In multiple linear regression analyses, urinary calcium excretion was directly associated with BP. After adjustment for multiple confounders (including weight, height, alcohol intake, calcium intake, urinary sodium level, and urinary potassium intake), systolic BP was 1.9 mm Hg higher per each 4.1 mmol per 24 hours (2 standard deviations) of higher urinary calcium excretion (associations were smaller for diastolic BP) in INTERMAP. Qualitatively similar associations were observed in INTERSALT analyses. Associations between magnesium excretion and BP were small and nonsignificant for most of the models examined. The present data suggest that altered calcium homoeostasis, as exhibited by increased calcium excretion, is associated with higher BP levels.

  • 187. Dekhtyar, Serhiy
    et al.
    Wang, Hui-Xin
    Scott, Kirk
    Goodman, Anna
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Herlitz, Agneta
    A life-course study of cognitive reserve in dementia from childhood to old age2015In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 23, no 9, p. 885-896Article in journal (Refereed)
    Abstract [en]

    Objective: To test a life-course model of cognitive reserve in dementia and examine if school grades around age 10 years, formal educational attainment, and lifetime occupational complexity affect the risk of dementia in old age. Methods: 7,574 men and women from the Uppsala Birth Cohort Multigenerational Study were followed for 21 years. Information on school performance, formal education, and occupational attainment was collected prospectively from elementary school archives and population censuses. Dementia diagnosis was extracted from the two Swedish registers. Discrete-time Cox proportional hazard models were estimated. Results: Dementia was diagnosed in 950 individuals (12.5%). Dementia risk was lower among individuals with higher childhood school grades (hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.68 to 0.93) and was lower among individuals in data-complex occupations (HR: 0.77; 95% CI: 0.64 to 0.92). Professional/university education predicted lower risk of dementia in minimally adjusted models (HR: 0.74; 95% CI: 0.60 to 0.91), although the effect faded with adjustment for occupational complexity. Lowest risk was found in the group with both higher childhood school performance and high occupational complexity with data (HR: 0.61; 95% CI: 0.50 to 0.75). Importantly, high occupational complexity could not compensate for the effect of low childhood grades. In contrast, dementia risk was reduced in those with higher school grades, irrespective of occupational complexity. Conclusion: Higher childhood school performance is protective of dementia risk, particularly when preserved through complex work environments in adulthood, although it will remain protective even in the absence of later-life educational or occupational stimulation.

  • 188. Dekhtyar, Serhiy
    et al.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Scott, Kirk
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Lund University, Sweden.
    Goodman, Anna
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Herlitz, Agneta
    Associations of head circumference at birth with earlylife school performance and later-life occupational prestige2015In: Longitudinal and Life Course Studies, E-ISSN 1757-9597, Vol. 6, no 1, p. 26-42Article in journal (Refereed)
    Abstract [en]

    Head circumference at birth has been suggested as a marker of foetal brain development. New-borns with small head size have been shown to have lower intelligence scores in childhood. It is, however, unclear whether this relationship extends into adult life, and more importantly, whether adult status attainment and lifetime success is affected as a result. Furthermore it is unclear how social origin at birth attenuates the relationship between foetal brain development, childhood cognitive outcomes, and lifetime status attainment. Using the Uppsala Birth Cohort Multigenerational Study, a unique population-based database of 14,192 individuals followed from birth into advanced old age, we demonstrate that those born with small head circumference experience reductions in both early-life school performance and lifetime occupational prestige. These effects are not subject to modification by parental social class: small head size at birth is associated with lower grades and lower occupational prestige among individuals born into both advantaged and disadvantaged social classes. Employing causal mediation analysis, we also demonstrate that the link between head circumference at birth and adult occupational prestige is mainly the result of a direct effect, although a portion of this effect is also mediated by early-life school performance which also contributes to occupational attainment trajectories. These findings demonstrate the importance of early-life environments for cognitive development as well as lifetime status attainment.

  • 189. DeStavola, Bianca
    et al.
    Leon, Dave
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Contribution of environmental factors to intergenerational correlations in size at birth (abstract)2010In: Longitudinal and Life Course Studies, Vol. 1, no 3 Supplement, p. 259-Article in journal (Refereed)
  • 190. DeYoung, C.G
    et al.
    Getchell, M.
    Koposov, R.A.
    Yrigollen, C.M.
    Haeffel, G.J.
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Oreland, L.
    Ruchkin, V.V.
    Pakstis, A.J.
    Grigorenko, E.L.
    Variation in the catechol-O-methyltransferase Val158Met polymorphism associated with conduct disorder and ADHD symptoms, among adolescent male delinquents2010In: Psychiatric Genetics, ISSN 0955-8829, E-ISSN 1473-5873, Vol. 20, no 1, p. 20-24Article in journal (Refereed)
    Abstract [en]

    Objective: Variation in the catechol-O-methyltransferase gene (COMT) has been associated with antisocial behavior in populations with attention deficit/hyperactivity disorder (ADHD). This study examined whether COMT would predict antisocial behavior in a sample with high levels of behavior problems, not necessarily ADHD. In addition, because previous research suggests that COMT may be associated with ADHD in males, association between COMT and ADHD symptoms was examined. Method: This study tested whether variation in three polymorphisms of the COMT gene was predictive of symptoms of conduct disorder and ADHD, in a sample of 174 incarcerated Russian adolescent male delinquents. Results: The Val allele of the Val¹⁵⁸ Met polymorphism was significantly associated with conduct disorder diagnosis and symptoms, whereas the Met allele was associated with ADHD symptoms. Conclusion: The Val¹⁵⁸ Met polymorphism of the COMT gene shows a complex relation to behavior problems, influencing conduct disorder and ADHD symptoms in opposite directions in a high-risk population.

  • 191. Donrovich, Robyn
    et al.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Early life conditions, partnership histories, and mortality risk for Swedish men and women born 1915-19292014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 108, p. 60-67Article, review/survey (Refereed)
    Abstract [en]

    This paper investigates the relationship between early life biological and social factors, partnership history, and mortality risk. Mortality risks for Swedish men and women over age 50 in the Uppsala Birth Cohort born 1915-1929 were estimated using survival analysis. Relative mortality risk was evaluated through nested multiplicative Gompertz models for 4348 men and 3331 women, followed from age 50 to the end of 2010. Being born to an unmarried mother was associated with higher mortality risk in later life for men and women, and relative to married individuals, being unmarried after age 50 was associated with elevated mortality risk. Single women and divorced men were the highest risk groups, and women were negatively impacted by a previous divorce or widowhood, while men were not. Both genders showed direct effects of early life variables on later life mortality and were vulnerable if unmarried in later life. However, in this study, previous marital disruptions appeared to have more (negative) meaning in the long-term for women.

  • 192. dos Santos Silva, Isabel
    et al.
    De Stavola, Bianca
    McCormack, Valerie
    Collaborative Group on Pre-Natal Risk Factors and Subsequent Risk of Breast Cancer,
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Birth Size and Breast Cancer Risk: Re-analysis of Individual Participant Data from 32 Studies2008In: PLoS Medicine, Vol. 5, no 9, p. e193-Article in journal (Refereed)
  • 193. Dribe, Martin
    et al.
    Juárez, Sol Pía
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Lund University, Sweden.
    Scalone, Francesco
    Is It Who You Are or Where You Live? Community Effects on Net Fertility at the Onset of Fertility Decline: A Multilevel Analysis Using Swedish Micro-Census Data2017In: Population, Space and Place, ISSN 1544-8444, E-ISSN 1544-8452, Vol. 23, no 2, article id e1987Article in journal (Refereed)
    Abstract [en]

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

  • 194.
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The effect of migration background characteristics on the association between unemployment and risk of suicide: A longitudinal studyManuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: 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 than that observed among native-origin men exposed to unemployment.  In unemployed foreign-born men, younger age at arrival and longer duration of residence were associated with increased risk of suicide, whereas those who arrived as adults and had a shorter duration of residence did not show excess risk.

    Conclusions: Overall, analyses indicated that the majority of the foreign-origin exposed to unemployment demonstrated excess risk of suicide that was often of a similar magnitude to that observed among their native-origin counterparts. There were notable differences in patterns of association by generational status, region of origin, age at arrival, and duration of residence.

  • 195.
    Dunlavy, Andrea C.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Garcy, Anthony M.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Educational mismatch and health status among foreign-born workers in Sweden2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 154, p. 36-44Article in journal (Refereed)
    Abstract [en]

    Foreign-born workers have been shown to experience poorer working conditions than native-born workers. Yet relationships between health and educational mismatch have been largely overlooked among foreign-born workers. This study uses objective and self-reported measures of educational mismatch to compare the prevalence of educational mismatch among native (n = 2359) and foreign born (n = 1789) workers in Sweden and to examine associations between educational mismatch and poor self-rated health. Findings from weighted multivariate logistic regression which controlled for social position and individual-level demographic characteristics suggested that over-educated foreign-born workers had greater odds ratios for poor-self rated health compared to native-born matched workers. This association was particularly evident among men (OR = 2.14, 95% CI: 1.04-4.39) and women (OR = 2.13, 95% CI: 1.12-4.03) from countries outside of Western Europe, North America, and Australia/New Zealand. Associations between under-education and poor-self rated health were also found among women from countries outside of Western Europe, North America, and Australia/New Zealand (OR = 2.02, 95% CI: 1.27-3.18). These findings suggest that educational mismatch may be an important work-related social determinant of health among foreign-born workers. Future studies are needed to examine the effects of long-term versus short-term states of educational mismatch on health and to study relationships over time.

  • 196.
    Dunlavy, Andrea C.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Health Inequalities among Workers with a Foreign Background in Sweden: Do Working Conditions Matter?2013In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 10, no 7, p. 2871-2887Article in journal (Refereed)
    Abstract [en]

    Employment and working conditions are key social determinants of health, yet current information is lacking regarding relationships between foreign background status, working conditions and health among workers in Sweden. This study utilized cross-sectional data from the 2010 Swedish Level of Living Survey (LNU) and the Level of Living Survey for Foreign Born Persons and their Children (LNU-UFB) to assess whether or not health inequalities exist between native Swedish and foreign background workers and if exposure to adverse psychosocial and physical working conditions contributes to the risk for poor health among foreign background workers. A sub-sample of 4,021 employed individuals aged 18–65 was analyzed using logistic regression. Eastern European, Latin American and Other Non-Western workers had an increased risk of both poor self-rated health and mental distress compared to native Swedish workers. Exposure to adverse working conditions only minimally influenced the risk of poor health. Further research should examine workers who are less integrated or who have less secure labor market attachments and also investigate how additional working conditions may influence associations between health and foreign background status.

  • 197.
    Dunlavy, Andrea
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Migration background characteristics and the association between unemployment and suicide2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

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

    Methods

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

    Results

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

    Conclusions

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

  • 198.
    Dunlavy, Andrea
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Arbetsmiljön bland utrikesfödda anställda i Sverige2017In: Arbetsmarknad & Arbetsliv, ISSN 1400-9692, E-ISSN 2002-343X, Vol. 23, no 1, p. 46-65Article in journal (Refereed)
    Abstract [sv]

    Denna artikel syftar till att utöka kunskapen kring arbetsmiljöförhållanden bland utlandsfödda på den svenska arbetsmarknaden. Studien undersöker hur exponering för bristfälliga psykosociala, strukturella och fysiska arbetsmiljöförhållanden varierar mellan olika grupper av anställda kvinnor och män beroende på födelseland. Resultaten visar skillnader när det gäller exponering för bristfälliga arbetsmiljöförhållanden mellan utlandsfödda och inrikes födda anställda på den svenska arbetsmarknaden. Dessa skillnader beror på den grupp som undersöks och det arbetsmiljöproblem som studeras.

  • 199. Eide, Ketil
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Inst, Dept Med, Stockholm, Sweden .
    Unaccompanied refugee children - vulnerability and agency2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 7, p. 666-668Article in journal (Refereed)
    Abstract [en]

    The numbers of refugee adolescents that arrive in Europe without their families has increased in recent years, particularly in Sweden. Research has demonstrated that these children have high rates of mental health problems, particularly depression and post-traumatic stress disorder, during the first years after resettlement. Despite this, there are also indications that many of these unaccompanied children are resourceful and arrive with a clear vision of a positive future in the new country. Follow-up studies in the United States and Norway have indicated fairly good social outcomes in the long term. Conclusion The education and care that unaccompanied minors receive during the first years after resettlement, together with their own drive to create a positive future, are key factors in their mental health and long-term adjustment.

  • 200. Eikemo, Terje A.
    et al.
    Hoffmann, Rasmus
    Kulik, Margarete C.
    Kulhanova, Ivana
    Toch-Marquardt, Marlen
    Menvielle, Gwenn
    Looman, Caspar
    Jasilionis, Domantas
    Martikainen, Pekka
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mackenbach, Johan P.
    How Can Inequalities in Mortality Be Reduced?: A Quantitative Analysis of 6 Risk Factors in 21 European Populations2014In: PLOS ONE, E-ISSN 1932-6203, Vol. 9, no 11, p. e110952-Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity. Methods: We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor. Findings: In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity. Interpretation: Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible.

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