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  • 301.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Arat, Arzu
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Klöfvermark, Josefin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Manhica, Hélio
    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).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Children as next of kin in Sweden2017Report (Other academic)
  • 302.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    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).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Barn som anhöriga: hur går det i skolan?2015In: Att se barn som anhöriga: om relationer, interventioner och omsorgsansvar / [ed] Ulrika Järkestig Berggren, Lennart Magnusson, Elizabeth Hanson, Kalmar: NKA och Linnéuniversitetet , 2015, p. 117-132Chapter in book (Other academic)
  • 303.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    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).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Barn som anhöriga: hur går det i skolan?2013Report (Other academic)
  • 304.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Manhica, Hélio
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Barn som anhöriga: Hur många är de?2015In: Att se barn som anhöriga: om relationer, interventioner och omsorgsansvar, Kalmar: NKA och Linnéuniversitetet , 2015, p. 101-116Chapter in book (Other academic)
  • 305.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Rajmil, Luis
    Kling, Stefan
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Karolinska Institutet, Sweden.
    Gender aspects of health-related quality of life of youth in secure residential care in Sweden2018In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 27, no 4, p. 358-363Article in journal (Refereed)
    Abstract [en]

    This study examined health-related quality of life of youth in secure residential care employing a gender perspective. The KIDSCREEN-52 questionnaire was administered to 91 youths (46 boys and 45 girls) aged 13-17, admitted to four secure residential units in southern Sweden, in connection with a medical examination. Results were compared with a national Swedish survey from 2009 of 86,000 youths aged 15-16years old. In age-adjusted analyses, youth in secure residential care units reported lower levels of wellbeing for all but one KIDSCREEN measure, compared with the national survey, with moderate to large differences in effect size. In the residential care sample, female gender was associated will lower psychological wellbeing, poorer parental relations and less school satisfaction, while male gender was associated with lower self-perception and peer relations.

  • 306.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Söderström, Ulf
    Åman, Jan
    East Africans in Sweden Have a High Risk for Type 1 Diabetes2012In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 35, no 3, p. 597-598Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To investigate the prevalence of type 1 diabetes in children with an origin in Sub-Saharan Africa in Sweden.

    RESEARCH DESIGN AND METHODS Nationwide register study based on retrieved prescriptions of insulin during 2009 in children aged 0–18 years. The study population consisted of 35,756 children in families with an origin in Sub-Saharan Africa and 1,666,051 children with native Swedish parents.

    RESULTS The odds ratio (OR) for insulin medication in Swedish-born children in families originating in East Africa was 1.29 (95% CI 1.02–1.63) compared with offspring of native Swedish parents, after adjustment for age and sex, and less common in children who themselves were born in East Africa: 0.50 (0.34–0.73). Offspring of parents from other parts of Sub-Saharan Africa had a comparatively low risk for insulin medication.

    CONCLUSIONS This study indicates that Swedish-born children with an origin in East Africa have a high risk of type 1 diabetes.

  • 307. Hodgins, S.
    et al.
    Larm, P.
    Westerman, Johan
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Individuals developing schizophrenia are hidden among adolescent substance misusers2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 14, p. 3041-3050Article in journal (Refereed)
    Abstract [en]

    Background Strategies are needed to identify youth developing schizophrenia. The present study aimed to determine whether adolescents treated for substance misuse were at elevated risk to develop schizophrenia, whether this risk has changed since the late 1960s, and whether substance misuse in adolescence predicted poorer outcomes through adulthood. Method In a Swedish city, since the mid-1960s there has been only one clinic for adolescent substance misuse. Three samples from this clinic were studied: 1992 individuals treated from 1968 to 1971 followed to age 50 years; 1576 treated from 1980 to 1984 followed to age 35 years; and 180 treated in 2004 followed to age 22 years. Each clinical sample was matched on age, sex and place of birth to an equal, or larger, number of randomly selected individuals from the general population. Schizophrenia, substance use disorders, physical disorders related to substance misuse, criminal convictions, poverty and death were identified using national registers. Results Individuals treated for substance misuse in adolescence were at increased risk to subsequently develop schizophrenia: in males the increase was approximately four-fold and in females between five- and seven-fold. There was no difference in risk for those treated in 1968-1971 and from 1980 to 1984 when cannabis use increased from 37.6% to 49.8% of the clinical samples. Among males who developed schizophrenia, treatment for substance misuse was associated with increased risk of substance use disorders and criminal convictions through adulthood. Conclusions Treatment programmes for adolescents misusing substances include a disproportionate number developing schizophrenia. Early detection and treatment have the potential to improve long-term outcomes.

  • 308.
    Holme, Petter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Umeå University, Sweden; Sungkyunkwan University, Korea.
    Masuda, Naoki
    The Basic Reproduction Number as a Predictor for Epidemic Outbreaks in Temporal Networks2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, article id e0120567Article in journal (Refereed)
    Abstract [en]

    The basic reproduction number R-0-the number of individuals directly infected by an infectious person in an otherwise susceptible population-is arguably the most widely used estimator of how severe an epidemic outbreak can be. This severity can be more directly measured as the fraction of people infected once the outbreak is over, Omega. In traditional mathematical epidemiology and common formulations of static network epidemiology, there is a deterministic relationship between R-0 and Omega. However, if one considers disease spreading on a temporal contact network-where one knows when contacts happen, not only between whom-then larger R-0 does not necessarily imply larger Omega. In this paper, we numerically investigate the relationship between R-0 and Omega for a set of empirical temporal networks of human contacts. Among 31 explanatory descriptors of temporal network structure, we identify those that make R-0 an imperfect predictor of Omega. We find that descriptors related to both temporal and topological aspects affect the relationship between R-0 and Omega, but in different ways.

  • 309. Holowko, N.
    et al.
    Jones, M.
    Tooth, L.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mishra, G.
    Education, educational mobility and weight trajectory in young Australian women2013In: Australasian Epidemiologist, ISSN 1327-8835, Vol. 20, no 2, p. 66-66Article in journal (Other academic)
  • 310. Holowko, N.
    et al.
    Jones, M.
    Tooth, L.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Mishra, G. D.
    Socioeconomic Position and Reproduction: Findings from the Australian Longitudinal Study on Women's Health2018In: Maternal and Child Health Journal, ISSN 1092-7875, E-ISSN 1573-6628, Vol. 22, no 12, p. 1713-1724Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association of socioeconomic position (SEP) with reproductive outcomes among Australian women. Methods: Data from the Australian Longitudinal Study on Women's Health's (population-based cohort study) 1973-1978 cohort were used (N = 6899, aged 37-42 years in 2015). The association of SEP (childhood and own, multiple indicators) with age at first birth, birth-to-pregnancy (BTP) intervals and total number of children was analysed using multinomial logistic regression. Results: 14% of women had their first birth aged < 24 years. 29% of multiparous women had a BTP interval within the WHO recommendation (18-27 months). Women with a low SEP had increased odds of a first birth < 24 years: low (OR 7.0: 95% C.I. 5.3, 9.3) or intermediate education (OR 3.8: 2.8, 5.1); living in rural (OR 1.8: 1.5, 2.2) or remote (OR 2.1: 1.7, 2.7) areas; who found it sometimes (OR 1.8: 1.5, 2.2) or always difficult (OR 2.0: 1.6, 2.7) to manage on their income; and did not know their parent's education (OR 4.5: 3.2, 6.4). Low SEP was associated with having a much longer than recommended BTP interval. Conclusion: As the first Australian study describing social differences in reproductive characteristics, these findings provide a base for reducing social inequalities in reproduction. Assisting adequate BTP spacing is important, particularly for women with existing elevated risks due to social disadvantage; including having a first birth < 24 years of age and a longer than recommended BTP interval. This includes reviewing services/access to postnatal support, free family planning/contraception clinics, and improved family policies.

  • 311. Holowko, N.
    et al.
    Mishra, G.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social differences in pre-pregnancy body mass index (BMI) and gestational weight gain: an opportunity to reduce long-lasting inequality in maternal and offspring health2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no suppl 2, p. 43-43Article in journal (Refereed)
  • 312. Holowko, Natalie
    et al.
    Chaparro, M. Pia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Nilsson, Katarina
    Ivarsson, Anneli
    Mishra, Gita
    Koupil, Illona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, UK .
    Social inequality in pre-pregnancy BMI and gestational weight gain in the first and second pregnancy among women in Sweden.2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 12, p. 1154-1161Article in journal (Refereed)
    Abstract [en]

    Background High pre-pregnancy body mass index (BMI) and inappropriate gestational weight gain (GWG) are associated with adverse short and long-term maternal and neonatal outcomes and may act as modifiable risk factors on the path to overweight/obesity, but their social patterning is not well established. This study investigates the association of education with BMI and GWG across two consecutive pregnancies. Methods The study includes 163 352 Swedish women, having their first and second singleton birth in 1982-2010. In both pregnancies, we investigated the association of women's education with (1) pre-pregnancy weight status and (2) adequacy of GWG. We used multinomial logistic regression, adjusting for child's birth year, mother's age and smoking status. Results Overall, the odds of starting either pregnancy at an unhealthy BMI were higher among women with a low education compared to more highly-educated women. Lower education also predicted a greater increase in BMI between pregnancies, with this effect greatest among women with excessive GWG in the first pregnancy (p<0.0001 for interaction). Education was also inversely associated with odds of excessive GWG in both pregnancies among healthy weight status women, but this association was absent or even weakly reversed among overweight and obese women. Conclusions Lower educated women had the largest BMI increase between pregnancies, and these inequalities were greatest among women with excessive GWG in the first pregnancy. The importance of a healthy pre-pregnancy BMI, appropriate GWG and a healthy postpartum weight should be communicated to all women, which may assist in reducing existing social inequalities in body weight.

  • 313. Holowko, Natalie
    et al.
    Jones, Mark
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Tooth, Leigh
    Mishra, Gita
    Combined effect of education and reproductive history on weight trajectories of young Australian women: A longitudinal study2016In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 24, no 10, p. 2224-2231Article in journal (Refereed)
    Abstract [en]

    Objective

    To investigate the combined effect of education and reproductive history on weight trajectory.

    Methods

    The association of education with weight trajectory (1996–2012) in relation to reproductive history was analyzed among 9,336 women (born 1973–1978) from the Australian Longitudinal Study on Women's Health using random effects models.

    Results

    Compared with women with a university degree/higher, lower-educated women were 2 kg heavier at baseline and gained an additional 0.24 kg/year. Giving birth was associated with an increase in weight which was more pronounced among women having their first birth <26 years of age (2.1 kg, 95% CI: 1.5–2.7), compared with 26 to 32 years or >32 years. While younger first-time mothers had a steeper weight trajectory (∼+0.16 kg/year, 95% CI: 0.1–0.3), this was less steep among lower-educated women. High-educated women with a second birth between 26 and 32 years had 0.9 kg decreased weight after this birth, while low-educated women gained 0.9 kg.

    Conclusions

    While the effect of having children on weight in young adulthood was minimal, women having their first birth <26 years of age had increased risk of weight gain, particularly primiparous women. Educational differences in weight persisted after accounting for reproductive history, suggesting a need to explore alternative mechanisms through which social differences in weight are generated.

  • 314. Holowko, Natalie
    et al.
    Jones, Mark
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Tooth, Leigh
    Mishra, Gita
    High education and increased parity are associated with breast-feeding initiation and duration among Australian women2016In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 19, no 14, p. 2551-2561Article in journal (Refereed)
    Abstract [en]

    Objective: Breast-feeding is associated with positive maternal and infant health and development outcomes. To assist identifying women less likely to meet infant nutritional guidelines, we investigated the role of socio-economic position and parity on initiation of and sustaining breast-feeding for at least 6 months.

    Design: Prospective cohort study.

    Setting: Australia.

    Subjects: Parous women from the Australian Longitudinal Study on Women’s Health (born 1973–78), with self-reported reproductive and breast-feeding history (N 4777).

    Results: While 89 % of women (83 % of infants) had ever breast-fed, only 60 % of infants were breast-fed for at least 6 months. Multiparous women were more likely to breast-feed their first child (~90 % v. ~71 % of primiparous women), and women who breast-fed their first child were more likely to breast-feed subsequent children. Women with a low education (adjusted OR (95 % CI): 2·09 (1·67, 2·62)) or a very low-educated parent (1·47 (1·16, 1·88)) had increased odds of not initiating breast-feeding with their first or subsequent children. While fewer women initiated breast-feeding with their youngest child, this was most pronounced among high-educated women. While ~60 % of women breast-fed their first, second and third child for at least 6 months, low-educated women (first child, adjusted OR (95 % CI): 2·19 (1·79, 2·68)) and women with a very low (1·82 (1·49, 2·22)) or low-educated parent (1·69 (1·33, 2·14)) had increased odds of not breast-feeding for at least 6 months.

    Conclusions: A greater understanding of barriers to initiating and sustaining breastfeeding, some of which are socio-economic-specific, may assist in reducing inequalities in infant breast-feeding.

  • 315. Holowko, Natalie
    et al.
    Jones, Mark
    Tooth, Leigh
    Koupil, Illona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mishra, Gita
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Centre for Longitudinal and Life Course Research, Australia.
    Educational mobility and weight gain over 13 years in a longitudinal study of young women2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 1219-Article in journal (Refereed)
    Abstract [en]

    Background: Limited evidence exists about the role of education and own educational mobility on body weight trajectory. A better understanding of how education influences long term weight gain can help us to design more effective health policies. 

    Methods: Using random effects models, the association between i) highest education (n = 10 018) and ii) educational mobility over a 9 year period (n = 9 907) and weight gain was analysed using five waves of data (over 13 years) from the Australian Longitudinal Study on Women's Health 1973-78 cohort (from 18-23 years to 31-36 years). 

    Results: Highest educational attainment was inversely associated with weight at baseline and weight gain over 13 years. Compared to high educated women, those with a low (12 years or less) or intermediate (trade/certificate/diploma) education, respectively, weighed an additional 2.6 kg (95% CI: 1.9 to 3.1) and 2.5 kg (95% CI: 1.9 to 3.3) at baseline and gained an additional 3.9 kg (95% CI: 2.6 to 5.2) and 3.1 kg (95% CI: 2.6 to 3.9) over 13 years. Compared to women who remained with a low education, women with the greatest educational mobility had similar baseline weight to the women who already had a high education at baseline (2.7 kg lighter (95% CI:-3.7 to -1.8) and 2.7 kg lighter (95% CI:-3.4 to -1.9), respectively) and similarly favourable weight gain (gaining 3.1 kg less (95% CI:-4.0 to -2.21) and 4.2 kg less (95% CI:-4.8 to -3.4) over the 13 years, respectively). 

    Conclusions: While educational attainment by mid-thirties was positively associated with better weight management, women's weight was already different in young adult age, before their highest education was achieved. These findings highlight a potential role of early life factors and personality traits which may influence both education and weight outcomes.

  • 316.
    Honkaniemi, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bacchus-Hertzman, Jennie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mortality by country of birth in the Nordic countries – a systematic review of the literature2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 511Article, review/survey (Refereed)
    Abstract [en]

    Background

    Immigration to the Nordic countries has increased in the last decades and foreign-born inhabitants now constitute a considerable part of the region’s population. Several studies suggest poorer self-reported health among foreign-born compared to natives, while results on mortality and life expectancy are inconclusive. To date, few studies have summarized knowledge on mortality differentials by country of birth. This article aims to systematically review previous results on all-cause and cause-specific mortality by country of birth in the Nordic countries.

    Methods

    The methodology was conducted and documented systematically and transparently using a narrative approach. We identified 43 relevant studies out of 6059 potentially relevant studies in August 2016, 35 of which used Swedish data, 8 Danish and 1 Norwegian.

    Results

    Our findings from fully-adjusted models on Swedish data support claims of excess mortality risks in specific categories of foreign-born. Most notably, immigrants from other Nordic countries, especially Finland, experience increased risk of mortality from all causes, and specifically by suicide, breast and gynaecological cancers, and circulatory diseases. Increased risks in people from Central and Eastern Europe can also be found. On the contrary, decreased risks for people with Southern European and Middle Eastern origins are found for all-cause, suicide, and breast and gynaecological cancer mortality. The few Danish studies are more difficult to compare, with conflicting results arising in the analysis. Finally, results from the one Norwegian study suggest significantly decreased mortality risks among foreign-born, to be explored in further research.

    Conclusions

    With new studies being published on mortality differentials between native and foreign-born populations in the Nordic countries, specific risk patterns have begun to arise. Regardless, data from most Nordic countries remains limited, as does the information on specific causes of death. The literature should be expanded in upcoming years to capture associations between country of birth and mortality more clearly.

  • 317.
    Honkaniemi, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Kauppi, M.
    Virtanen, P.
    Lipiäinen, L.
    Pentti, J.
    Kivimäki, M.
    Vahtera, J.
    Trajectories of Antidepressant Use before and after the Loss of a Family Member: Evidence from the Finnish Public Sector Study2018In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 87, no 4, p. 246-248Article in journal (Refereed)
  • 318.
    Hossin, Muhammad Zakir
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Is the association between late-life morbidity and disability attenuated over time?: Exploring the dynamic equilibrium of morbidity hypothesis2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Context: There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of disabling chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these seemingly contradictory trends are due to the attenuation of the morbidity-disability link over time. The aim of this study was to empirically test this assumption.Methods: Data were drawn from three repeated cross-sections of SWEOLD, a population-based survey among the Swedish men and women ages 77 and older. Logistic regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined in both multiplicative and additive models.Results: Between 1992 and 2011, the odds of ADL disability significantly declined among women whereas the odds of IADL disability significantly declined among men. During the same period, the prevalence of most chronic morbidities including multimorbidity went up. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, psychological distress, and multimorbidity.Conclusion: In agreement with the dynamic equilibrium hypothesis, this study concludes that the associations between chronic conditions and disability among the Swedish older adults have largely waned over time.

  • 319. Hossin, Zakir
    et al.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Is the Association Between Late Life Morbidity and Disability Attenuated Over Time? Exploring the Dynamic Equilibrium of Morbidity Hypothesis2017In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368Article in journal (Refereed)
    Abstract [en]

    Objective:

    There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these patterns are due to the attenuation of the morbidity-disability link over time. This study aimed to test this assumption empirically.

    Methods:

    Data were drawn from three repeated cross-sections of SWEOLD, a nationally representative survey of the Swedish population aged 77 years and older. Poisson regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined on both multiplicative and additive scales.

    Results:

    Between 1992 and 2011, the prevalence of both ADL and IADL disabilities decreased whereas the prevalence of nearly all chronic morbidities increased. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, and psychological distress.

    Discussion:

    In agreement with the dynamic equilibrium of morbidity hypothesis, this study concludes that the morbidity-disability associations among the Swedish older adults largely waned between 1992 and 2011.

  • 320. Howard, Jennifer
    et al.
    Loizon, Séverine
    Tyler, Christopher J.
    Duluc, Dorothée
    Moser, Bernhard
    Mechain, Matthieu
    Duvignaud, Alexandre
    Malvy, Denis
    Troye-Blomberg, Marita
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    Moreau, Jean-Francois
    Eberl, Matthias
    Mercereau-Puijalon, Odile
    Déchanet-Merville, Julie
    Behr, Charlotte
    Mamani-Matsuda, Maria
    The Antigen-Presenting Potential of V gamma 9V delta 2 T Cells During Plasmodium falciparum Blood-Stage Infection2017In: Journal of Infectious Diseases, ISSN 0022-1899, E-ISSN 1537-6613, Vol. 215, no 10, p. 1569-1579Article in journal (Refereed)
    Abstract [en]

    During Plasmodium falciparum infections, erythrocyte-stage parasites inhibit dendritic cell maturation and function, compromising effective antimalarial adaptive immunity. Human V gamma 9V delta 2 T cells can act in vitro as antigen-presenting cells (APCs) and induce alpha beta T-cell activation. However, the relevance of this activity in vivo has remained elusive. Because V gamma 9V delta 2 T cells are activated during the early immune response against P. falciparum infection, we investigated whether they could contribute to the instruction of adaptive immune responses toward malaria parasites. In P. falciparum-infected patients, V gamma 9V delta 2 T cells presented increased surface expression of APC-associated markers HLA-DR and CD86. In response to infected red blood cells in vitro, V gamma 9V delta 2 T cells upregulated surface expression of HLA-DR, HLA-ABC, CD40, CD80, CD83, and CD86, induced naive alpha beta T-cell responses, and cross-presented soluble prototypical protein to antigen-specific CD8(+) T cells. Our findings qualify V gamma 9V delta 2 T cells as alternative APCs, which could be harnessed for therapeutic interventions and vaccine design.

  • 321. Hu, Yaoyue
    et al.
    Leinonen, Taina
    University of Helsinki, Finland.
    Myrskylä, Mikko
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Changes in Socioeconomic Differences in Hospital Days With Age: Cumulative Disadvantage, Age-as-Leveler, or Both?2019In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368Article in journal (Refereed)
    Abstract [en]

    Objectives: Length of hospital stay is inversely associated with socioeconomic status (SES). It is less clear whether socioeconomic disparities in numbers of hospital days diverge or converge with age.

    Method: Longitudinal linked Finnish registry data (1988-2007) from 137,653 men and women aged 50-79 years at the end of 1987 were used. Trajectories of annual total hospital days by education, household income, and occupational class were estimated using negative binomial models.

    Results: Men and women with higher education, household income, and occupational class had fewer hospital days in 1988 than those with lower SES. Hospital days increased between 1988 and 2007. For some age groups, higher SES was associated with a faster annual rate of increase, resulting in narrowing rate ratios of hospital days between SES groups (relative differences); the rate ratios remained stable for other groups. Absolute SES differences in numbers of hospital days appeared to diverge with age among those aged 50-69 years at baseline, but converge among those aged 70-79 years at baseline.

    Discussion: The hypotheses that socioeconomic disparities in health diverge or converge with age may not be mutually exclusive; we demonstrated convergence/maintenance in relative differences for all age groups, but divergence or convergence in absolute differences depending on age.

  • 322. Hulvej Rod, Naja
    et al.
    Vahtera, Jussi
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University College London, United Kingdom.
    Kivimäki, Mika
    Zins, Marie
    Goldberg, Marcel
    Lange, Theis
    Sleep Disturbances and Cause-Specific Mortality: Results From the GAZEL Cohort Study2011In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 173, no 3, p. 300-309Article in journal (Refereed)
    Abstract [en]

    Poor sleep is an increasing problem in modern society, but most previous studies on the association between sleep and mortality rates have addressed only duration, not quality, of sleep. The authors prospectively examined the effects of sleep disturbances on mortality rates and on important risk factors for mortality, such as body mass index, hypertension, and diabetes. A total of 16,989 participants in the GAZEL cohort study were asked validated questions on sleep disturbances in 1990 and were followed up until 2009, with <1% loss to follow-up. Body mass index, hypertension, and diabetes were measured annually through self-reporting. During follow-up, a total of 1,045 men and women died. Sleep disturbances were associated with a higher overall mortality risk in men (P = 0.005) but not in women (P = 0.33). This effect was most pronounced for men <45 years of age (≥3 symptoms vs. none: hazard ratio = 2.03, 95% confidence interval: 1.24, 3.33). There were no clear associations between sleep disturbances and cardiovascular mortality rates, although men and women with sleep disturbances were more likely to develop hypertension and diabetes (P < 0.001). Compared with people with no sleep disturbances, men who reported ≥3 types of sleep disturbance had an almost 5 times' higher risk of committing suicide (hazard ratio = 4.99, 95% confidence interval: 1.59, 15.7). Future strategies to prevent premature deaths may benefit from assessment of sleep disturbances, especially in younger individuals.

  • 323.
    Härkönen, Juho
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. European University Institute, Italy; University of Turku, Finland.
    Lindberg, Matti
    Karlsson, Linnea
    Karlsson, Hasse
    Scheinin, Noora M.
    Education is the strongest socio-economic predictor of smoking in pregnancy2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 6, p. 1117-1126Article in journal (Refereed)
    Abstract [en]

    Aims To investigate socio-economic disparities in smoking in pregnancy (SIP) by the mother's education, occupational class and current economic conditions. Design Cross-sectional analysis with linked survey and register data. Setting South-western Finland. Participants A total of 2667 pregnant women [70% of the original sample (n=3808)] from FinnBrain, a prospective pregnancy cohort study. Measurements The outcome was smoking during the first pregnancy trimester, measured from the Finnish Medical Birth Register. Education and occupational class were linked from population registers. Income support recipiency and subjective economic wellbeing were questionnaire-based measures of current economic conditions. These were adjusted for age, partnership status, residential area type, parental separation, parity, childhood socio-economic background, childhood adversities (the Trauma and Distressing Events During Childhood scale) and antenatal stress (Edinburgh Postnatal Depression Scale). Logistic regressions and attributable fractions (AF) were estimated. Findings Mother's education was the strongest socio-economic predictor of SIP. Compared with university education, adjusted odds ratios (aORs) of SIP were: 2.2 [95% confidence interval (CI)=1.2-3.9; P=0.011] for tertiary vocational education, 4.4 (95% CI=2.1-9.0; P<0.001) for combined general and vocational secondary education, 2.9 (95% CI=1.4-6.1; P=0.006) for general secondary education, 9.5 (95% CI 5.0-18.2; P<0.001) for vocational secondary education and 14.4 (95% CI=6.3-33.0; P<0.001) for compulsory schooling. The total AF of education was 0.5. Adjusted for the other variables, occupational class and subjective economic wellbeing did not predict SIP. Income support recipiency was associated positively with SIP (aOR=1.8; 95% CI=1.1-3.1; P=0.022). Antenatal stress predicted SIP (aOR=2.0; 95% CI=1.4-2.8; P<0.001), but did not attenuate its socio-economic disparities. Conclusions In Finland, socio-economic disparities in smoking in pregnancy are attributable primarily to differences in the mother's educational level (low versus high) and orientation (vocational versus general).

  • 324. Härter Griep, Rosane
    et al.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Santos, Itamar S.
    Rotenberg, Lucia
    Juvanhol, Leidjaira Lopes
    Goulart, Alessandra C.
    Aquino, Estela M.
    Benseñor, Isabela
    Work-family conflict, lack of time for personal care and leisure, and job strain in migraine: Results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)2016In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 59, no 11, p. 987-1000Article in journal (Refereed)
    Abstract [en]

    Background

    Work-family conflict and time scarcity may affect health. We investigated the association between these issues and migraine, taking into account job strain.

    Methods

    Baseline data from ELSA-Brasil (6,183 women; 5,664 men) included four indicators of work-family conflict: time- and strain-based interference of work with family (TB-WFC, SB-WFC), interference of family with work (FWC) and lack of time for personal care and leisure (LOT). Migraine was classified according to International Headache Society criteria.

    Results

    Among women, definite migraine was associated with SB-WFC (odds ratio [OR] = 1.28; 95% confidence interval [CI] 1.06–1.55), FWC (OR = 1.32; 1.00–1.75), and LOT (OR = 1.30; 1.08–1.58). Probable migraine was associated with SB-WFC (OR = 1.17; 1.00–1.36). High psychological job demands and low social support interacted with LOT in association with definite migraine. Among men, probable migraine was associated with LOT (OR = 1.34; 1.09–1.64), and there were interactions between job strain and WFC for probable migraine.

    Conclusions

    Balancing the demands of professional and domestic spheres could be highly relevant in the management of migraines.

  • 325.
    Härter Griep, Rosane
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Oswaldo Cruz Foundation, Brazil.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    van Diepen, Cornelia
    Guimarães, Johanna M. N.
    Camelo, Lidyane V.
    Lopes Juvanhol, Leidjaira
    Aquino, Estela M.
    Chor, Dóra
    Work–family conflict and self-rated health: the role of gender and educational level. Baseline data from the Brazilian longitudinal study of adult health (ELSA-Brasil)2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 3, p. 372-382Article in journal (Refereed)
    Abstract [en]

    Purpose

    This study examined gender differences in the association between work–family conflict and self-rated health and evaluated the effect of educational attainment.

    Method

    We used baseline data from ELSA-Brasil, a cohort study of civil servants from six Brazilian state capitals. Our samples included 12,017 active workers aged 34–72 years. Work–family conflict was measured by four indicators measuring effects of work on family, effects of family in work and lack of time for leisure and personal care.

    Results

    Women experienced more frequent work–family conflict, but in both genders, increased work–family conflict directly correlated with poorer self-rated health. Women’s educational level interacted with three work–family conflict indicators. For time-based effects of work on family, highly educated women had higher odds of suboptimal self-rated health (OR = 1.54; 95 % CI = 1.19–1.99) than less educated women (OR = 1.14; 95 % CI = 0.92–1.42). For strain-based effects of work on family, women with higher and lower education levels had OR = 1.91 (95 % CI 1.48–2.47) and OR = 1.40 (95 % CI 1.12–1.75), respectively. For lack of time for leisure and personal care, women with higher and lower education levels had OR = 2.60 (95 % CI = 1.95–3.47) and OR = 1.11 (95 % CI = 0.90–1.38), respectively.

    Conclusion

    Women’s education level affects the relationship between work–family conflict and self-rated health. The results may contribute to prevention activities.

  • 326. Hébert, Sylvie
    et al.
    Canlon, Barbara
    Hasson, Dan
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Tinnitus severity is reduced with reduction of depressive mood - a prospective population study in Sweden2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 5, article id e37733Article in journal (Refereed)
    Abstract [en]

    Tinnitus, the perception of sound without external source, is a highly prevalent public health problem with about 8% of the population having frequently occurring tinnitus, and about 1-2% experiencing significant distress from it. Population studies, as well as studies on self-selected samples, have reported poor psychological well-being in individuals with tinnitus. However, no study has examined the long-term co-variation between mood and tinnitus prevalence or tinnitus severity. In this study, the relationship between depression and tinnitus prevalence and severity over a 2-year period was examined in a representative sample of the general Swedish working population. Results show that a decrease in depression is associated with a decrease in tinnitus prevalence, and even more markedly with tinnitus severity. Hearing loss was a more potent predictor than depression for tinnitus prevalence, but was a weaker predictor than depression for tinnitus severity. In addition, there were sex differences for tinnitus prevalence, but not for tinnitus severity. This study shows a direct and long-term association between tinnitus severity and depression.

  • 327.
    Hélio, Manhica
    et al.
    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).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mortality in adult offspring of immigrants: a Swedish national cohort study2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 2, article id e0116999.Article in journal (Refereed)
  • 328.
    Hössjer, Ola
    et al.
    Stockholm University, Faculty of Science, Department of Mathematics.
    Alfredsson, Lars
    Hedström, Anna Karin
    Lekman, Magnus
    Kockum, Ingrid
    Olsson, Tomas
    Quantifying and estimating additive measures of interaction from case-control data2017In: Modern stochastics: theory and applications, ISSN 2351-6054, Vol. 4, no 2, p. 109-125Article in journal (Refereed)
    Abstract [en]

    In this paper we develop a general framework for quantifying how binary risk factors jointly influence a binary outcome. Our key result is an additive expansion of odds ratios as a sum of marginal effects and interaction terms of varying order. These odds ratio expansions are used for estimating the excess odds ratio, attributable proportion and synergy index for a case-control dataset by means of maximum likelihood from a logistic regression model. The confidence intervals associated with these estimates of joint effects and interaction of risk factors rely on the delta method. Our methodology is illustrated with a large Nordic meta dataset for multiple sclerosis. It combines four studies, with a total of 6265 cases and 8401 controls. It has three risk factors (smoking and two genetic factors) and a number of other confounding variables.

  • 329.
    Høj Jørgensen, Terese Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Copenhagen, Denmark.
    Juul Nilsson, Charlotte
    Lund, Rikke
    Siersma, Volkert
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Intergenerational relations and social mobility: Social inequality in physical function in old age2019In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 80, p. 58-64Article in journal (Refereed)
    Abstract [en]

    Background: The concept of social foreground describes how adult offspring's socioeconomic resources may influence older adults' health and several studies have shown an association between socioeconomic position of adult offspring and the health of their older parents. However, little is known about the factors that generate these associations. We study 1) how adult offspring's social class is associated with physical function (PF) among older adults, 2) whether geographical closeness and contact frequency with offspring modify the association, and 3) whether intergenerational social mobility of offspring is associated with PF of older adults. Method: Data are obtained from the 2002 (n = 621) and 2011 (n = 931) waves of the Swedish Panel Study of Living Conditions of the Oldest Old. Multivariable linear regression models were employed and adjusted for own and partner's prior social class and offspring's age and gender. Results: Compared to offspring with non-manual occupation, offsprings with manual occupation was associated with poorer PF in older adults ( -0.14, CI95%: -0.28;0.00). In stratified analyses, offspring's social class was only associated with older adults' PF among those who lived geographically close. Contact frequency between the offspring and the older adults did not modify the associations. Older adults whose offspring experienced downward intergenerational social mobility were associated with the poorest PF. Conclusion: This study supports evidence of a relationship between social foreground and older adults' PF where geographical closeness and social mobility are important components.

  • 330. Ihlström, Jonas
    et al.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Anund, Anna
    Split-shift work in relation to stress, health and psychosocial work factors among bus drivers2017In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 56, no 4, p. 531-538Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Shift work has been associated with poor health, sleep and fatigue problems and low satisfaction with working hours. However, one type of shift working, namely split shifts, have received little attention.

    OBJECTIVE: This study examined stress, health and psychosocial aspects of split-shift schedules among bus drivers in urban transport.

    METHODS: A questionnaire was distributed to drivers working more than 70% of full time which 235 drivers in total answered.

    RESULTS: In general, drivers working split-shift schedules (n = 146) did not differ from drivers not working such shifts (n = 83) as regards any of the outcome variables that were studied. However, when individual perceptions towards split-shift schedules were taken into account, a different picture appeared. Bus drivers who reported problems working split shifts (36%) reported poorer health, higher perceived stress, working hours interfering with social life, lower sleep quality, more persistent fatigue and lower general work satisfaction than those who did not view split shifts as a problem. Moreover, drivers who reported problems with split shifts also perceived lower possibilities to influence working hours, indicating lower work time control.

    CONCLUSIONS: This study indicates that split shifts were not associated with increased stress, poorer health and adverse psychosocial work factors for the entire study sample. However, the results showed that individual differences were important and approximately one third of the drivers reported problems with split shifts, which in turn was associated with stress, poor health and negative psychosocial work conditions. More research is needed to understand the individual and organizational determinants of tolerance to split shifts.

  • 331.
    Ingre, Michael
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    van Leeuwen, Wessel M A
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Klemets, T
    Ullvetter, C
    Hough, S
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Karlsson, D
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Validating and extending the three process model (TPM) of alertness in airline operations.2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no S1, p. 264-264, article id P836Article in journal (Other academic)
  • 332. Ishtiak-Ahmed, Kazi
    et al.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Mittendorfer-Rutz, Ellenor
    Risk markers of all-cause and diagnosis-specific disability pension - a prospective cohort study of individuals sickness absent due to stress-related mental disorders2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 805-Article in journal (Refereed)
    Abstract [en]

    Background: Stress-related mental disorders rank among the leading causes of sickness absence in several European countries. The aim of this study was to investigate predictors of all-cause and diagnosis-specific disability pension in sickness absentees with stress-related mental disorders. Methods: A cohort of 36304 non-retired individuals aged 16-64 years at 31.12.2004 with at-least one sickness absence spell due to stress-related mental disorders (SRMD) initiated in 2005 in Sweden was followed-up with regard to disability pension (2006-2010) by linkage of registers. Uni- and multivariate Hazard ratios (HR) with 95% Confidence Intervals, CI, were estimated using Cox regression for several risk markers. Results: During the follow-up period, 2735 individuals (7.5%) were granted a disability pension, predominantly due to mental diagnoses (n = 2004, 73.3%). In the multivariate analyses, female sex, age exceeding 35 years, low educational level, being born in a country outside EU25 and Northern Europe, residing outside big cities, living alone, having had a long duration of the first spell due to SRMD (>90 days); mental disorders necessitating frequent specialised health care as well as comorbid somatic disorders were found to be predictive of granting disability pension. Some different patterns emerged for risk factors related to diagnosis-specific disability pension and for younger and older individuals. Conclusions: Several predictors could be identified as risk markers for disability pension. The variation in the effect of risk markers with regard to age and diagnosis of disability pension speaks in favour of the importance of a person-centered approach in treatment and rehabilitation.

  • 333. Jablonska, Beata
    et al.
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindberg, Lene
    Rasmussen, Finn
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Uppsala University, Sweden.
    A national cohort study of parental socioeconomic status and non-fatal suicidal behaviour-the mediating role of school performance2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, article id 17Article in journal (Refereed)
    Abstract [en]

    Background: A link between low parental socioeconomic status and mental health problems in offspring is well established in previous research. The mechanisms that explain this link are largely unknown. The present study investigated whether school performance was a mediating and/or moderating factor in the path between parental socioeconomic status and the risk of hospital admission for non-fatal suicidal behaviour.

    Methods: A national cohort of 447 929 children born during 1973-1977 was followed prospectively in the National Patient Discharge Register from the end of their ninth and final year of compulsory school until 2001. Multivariate Cox proportional hazards and linear regression analyses were performed to test whether the association between parental socioeconomic status and non-fatal suicidal behaviour was mediated or moderated by school performance.

    Results: The results of a series of multiple regression analyses, adjusted for demographic variables, revealed that school performance was as an important mediator in the relationship between parental socioeconomic status and risk of non-fatal suicidal behaviour, accounting for 60% of the variance. The hypothesized moderation of parental socioeconomic status--non-fatal suicidal behaviour relationship by school performance was not supported.

    Conclusions: School performance is an important mediator through which parental socioeconomic status translates into a risk for non-fatal suicidal behaviour. Prevention efforts aimed to reduce socioeconomic inequalities in non-fatal suicidal behaviour among young people will need to consider socioeconomic inequalities in school performance.

  • 334. Jablonska, Beata
    et al.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindberg, Lene
    Rasmussen, Finn
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    School effects on risk of non-fatal suicidal behaviour: a national multilevel cohort study2014In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 49, no 4, p. 609-618Article in journal (Refereed)
    Abstract [en]

    Objective

    Research has demonstrated school effects on health, over and above the effects of students’ individual characteristics. This approach has however been uncommon in mental health research. The aim of the study was to assess whether there are any school-contextual effects related to socioeconomic characteristics and academic performance, on the risk of hospitalization from non-fatal suicidal behaviour (NFSB).

    Methods

    A Swedish national cohort of 447,929 subjects was followed prospectively in the National Patient Discharge Register from the completion of compulsory school in 1989–93 (≈16 years) until 2001. Multilevel logistic regression was used to assess the association between school-level characteristics and NFSB.

    Results

    A small but significant share of variation in NFSB was accounted for by the school context (variance partition coefficient <1 %, median odds ratio = 1.26). The risk of NFSB was positively associated with the school’s proportion of students from low socioeconomic status (SES), single parent household, and the school’s average academic performance. School effects varied, in part, by school location.

    Conclusion

    NFSB seems to be explained mainly by individual-level characteristics. Nevertheless, a concentration of children from disadvantaged backgrounds in schools appears to negatively affect mental health, regardless of whether or not they are exposed to such problems themselves. Thus, school SES should be considered when planning prevention of mental health problems in children and adolescents.

  • 335. Jankipersadsing, Soesma A.
    et al.
    Hadizadeh, Fatemeh
    Bonder, Marc Jan
    Tigchelaar, Ettje F.
    Deelen, Patrick
    Fu, Jingyuan
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Agreus, Lars
    Walter, Susanna
    Wijmenga, Cisca
    Hysi, Pirro
    D'Amato, Mauro
    Zhernakova, Alexandra
    A GWAS meta-analysis suggests roles for xenobiotic metabolism and ion channel activity in the biology of stool frequency2017In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 66, no 4, p. 756-758Article in journal (Refereed)
  • 336. Jans, Jenny
    et al.
    Johansson, Per
    Nilsson, J. Peter
    Stockholm University, Faculty of Social Sciences, Institute for International Economic Studies. Uppsala Center for Labor Studies (UCLS), Sweden.
    Economic status, air quality, and child health: Evidence from inversion episodes2018In: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 61, p. 220-232Article in journal (Refereed)
    Abstract [en]

    Normally, the temperature decreases with altitude, allowing air pollutants to rise and disperse. During inversion episodes, warmer air at higher altitude traps air pollutants at the ground. By merging vertical temperature profile data from NASA with pollution monitors and health care records, we show that inversions increase the PM10 levels by 25% and children's respiratory health problems by 5.5%. Low-income children are particularly affected, and differences in baseline health seem to be a key mediating factor behind the effect of pollution on the SES health gap. Policies that improve dissemination of information on inversion status may hence improve child health, either through private action or via policies that curb emissions during inversion episodes.

  • 337.
    Jansson, Fredrik
    Stockholm University, Faculty of Humanities, Department of Archaeology and Classical Studies, Centre for the Study of Cultural Evolution. Mälardalen University, Sweden; Linköping University, Sweden.
    Using register data to deduce patterns of social exchange2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, p. 56-61Article in journal (Refereed)
    Abstract [en]

    This paper presents a novel method for deducting propensities for social exchange between individuals based on the choices they make, and based on factors such as country of origin, sex, school grades and socioeconomic background. The objective here is to disentangle the effect of social ties from the other factors, in order to find patterns of social exchange. This is done through a control-treatment design on analysing available data, where the treatment' is similarity of choices between socially connected individuals, and the control is similarity of choices between non-connected individuals. Structural dependencies are controlled for and effects from different classes are pooled through a mix of methods from network and meta-analysis. The method is demonstrated and tested on Swedish register data on students at upper secondary school. The results show that having similar grades is a predictor of social exchange. Also, previous results from Norwegian data are replicated, showing that students cluster based on country of origin.

  • 338.
    Jarynowski, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Istytut Fizyki, Uniwersytet Jagiellonski.
    Modelowanie epidemiologiczne: klasycznie i na sieciowo2012Conference paper (Other (popular science, discussion, etc.))
  • 339.
    Jarynowski, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Modelowanie epidemiologiczne przy wykorzystaniu analizy tymczasowych sieci społecznych2013In: Postępy inżynierii biomedycznej / [ed] Leniowska, Lucyna and Nawrat, Zbigniew, Rzeszów: Uniwersytet Rzeszowski-InProNa , 2013, p. 91-100Chapter in book (Refereed)
  • 340.
    Jarynowski, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Serafimovic, Ana
    Stockholm University, Faculty of Science, Department of Mathematics.
    Studying Possible Outcomes in a Model of Sexually Transmitted Virus (HPV) Causing Cervical Cancer for Poland2014In: Advances in social simulation: proceedings of the 9th Conference of the European Social Simulation Association / [ed] Bogumił Kamiński, Grzegorz Koloch., Berlin, Heidelberg: Springer Berlin/Heidelberg, 2014, Vol. 229, p. 386p. 129-141Chapter in book (Refereed)
    Abstract [en]

    The aim of this paper is to supplement knowledge about the spread of sexually transmitted diseases through computer simulations. The model has aggregated the most important properties of HPV infections and development of cervical cancer in demographically changing Polish society. The main goal is the authoritative analysis of the potential epidemiological control strategies and their impact on situation in Poland in the future 25 years. Constructed model shows indication that vaccination with screening organized alongside would be effective measures against cervical cancer. It also alarms authorities that processes like aging of society and increase of sexual activity (which are taking place in Poland at the moment) could recall epidemic, if prevention would not act properly.

  • 341. Jasilionis, Domantas
    et al.
    Shkolnikov, Vladimir M.
    Andreev, Evgueni M.
    Jdanov, Dmitri A.
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Meslé, France
    Vallin, Jacques
    L’avant-garde en matière d’espérance de vie montre-t-elle la voie au reste de la population?2014In: Population, ISSN 0032-4663, E-ISSN 1957-7966, Vol. 69, no 4, p. 589-615Article in journal (Refereed)
    Abstract [en]

    Do vanguard populations open new frontiers of survival and longevity that will eventually be reached by others? The main aim of this study is to identify the extent to which the non-vanguard populations in Finland, Norway, and Sweden might follow the mortality trajectories of the vanguard groups in these countries for different age ranges and for the major causes of death. The results show no systematic convergence between vanguard and non-vanguard sub-populations. On the contrary, they confirm the theory whereby each major epidemiological development initially gives rise to divergence in mortality trends. Our study found that at the sub-national level, rather than simply following (with a certain time lag) the same path as the vanguard groups, non-vanguard groups have their own pathways to low mortality which are related to specific determinants of mortality change. The study also found that a long time is needed for the non-vanguard group to attain the mortality levels already reached by the vanguard group at the start of the observation period. This is notably the case for the treatment and prevention of cardiovascular diseases.

  • 342. Jayasekara, Harindra
    et al.
    English, Dallas R.
    Haydon, Andrew
    Hodge, Allison M.
    Lynch, Brigid M.
    Rosty, Christophe
    Williamson, Elizabeth J.
    Clendenning, Mark
    Southey, Melissa C.
    Jenkins, Mark A.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia; The University of Melbourne, Australia.
    Hopper, John L.
    Milne, Roger L.
    Buchanan, Daniel D.
    Giles, Graham G.
    MacInnis, Robert J.
    Associations of alcohol intake, smoking, physical activity and obesity with survival following colorectal cancer diagnosis by stage, anatomic site and tumor molecular subtype2018In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 142, no 2, p. 238-250Article in journal (Refereed)
    Abstract [en]

    The influence of lifestyle factors on survival following a diagnosis of colorectal cancer (CRC) is not well established. We examined associations between lifestyle factors measured before diagnosis and CRC survival. The Melbourne Collaborative Cohort Study collected data on alcohol intake, cigarette smoking and physical activity, and body measurements at baseline (1990-1994) and wave 2 (2003-2007). We included participants diagnosed to 31 August 2015 with incident stages I-III CRC within 10-years post exposure assessment. Information on tumor characteristics and vital status was obtained. Tumor DNA was tested for microsatellite instability (MSI) and somatic mutations in oncogenes BRAF (V600E) and KRAS. We estimated hazard ratios (HRs) for associations between lifestyle factors and overall and CRC-specific mortality using Cox regression. Of 724 eligible CRC cases, 339 died (170 from CRC) during follow-up (average 9.0 years). Exercise (non-occupational/leisure-time) was associated with higher CRC-specific survival for stage II (HR=0.25, 95% CI: 0.10-0.60) but not stages I/III disease (p for interaction=0.01), and possibly for colon and KRAS wild-type tumors. Waist circumference was inversely associated with CRC-specific survival (HR=1.25 per 10 cm increment, 95% CI: 1.08-1.44), independent of stage, anatomic site and tumor molecular status. Cigarette smoking was associated with lower overall survival, with suggestive evidence of worse survival for BRAF mutated CRC, but not with CRC-specific survival. Alcohol intake was not associated with survival. Survival did not differ by MSI status. We have identified pre-diagnostic predictors of survival following CRC that may have clinical and public health relevance.

  • 343. Jayasekara, Harindra
    et al.
    Juneja, Surender
    Hodge, Allison M.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia; The University of Melbourne, Australia.
    Milne, Roger L.
    Hopper, John L.
    English, Dallas R.
    Giles, Graham G.
    MacInnis, Robert J.
    Lifetime alcohol intake and risk of non-Hodgkin lymphoma: Findings from the Melbourne Collaborative Cohort Study2018In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 142, no 5, p. 919-926Article in journal (Refereed)
    Abstract [en]

    Cohort studies have reported inconsistent evidence regarding alcohol intake and risk of non-Hodgkin lymphoma (NHL), mostly based on alcohol intake assessed close to study enrolment. We examined this association using alcohol intake measured from age 20 onwards. We calculated usual alcohol intake for 10-year periods from age 20 using recalled frequency and quantity of beverage-specific consumption for 37,990 participants aged 40-69 years from the Melbourne Collaborative Cohort Study. Cox regression was performed to derive hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between alcohol intake (g/day) and NHL risk. After a mean follow-up of 19.3 years, 538 NHL cases were diagnosed. Approximately 80% of participants were either lifetime abstainers or consumed below 20 g of ethanol/day. All categories of lifetime alcohol intake were associated with about 20% lower incidence of NHL compared with lifetime abstention, but there was no evidence of a trend by amount consumed (HR=0.97 per 10 g/day increment in intake, 95% CI: 0.92-1.03; p value=0.3). HRs for beer, wine and spirits were 0.91 (95% CI: 0.83-1.00; p value=0.05), 1.03 (95% CI: 0.94-1.12; p value=0.6), and 1.06 (95% CI: 0.83-1.37; p value=0.6), respectively, per 10 g/day increment in lifetime intake. There were no significant differences in associations between NHL subtypes. In this low-drinking cohort, we did not detect a dose-dependent association between lifetime alcohol intake and NHL risk.

  • 344. Jayasekara, Harindra
    et al.
    MacInnis, Robert J.
    Hodge, Allison M.
    Hopper, John L.
    Giles, Graham G.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University of Melbourne, Australia; Turning Point Alcohol and Drug Centre, Australia.
    English, Dallas R.
    Lifetime alcohol consumption and upper aero-digestive tract cancer risk in the Melbourne Collaborative Cohort Study2015In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 26, no 2, p. 297-301Article in journal (Refereed)
    Abstract [en]

    Cohort studies have rarely examined the association between upper aero-digestive tract (UADT) cancer risk and lifetime alcohol intake. We examined the associations between incident squamous cell carcinoma of the UADT (oral cavity, pharynx, larynx, and esophagus) and alcohol intake for different periods in life using data from the Melbourne Collaborative Cohort Study. Usual alcohol intake for 10-year periods from age 20 was calculated using recalled frequency and quantity of beverage-specific consumption. Cox regression with age as the time axis was performed to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for the associations of UADT cancer with alcohol intake for different periods in life compared with abstention. During a mean follow-up of 16.2 person-years, 98 incident cases of UADT cancer were identified. We observed a dose-dependent association between lifetime alcohol intake and the risk of UADT cancer (multivariable-adjusted HR 2.67, 95 % CI 1.27-5.60 for an intake of a parts per thousand yen40 g/day and multivariable-adjusted HR 1.16, 95 % CI 1.06-1.28 for a 10 g/day increment in intake). A positive association with baseline alcohol intake (multivariable-adjusted HR 1.12, 95 % CI 1.02-1.24 for a 10 g/day increment in intake) was found to be a slightly weaker predictor of risk than lifetime intake. Limiting alcohol intake from early adulthood may reduce UADT cancer risk.

  • 345. Jernelov, S.
    et al.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Almqvist, C.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Larsson, H.
    Development of atopic disease and disturbed sleep in childhood and adolescence a longitudinal population-based study2013In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 43, no 5, p. 552-559Article in journal (Refereed)
    Abstract [en]

    Background Both atopic diseases and sleep disturbances have increased during recent decades, especially in children. Sleep is important for many aspects of immune regulation relevant in allergic diseases, and sleep disturbances are common in patients with such diseases. A connection between sleep disturbances and fatigue, and atopic disease is well established. However, the time course and putative causal relationships between these factors are obscure.

    Objective We aimed at investigating the developmental relationships between subjectively reported sleep disturbances and symptoms of atopic disease, from childhood to adolescence.

    Methods This longitudinal study used parent-report questionnaire data on symptoms of atopic disease, and sleep disturbances, from the Twin Study of Child and Adolescent Development (TCHAD). Overall, 1480 twin pairs born in Sweden were approached first when children were 89years old, and again later at 1314years old. Response rates were 75% and 72%. Data from the TCHAD questionnaires were linked to the Swedish Medical Birth Register based on personal identification numbers.

    Results Being overtired at age 8 increased the risk [OR; 95% CI (2.59; 1.315.11)] to develop rhinitis symptoms at age 13, even when controlling for gender, previous rhinitis, Socio-economic status, birth weight and other sleep disturbances at age 8. Likewise, symptoms of asthma at age 8 was an independent risk factor for being overtired at age 13 [OR; 95% CI (2.64; 1.444.84)], controlling for similar confounders.

    Conclusion & Clinical Relevance The findings from this study are consonant with the proposition that atopic disease and disturbed sleep are more than passively interrelated. Future research needs to delineate whether causal relationships between these problems are at hand and, if so, at what periods in development this applies. These results point to a need for clinicians to investigate sleep difficulties and treat impaired sleep in paediatric patients with atopic disease.

  • 346. Jiang, Heng
    et al.
    Livingston, Michael
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Chenhall, Richard
    English, Dallas R.
    Temporal Associations of Alcohol and Tobacco Consumption With Cancer Mortality2018In: Jama Network Open, ISSN 2574-3805, Vol. 1, no 3, article id e180713Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Understanding whether the population-level consumption of alcohol and tobacco is associated with cancer mortality is a crucial question for public health policy that has not been answered by previous studies. OBJECTIVE To examine temporal associations of alcohol and tobacco consumption with overall cancer mortality in the Australian population, looking across different sex and age groups. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study conducted a time series analysis (autoregressive integrated moving average models) using aggregate-level annual time series data from multiple sources. Data on alcohol consumption and tobacco consumption per capita between 1935 and 2014 among the Australian population aged 15 years and older were collected from the Australian Bureau of Statistics and Cancer Council Victoria. Analysis was conducted from June 1, 2017, to October 30, 2017. EXPOSURES Sex- and age-specific cancer mortality rates from 1968 to 2014 were collected from the Australian Institute Health and Welfare. MAIN OUTCOMES AND MEASURES Population-level cancer mortality in different sex and age groups in Australia, controlling for the effects of health expenditure. RESULTS Among the Australian total population aged 15 years and older in this study, 50.5% were women. Cancer death rates per 100 000 persons increased from 199 in 1968 to 214 in 1989 and then decreased steadily to 162 in 2014. Taking into account lagged effects, 1-L decreases in alcohol consumption per capita were associated with a decline of 3.9% in overall cancer mortality over a 20-year period, and 1-kg decreases in tobacco consumption per capita were associated with a 16% reduction. Alcohol consumption per capita was significantly associated with overall cancer mortality among men aged 50 to 69 years and women aged 50 years and older. Tobacco consumption per capita was found to be significantly associated with overall cancer mortality only among men aged 50 years and older. CONCLUSIONS AND RELEVANCE In this study, alcohol consumption per capita was positively associated with overall cancer mortality among older men and women, and tobacco consumption per capita was positively associated with overall cancer mortality among older men over a 20-year period. This study provides evidence that a decrease in population-level drinking and tobacco smoking could lead to a reduction in cancer mortality.

  • 347. Jiang, Heng
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Action on minimum unit pricing of alcohol: a broader need2018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 391, no 10126, p. 1157-1157Article in journal (Other academic)
  • 348. Johansen, Vegard
    et al.
    Aronsson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Marklund, Staffan
    Positive and negative reasons for sickness presenteeism in Norway and Sweden: a cross-sectional survey2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 2, p. e004123-Article in journal (Refereed)
    Abstract [en]

    Objectives This article investigates various reasons for sickness presenteeism (SP), that is, going to work despite illness. The research questions asked is: What are the main reported reasons for SP in Norway and Sweden? Design Cross-sectional survey in Norway and Sweden. Use of binomial logistic regression analysis. Participants A random sample of people aged between 20 and 60years was obtained from complete and updated databases of the Norwegian and Swedish populations. A postal questionnaire was sent to the selected individuals, with response rate 33% (n=2843). 2533 workers responded to questions about SP during the last 12months. Primary and secondary outcome measures The article informs about the distribution of reasons for SP in Norway and Sweden, selected by the respondents from a closed list. The article also examines which factors influence the most often reported reasons for SP. Results 56% of the Norwegian and Swedish respondents experienced SP in the previous year. The most frequently reported reasons for SP include not burden colleagues (43%), enjoy work (37%) and feeling indispensable (35%). A lower proportion of Norwegians state that they cannot afford taking sick leave adjusted OR (aOR 0.16 (95% CI 0.10 to 0.22)), while a higher proportion of Norwegians refer to that they enjoy their work (aOR=1.64 (95% CI 1.28 to 2.09)). Women and young workers more often report that they do not want to burden their colleagues. Managers (aOR=2.19 (95% CI 1.67 to 2.86)), highly educated persons and the self-employed more often report that they are indispensable. Conclusions Positive and negative reasons for SP are reported, and there are significant differences between respondents from the two countries. The response rate is low and results must be interpreted with caution. Study design Cross-sectional study.

  • 349. Johnson, Charisse M.
    et al.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Svensson, Anna C.
    Engström, Karin
    The role of social capital in explaining mental health inequalities between immigrants and Swedish-born: a population-based cross-sectional study2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 117Article in journal (Refereed)
    Abstract [en]

    Background

    Social capital may theoretically explain health inequalities between social groups, but empirical evidence is lacking. Some studies indicate that social capital may be particularly important for immigrant health. Nearly 16% of Sweden's population are foreign-born immigrants and research has shown them to be susceptible to psychological distress, though significant variation has been found between groups. In this study, we investigate the following hypotheses: 1) if non-refugees have better mental health than Swedish-born, and refugees experience worse mental health than Swedish-born; 2) if mental health status converges with that of Swedish-born with longer duration of residence; and 3) if social capital mediates the effect of immigrant status on psychological distress for different immigrant groups as compared to Swedish-born.

    Methods

    This cross-sectional study uses baseline data from the Stockholm Public Health Cohort and includes 50,498 randomly-selected individuals from Stockholm County in 2002, 2006, and 2010. Mental health was measured as psychological distress, using the 12-item General Health Questionnaire. Social capital was measured using indicators of bonding, bridging, and linking social capital. Both cognitive and structural aspects were measured for the latter two indicators. Mediation was tested using logistic regression and the Sobel test.

    Results

    The results show that refugees generally had greater odds of psychological distress than non-refugees compared to their respective Swedish-born counterparts. Among immigrant men, both refugees and non-refugees had significantly greater odds of psychological distress than Swedish-born men. Only refugee women in Sweden 10 years or more had significantly greater odds of psychological distress compared to Swedish-born women. The mediation analysis demonstrated that indicators of social capital mediated the association for all immigrant men (except non-refugees in Sweden 3-9 years) and for refugee women in Sweden 10 years or more. While bonding social capital showed the greatest mediatory role among the three social capital types, adding them together had the strongest explanatory effect.

    Conclusions

    Social capital explains differences in mental health for some immigrant groups, highlighting its role as a potentially important post-migration factor. Increased investment from policy-makers regarding how social capital can be promoted among new arrivals may be important for preventing psychological distress.

  • 350. Johnson-Singh, Charisse M.
    et al.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ponce de Leon, Antonio
    Forsell, Yvonne
    Engström, Karin
    Ethnic heterogeneity, social capital and psychological distress in Sweden2018In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 52, p. 70-84Article in journal (Refereed)
    Abstract [en]

    Introduction

    Ethnic heterogeneity has been linked to both protective and detrimental effects on mental health. Few studies have investigated the role of social capital in this relationship and none have found that it has an explanatory role. The aim of this study is to investigate the relationship between two measures of ethnic heterogeneity and psychological distress in Stockholm County, as well as the explanatory role of social capital for individuals with Swedish-background, foreign-background and those who are foreign-born.

    Methods

    This study used data collected from respondents aged 18-64 to the 2002, 2006, 2010 baseline questionnaires of the Stockholm Public Health Cohort and was linked with individual and area-level register information. Ethnic heterogeneity was the main exposure, measured by: 1) ethnic density, defined as the proportion of first and second generation immigrants with 2 foreign-born parents; and 2) ethnic diversity, using the fragmentation index. Social capital measures of individual and contextual-level social support and horizontal trust were the main explanatory factors of interest. The outcome, psychological distress, was assessed using the General Health Questionnaire-12 with a 2/3 cut-off. Prevalence ratios with 95% confidence intervals were estimated using multi-level poisson regression with robust variances.

    Results

    Age and sex adjusted analyses for the whole study population demonstrated that a 10% increase in ethnic density or diversity was associated with a 1.06 (1.05-1.07) times higher prevalence of psychological distress. In the stratified analyses, both foreign-born respondents and those with Swedish-background showed increasing prevalence of psychological distress with increasing ethnic heterogeneity. However, this trend was entirely explained by socioeconomic factors in the Swedish-background respondents and by additional adjustments for individual and contextual social support and horizontal trust for the foreign-born. Further adjustment for contextual horizontal trust showed ethnic heterogeneity to be protective for respondents Swedish-background. There was no clear trend between ethnic heterogeneity and psychological distress for respondents with foreign-background.

    Conclusion

    The association between ethnic heterogeneity and psychological distress differs by ethnic background. There was no difference in this association based on the measure of ethnic heterogeneity used, nor in the explanatory role of social capital between ethnic heterogeneity measures. Socioeconomic indicators and some elements of individual and contextual social capital are important explanatory factors of the excess risk of psychological distress with regards to ethnic heterogeneity.

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