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  • 51.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Small, Rhonda
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Schytt, Erica
    Length of residence and caesarean section in migrant women in Sweden: a population-based study2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 6, p. 1073-1079Article in journal (Refereed)
    Abstract [en]

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

  • 52.
    Juárez, Sol Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Aradhya, Siddartha
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Differences in hospitalizations associated with severe COVID-19 disease among foreign- and Swedish-born2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 3, p. 522-527Article in journal (Refereed)
    Abstract [en]

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

  • 53.
    Khanolkar, Amal
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Byberg, Liisa
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Parental influences on cardiovascular risk factors in Swedish children aged 5–14 years2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no 6, p. 840-847Article in journal (Refereed)
    Abstract [en]

    Background: Precursors of cardiovascular diseases (CVD) originate in childhood. We investigated relationships of children's CVD risk factors with parent's socio-economic position (SEP) and lifestyle and how CVD risk factors correlate within families. Methods: We studied 602 families with 2141 individuals comprising two full sibs; aged 5–14 years, and their biological parents (Uppsala Family Study). Parental SEP (occupational class and education) and lifestyle habits [smoking, physical activity (PA), alcohol consumption] were taken from questionnaires. Associations with cholesterol, ApoB/ApoA1, leptin, adiponectin, blood pressure, body mass index (BMI) and overweight/obesity (OW/OB) were analysed by linear/logistic regression. Results were adjusted for child's age, gender, pubertal stage and family clustering. Results: We observed no consistent associations between parental SEP and children's CVD risk factors. Parental lifestyle had stronger effects, independent of parental SEP. Children of smoking fathers had higher BMI (4%, 95% CI 1–7%) and leptin levels (27%, 95% CI 1.00–61.60%). Children of mothers reporting vigorous PA had lower BMI, cholesterol and decreased odds for OW/OB with a possible dose effect. Compared with mothers reporting no vigorous activity, mothers with ≤75 min and 76–150 min/week of vigorous activity had 43% (OR 0.57, 95% CI 0.22–0.89) and 72% (OR 0.28, 95% CI 0.14–0.60) lower risk of having an OW/OB child, respectively, after adjustment for confounders. Independent, consistently stronger and significant associations were found between all studied parents’ and children's CVD risk factors. Conclusion: Parental behaviours: smoking, alcohol consumption, low PA are associated with higher levels of CVD risk factors (BMI, OW/OB, cholesterol) in children. Strong correlations in CVD risk factors within families not related to parental SEP/lifestyle suggest a role of genetics in influencing children's CVD risk factors. Public health policies should target families with unhealthy lifestyles.

  • 54. Kilpi, Fanny
    et al.
    Silventoinen, Karri
    Konttinen, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Disentangling the relative importance of different socioeconomic resources for myocardial infarction incidence and survival: a longitudinal study of over 300 000 Finnish adults2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 2, p. 260-266Article in journal (Refereed)
    Abstract [en]

    Background: Lower socioeconomic position (SEP) is associated with an increased risk of myocardial infarction (MI) incidence and mortality, but the relative importance of different socioeconomic resources at different stages of the disease remains unclear. Methods: A nationally representative register-based sample of 40- to 60-year-old Finnish men and women in 1995 (n = 302 885) were followed up for MI incidence and mortality in 1996-2007. We compared the effects of education, occupation, income and wealth on first MI incidence, first-day and long-term fatality. Cox's proportional hazards regression and logistic regression models were estimated adjusting for SEP covariates simultaneously to assess independent effects. Results: Fully adjusted models showed greatest relative inequalities of MI incidence by wealth in both sexes, with an increased risk also associated with manual occupations. Education was a significant predictor of incidence in men. Low income was associated with a greater risk of death on the day of MI incidence [odds ratio (OR) = 1.40 in men and 1.95 in women when comparing lowest and highest income quintiles], and in men, with long-term fatality [hazard ratio (HR) = 1.74]. Wealth contributed to inequalities in first-day fatality in men and in long-term fatality in both sexes. Conclusion: The results show that different socioeconomic resources have diverse effects on the disease process and add new evidence on the significant association of wealth with heart disease onset and fatality. Targeting those with the least resources could improve survival in MI patients and help reduce social inequalities in coronary heart disease mortality.

  • 55.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Smith KE, Hill S and Bambra C (eds.). Health inequalities, critical perspectives2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 2, p. 363-363Article, book review (Other academic)
  • 56. Kulhánová, Ivana
    et al.
    Menvielle, Gwenn
    Hoffmann, Rasmus
    Eikemo, Terje A.
    Kulik, Margarete C.
    Toch-Marquardt, Marlen
    Deboosere, Patrick
    Leinsalu, Mall
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Regidor, Enrique
    Looman, Caspar W. N.
    Mackenbach, Johan P.
    The role of three lifestyle risk factors in reducing educational differences in ischaemic heart disease mortality in Europe2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 2, p. 203-210Article in journal (Refereed)
    Abstract [en]

    Background: Ischaemic heart disease (IHD) is one of the leading causes of death worldwide with a higher risk of dying among people with a lower socioeconomic status. We investigated the potential for reducing educational differences in IHD mortality in 21 European populations based on two counterfactual scenarios—the upward levelling scenario and the more realistic best practice country scenario. Methods: We used a method based on the population attributable fraction to estimate the impact of a modified educational distribution of smoking, overweight/obesity, and physical inactivity on educational inequalities in IHD mortality among people aged 30–79. Risk factor prevalence was collected around the year 2000 and mortality data covered the early 2000s. Results: The potential reduction of educational inequalities in IHD mortality differed by country, sex, risk factor and scenario. Smoking was the most important risk factor among men in Nordic and eastern European populations, whereas overweight and obesity was the most important risk factor among women in the South of Europe. The effect of physical inactivity on the reduction of inequalities in IHD mortality was smaller compared with smoking and overweight/obesity. Although the reduction in inequalities in IHD mortality may seem modest, substantial reduction in IHD mortality among the least educated can be achieved under the scenarios investigated. Conclusion: Population wide strategies to reduce the prevalence of risk factors such as smoking, and overweight/obesity targeted at the lower socioeconomic groups are likely to substantially contribute to the reduction of IHD mortality and inequalities in IHD mortality in Europe.

  • 57. Kyrönlahti, Saila M.
    et al.
    Nygård, Clas-Håkan
    Prakash, K. C.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Tampere University, Finland; University of Turku and Turku University Hospital, Finland.
    Neupane, Subas
    Trajectories of low back pain from midlife to retirement and functional ability at old age 2021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 3, p. 497-503, article id ckab191Article in journal (Refereed)
    Abstract [en]

    Background: This study aimed to identify trajectories of low back pain (LBP) over a 16-year follow-up from midlife to retirement and investigate their association with mobility limitations and disability in activities of daily living (ADL-disability) in later life. Methods: The study population consisted of 6257 baseline (1981) respondents aged 44–58 years from Finnish Longitudinal study on Aging Municipal Employees. Repeated measurements of LBP were collected in 1985, 1992 and 1997. We studied persons who had data on LBP at baseline and in at least one of the follow-ups and had information on mobility limitations (n = 2305) and ADL-disability (n = 2359) at a 28-year follow-up in 2009. Latent class growth analysis was used to identify LBP trajectories. Odds ratios (ORs) with 95% confidence intervals (CIs) for the associations of LBP trajectory and later life mobility limitations and ADL-disability were estimated and adjusted for confounders. Results: Three LBP trajectories with parallel shapes were identified: high-decreasing (19%), intermediate-stable (60%) and low (21%). After adjustment for confounders, high-decreasing trajectory had 3.2 times the odds (95% CI 2.1–4.9) of mobility limitations and 2.9 times the odds (95% CI 2.0–4.2) of ADL-disability as compared to low trajectory. The respective ORs for intermediate-stable trajectory were 1.6 (95% CI 1.2–2.1) and 1.7 (95% CI 1.3–2.3). Conclusions: Among majority of respondents, LBP remained stable over the follow-up. The respondents belonging to intermediate-stable and high-decreasing trajectories of LBP had higher odds of mobility limitations and ADL-disability at old age. This highlights that LBP during midlife to retirement has far-reached consequences on functional ability at old age.

  • 58. Lahelma, E.
    et al.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Health inequalities in European welfare states2009In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 19, no 5, p. 445-446Article in journal (Refereed)
  • 59.
    Larm, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Hellström, Charlotta
    Raninen, Jonas
    Åslund, Cecilia
    Nilsson, Kent W.
    Giannotta, Fabrizia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Do non-drinking youth drink less alcohol in young adulthood or do they catch up? Findings from a Swedish birth cohort2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 4, p. 640-644Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol consumption among adolescents has declined considerably during the last two decades. However, it is unknown if these adolescents’ alcohol consumption will remain low as they grow older. To our knowledge, this is one of the first studies that uses longitudinal data to examine if non-drinking adolescents have a lower alcohol consumption in young adulthood or if they catch up. Methods: A self-report survey was distributed to a birth cohort (n = 794) born in 1997 in a Swedish region when cohort members attended ninth grade (age 14–15 years) in 2012. Responders were divided into non-drinkers and alcohol users and assessed again in their late teens (17–18 years) and young adulthood (20–21 years). Results: In their late teens (17–18 years), non-drinkers at baseline consumed less alcohol and had a lower probability of harmful use compared with their alcohol-using peers. In young adulthood (20–21 years), these effects disappeared when adjustment was made for covariates. However, a stratified analysis showed that non-drinking adolescents low in conduct problems consumed less alcohol and had a lower probability of harmful use in young adulthood than alcohol-using peers. Conclusions: This study suggests that the decline in alcohol use among adolescents in the past decades may be associated with a lower alcohol consumption in the late teens and young adulthood among those low in conduct problems. This may have promising implications for alcohol-related morbidity and mortality.

  • 60.
    Leineweber, Constanze
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Baltzer, Maria
    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.
    Work-family conflict and health in Swedish working women and men: a 2-year prospective analysis (the SLOSH study)2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 4, p. 710-716Article in journal (Refereed)
    Abstract [en]

    Background: Research has suggested that gender is related to perceptions of work-family conflict (WFC) and an underlying assumption is that interference of paid work with family life will burden women more than men. There is, however, mixed evidence as to whether men and women report different levels of WFC. Even less studies investigate gender differences in health outcomes of WFC. Also the number of longitudinal studies in this field is low. METHODS: Based on the Swedish Longitudinal Occupational Survey of Health, we prospectively examined the effects of WFC on three different health measures representing a wide spectrum off ill health (i.e. self-rated health, emotional exhaustion and problem drinking). Logistic regression analyses were used to analyse multivariate associations between WFC in 2008 and health 2 years later. RESULTS: The results show that WFC was associated with an increased risk of emotional exhaustion among both men and women. Gender differences are suggested as WFC was related to an increased risk for poor self-rated health among women and problem drinking among men. Interaction analyses revealed that the risk of poor self-rated health was substantially more influenced by WFC among women than among men. CONCLUSIONS: We conclude that, despite the fact that women experience conflict between work and family life slightly more often than men, both men's and women's health is negatively affected by this phenomenon.

  • 61.
    Liu, Can
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Ahlberg, Mia
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Stephansson, Olof
    Perinatal health of refugee and asylum-seeking women in Sweden 2014-17: a register-based cohort study2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 6, p. 1048-1055Article in journal (Refereed)
    Abstract [en]

    Background

    An increasing number of migrants have fled armed conflict, persecution and deteriorating living conditions, many of whom have also endured risky migration journeys to reach Europe. Despite this, little is known about the perinatal health of migrant women who are particularly vulnerable, such as refugees, asylum-seekers, and undocumented migrants, and their access to perinatal care in the host country.

    Methods

    Using the Swedish Pregnancy Register, we analyzed indicators of perinatal health and health care usage in 31 897 migrant women from the top five refugee countries of origin between 2014 and 2017. We also compared them to native-born Swedish women.

    Results

    Compared to Swedish-born women, migrant women from Syria, Iraq, Somali, Eritrea and Afghanistan had higher risks of poor self-rated health, gestational diabetes, stillbirth and infants with low birthweight. Within the migrant population, asylum-seekers and undocumented migrants had a higher risk of poor maternal self-rated health than refugee women with residency, with an adjusted risk ratio (RR) of 1.84 and 95% confidence interval (95% CI) of 1.72–1.97. They also had a higher risk of preterm birth (RR 1.47, 95% CI 1.21–1.79), inadequate antenatal care (RR 2.56, 95% CI 2.27–2.89) and missed postpartum care visits (RR 1.15, 95% CI 1.10–1.22).

    Conclusion

    Refugee, asylum-seeking and undocumented migrant women were vulnerable during pregnancy and childbirth. Living without residence permits negatively affected self-rated health, pregnancy and birth outcomes in asylum-seekers and undocumented migrants. Pregnant migrant women’s special needs should be addressed by those involved in the asylum reception process and by health care providers.

  • 62. Lundberg, Christina E.
    et al.
    Santosa, Ailiana
    Björk, Jonas
    Brandén, Maria
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Linköping University, Sweden.
    Cronie, Ottmar
    Lindgren, Martin
    Edqvist, Jon
    Åberg, Maria
    Adiels, Martin
    Rosengren, Annika
    Age and sex differences in cause-specific excess mortality and years of life lost associated with COVID-19 infection in the Swedish population2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 5, p. 916-922Article in journal (Refereed)
    Abstract [en]

    Background: Estimating excess mortality and years of life lost (YLL) attributed to coronavirus disease 19 (COVID-19) infection provides a comprehensive picture of the mortality burden on society. We aimed to estimate the impact of the COVID-19 pandemic on age- and sex-specific excess mortality and YLL in Sweden during the first 17 months of the pandemic. Methods: In this population-based observational study, we calculated age- and sex-specific excess all-cause mortality and excess YLL during 2020 and the first 5 months of 2021 and cause-specific death [deaths from cardiovascular disease (CVD), cancer, other causes and deaths excluding COVID-19] in 2020 compared with an average baseline for 2017–19 in the whole Swedish population. Results: COVID-19 deaths contributed 9.9% of total deaths (98 441 deaths, 960 305 YLL) in 2020, accounting for 75 151 YLL (7.7 YLL/death). There were 2672 (5.7%) and 1408 (3.0%) excess deaths, and 19 141 (3.8%) and 3596 (0.8%) excess YLL in men and women, respectively. Men aged 65–110 years and women aged 75–110 years were the greatest contributors. Fewer deaths and YLL from CVD, cancer and other causes were observed in 2020 compared with the baseline adjusted to the population size in 2020. Conclusions: Compared with the baseline, excess mortality and YLL from all causes were experienced in Sweden during 2020, with a higher excess observed in men than in women, indicating that more men died at a younger age while more women died at older ages than expected. A notable reduction in deaths and YLL due to CVD suggests a displacement effect from CVD to COVID-19.

  • 63.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    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).
    Bergqvist, Kersti
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ferranini, Tommy
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Nelson, Kenneth
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Rehnberg, Johan
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    The effect of social protection and income maintenance policies on health and health inequalities2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no Suppl. 1Article in journal (Other academic)
    Abstract [en]

    Background

    As a starting point we review the existing evidence on welfare states, health and health inequalities, from 2005 onwards. Three different approaches emerge in these previous studies – the welfare regime approach, the welfare institutions approach and the social spending approach. While no clear picture emerges for the welfare regime approach, summarising findings regarding the institutional and expenditure approach suggest that a higher degree of generosity and social spending benefits public health. These are therefore approaches we follow to arrive at a better understanding of what type of policies are linked to smaller inequalities in health across the life-course.

    Methods

    A starting point in the analyses is the relation between income, poverty and mortality. The cross-national variation in poverty rates, both absolute (poverty threshold) and relative (60 per cent of median income) measure, and mortality rates in European 26 countries will be considered.

    The second step in the analysis focuses on the relationship between social rights and subjective health in Europe, with a focus on national variations and changes in social rights to levels and changes in subjective health outcomes across several countries. The data holds information regarding social rights and social expenditure, including individual data from EU-SILC.

    Results

    Preliminary results indicate that it is the totality of social protection that is important rather than individual policies. A sub-study regarding social rights and health among youth highlight also the importance of active and passive labour market policy in the 16 included countries.

    Conclusions

    In sum our diverse approach to analysing welfare state efforts and their links to health inequalities suggest that there is a clear relationship between more ambitious policies and smaller inequalities in health. These results are discussed in relation to previous findings.

  • 64. Marinković, Ivan
    et al.
    Tramošljanin, Ana
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Galjak, Marko
    Assessing the availability and quality of COVID-19 mortality data in Europe: a comparative analysis2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 5, p. 944-946Article in journal (Refereed)
    Abstract [en]

    Researching mortality during the COVID-19 pandemic has been challenging due to methodological inconsistencies and the limited availability of vital statistics data. At the beginning of the pandemic, the World Health Organization recommended daily data publication to inform policy response, but these data were often poor. Final data on COVID-19 deaths in many countries are not yet available, especially for 2021. This report shows that many countries have significant inconsistencies between the preliminary number of deaths and what vital statistics and excess mortality indicate. The inconsistencies in the mortality data raise concerns about the reliability of analyses and public health recommendations. 

  • 65. Meyer, Anna C.
    et al.
    Torssander, Jenny
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Talbäck, Mats
    Modig, Karin
    Parents survive longer after stroke than childless individuals: a prospective cohort study of Swedes over the age of 652019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 6, p. 1090-1095Article in journal (Refereed)
    Abstract [en]

    Background: Parents have lower mortality than childless individuals, and one possible explanation is support provided by adult children. Since stroke often results in functional limitations, support from children may be of particular importance. Here, we examine whether the presence of children matters for survival after stroke among older Swedish men and women. Methods: This prospective cohort study linked data from several Swedish population registers. Individuals aged 65 years and older hospitalized for their first ischemic stroke between 1998 and 2002 (33 960 men and 36 189 women) were followed 12 years for survival. Hazard ratios for all-cause mortality were calculated by number of children using Cox proportional hazard regression stratified by sex and marital status and adjusted for education, income and comorbidities. Results: Childlessness and having only one child was associated with higher mortality after stroke compared with having two children among men and women. The relative survival disadvantage of childless individuals was largest among married women [HR 1.28 (1.18-1.39)] and smallest among married men [1.09 (1.03-1.15)]. The differences in predicted median survival between childless individuals and those with two children were 4 and 7 months among married and unmarried men, and 15 and 9 months among married and unmarried women, respectively. Conclusions: Having children is associated with a longer survival after stroke among men and women regardless of marital status. Our findings further suggest that the presence of children is especially connected to married women's survival. These results may have implications for the improvement of informal care for childless older individuals.

  • 66.
    Miething, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rydgren, Jens
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Social network characteristics and alcohol use among young Swedes with different ethnic backgrounds2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no Supplement 4, p. 49-49Article in journal (Other academic)
    Abstract [en]

    Background

    The study explores how social network determinants relate to the prevalence and frequency of alcohol use of members of social networks. In a so-called dyadic design we study how similar alcohol habits co-exist among individuals (egos) and their peers (alters), when variables such as ethnic background, network composition, and other socio-cultural aspects are considered.

    Methods

    The data were derived from a Swedish survey entitled “Social Capital and Labor Market Integration: A Cohort Study.” The study participants (egos; n = 1989) were around age 23 at the time of the interview. A so-called dyadic design was applied, which means that all components of the analysis refer to ego-alter pairs (n = 7828).

    The outcome variable considered how alcohol prevalence and frequency of binge-drinking co-exist between egos and their alters. The independent variables also measured mutual attributes and behaviors - whether egos and alters were at the same age and sex, had same ethnic background, were relatives or friends, had similar religious affiliations, or intensely interacted with friends.

    Results

    The analysis revealed that ego-alter similarity in terms of age, sex and ethnic background predict ego-alter similarity in alcohol use and binge-drinking. For example, if egos and alters shared a similar ethnic background, their risk of alcohol use was at least 30 percent higher as compared to those with different ethnic backgrounds. Relative to ego-alter pairs with mixed ethnic backgrounds, the odds of binge-drinking were highest for ego-alters pairs with Yugoslavian background (OR 1.76; 95% CI 1.27-2.42), followed by those with Iranian (OR 1.57; 1.04-2.35) and Swedish background (OR 1.28; 0.84-1.95).

    Conclusions

    We conclude that network similarity (i.e., homophily) is an important explanation for the co-existence of alcohol use among members of peer networks. Alcohol use is more common in homogeneous peer dyads representing population groups with higher use.

    Key messages

    • Peer similarity predicts alcohol use and binge drinking.

    • Ethnic similarity of peers is associated with increased alcohol use and binge drinking.

  • 67.
    Miething, Alexander
    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).
    Rydgren, Jens
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    3.2-O2 Lacking occupational network contacts: an explanation for the ethnic variation of depressive symptoms in young adults in Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 1, p. 48-48Article in journal (Other academic)
  • 68.
    Miyakawa, Michiko
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Hosei University, Japan.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Subjective social status: its determinants and association with health in the Swedish working population (the SLOSH study)2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no 4, p. 593-597Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study aims to confirm associations between subjective social status (SSS) and health in the Swedish working population, to investigate if SSS is related to health over and above conventional measures of socio-economic status and to identify factors related to perception of SSS.

    METHODS: The study includes 2358 men and 2665 women in the age group of 19-68 years who participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH). SSS was measured using the MacArthur scale, a 10-rung ladder on which individuals indicate where they think they stand in the social hierarchy. Health, health behaviors and social situation were also measured in 2006, while more objective measures of socio-economic position were derived from registry data and interviews in 2003.

    RESULTS: Perception of SSS was cross-sectionally related to age-adjusted prevalence of suboptimal perceived general health, sleep disturbances, musculoskeletal symptoms, depressive symptoms and emotional exhaustion. Relative Indices of Inequalities (RII) showed significant relationships between SSS and health, which were attenuated by adjustment for general life satisfaction. Adjustment for occupational grade, education and income further attenuated the relationship. The main predictors of SSS in 2006 were occupational grade, personal income and education in 2003; household financial situation, general life satisfaction and job control in 2006. When ranking their SSS, women put more weight on household financial situation and men on their personal income.

    CONCLUSION: SSS is associated with prevalence of several health complaints in the Swedish working population over and above conventional SES, indicating that SSS is a valid measure of social inequality in health.

  • 69.
    Modin, Bitte
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bullying in context – an analysis of health complaints among adolescents in greater Stockholm2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no supplement 2, p. 221-221Article in journal (Refereed)
  • 70. Mortensen, Jesper
    et al.
    Dich, Nadya
    Lange, Theis
    Høst Ramlau-Hansen, Cecilia
    Head, Jenny
    Kivimäki, Mika
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Rod, Naja Hulvej
    Weekly hours of informal caregiving and paid work, and the risk of cardiovascular disease2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 4, p. 743-747Article in journal (Refereed)
    Abstract [en]

    Background: Little is known on the association between weekly hours of informal caregiving and risk of cardiovascular disease (CVD). The objective was to investigate the individual and joint effects of weekly hours of informal caregiving and paid work on the risk of CVD. Methods: Pooled analysis with 1396 informal caregivers in gainful employment, from the Swedish Longitudinal Occupational Survey of Health and the Whitehall II study. Informal caregiving was defined as care for an aged or disabled relative. The outcome was CVD during 10years follow-up. Analyzes were adjusted for age, sex, children, marital status and occupational grade. Results: There were 59 cases of CVD. Providing care >20 h weekly were associated with a higher risk of CVD compared to those providing care 1-8 h weekly (hazard ratio = 2.63, 95%CI: 1.20; 5.76), irrespectively of weekly work hours. In sensitivity analyzes, we found this risk to be markedly higher among long-term caregivers (6.17, 95%CI: 1.73; 22.1) compared to short-term caregivers (0.89, 95%CI: 0.10; 8.08). Caregivers working >= 55 h weekly were at higher risk of CVD (2.23, 95%CI: 1.14; 4.35) compared to those working 35-40 h weekly. Those providing care >8 h and working <= 40 h weekly had a higher risk of CVD compared to those providing care 1-8 h and working <= 40 h (3.23, 95%CI: 1.25; 8.37). Conclusion: A high number of weekly hours of informal caregiving as opposed to few weekly hours is associated with a higher risk of CVD, irrespectively of weekly work hours. The excess risk seemed to be driven by those providing care over long periods of time.

  • 71. Moustgaard, Heta
    et al.
    Joutsenniemi, Kaisla
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    A longitudinal study of educational differences in antidepressant use before and after hospital care for depression2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 6, p. 1034-1039Article in journal (Refereed)
    Abstract [en]

    Background: Despite social inequalities in depression various studies report small or even reversed social gradients for antidepressant treatment, suggesting unmet need for treatment among those with low social position. However, few studies assess need for treatment or compare longitudinal antidepressant use patterns between socioeconomic groups. Methods: We used a nationally representative register cohort of Finnish adults with hospital care for depression in 1998–2007 (n = 7249). We compared the prevalence of any use and daily use of antidepressants across educational groups in consecutive 3-month periods up to 5 years before admission and 5 years after discharge, adjusting for important confounders. Results: We found no educational differences in any antidepressant use in the 5 years leading to hospital care for depression but a 3–4 percentage-point higher prevalence among those with high education in the 3-month periods immediately preceding and following hospital care for depression. Furthermore, decline in the prevalence of antidepressant use after discharge was more rapid in low education resulting in a significant 4–6 percentage-point higher prevalence among the highly educated lasting until 2.5 years after discharge. Daily use was significantly more common among the highly educated for a year before admission, immediately after discharge and for 2.5 years thereafter, the excess being 3–8 percentage-points. Conclusion: Our results suggest rather equitable access to antidepressant treatment at the time of evident need, i.e. immediately after discharge from hospital care for depression. However, early discontinuation of treatment as well as below guideline use of antidepressants were more common among the low educated.

  • 72. Mäki, Netta E.
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Premature mortality after suicide attempt in relationto living arrangements. A register-based study in Finland in 1988-20072017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 73-79Article in journal (Refereed)
    Abstract [en]

    Background: Several studies have shown that individuals with a history of suicide attempt form a high-risk mortality group. Completed suicide is the main cause of death among them, but excess mortality for other causes of death is much less studied. Furthermore, little is known whether living with others modifies the excess risk of mortality among suicide attempters. Methods: We evaluated an 11% sample from the population registration data of Finns aged 15 years and older in the period 1988-2007 with an 80% oversample of death records and a linkage with information on causes of hospitalisation. We estimate standardised mortality rates and Poisson regression models separately for the general population and those treated in hospital for suicide attempt. Results: Compared with the general population, all-cause mortality risk was similar to 10-fold among women and well over 10-fold among men during the first 3 months following suicide attempt. The risk for suicide was even greater, but in addition to external causes of death, mortality from smoking-and alcohol-related diseases was elevated. Instead, the proportion of alcohol-associated suicides was smaller among the suicide attempters. Among suicide attempters, the association between living arrangements and mortality was much weaker than in the general population. Conclusion: Premature mortality is extremely high after suicide attempt, especially in the first year. Our results do not support the idea that the resources provided by living with others ameliorate the effects of suicide attempt on subsequent mortality. Suicide prevention should focus on designing adequate aftercare following the attempt, especially for those with alcohol problems.

  • 73. Möller, Sanne P.
    et al.
    Andersen, A-M N.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Nörredam, M.
    Uptake of vaccinations and health examinations among refugee children compared to Danish-born children - a register based cohort study2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no S2, p. 165-166Article in journal (Refereed)
    Abstract [en]

    Background

    In Denmark, vaccinations recommended for children include among others vaccinations against diphteria, tetanus, pertussis and polio (DTwP) and measles, mumps and rubella (MMR). Children are also offered seven child health examinations (CHE). Both are important to prevent illness and to ensure early detection of developmental progblems. It is crucial that both services are utilized by all families regardless of their socioeconomic position, ethnic background or migrant status. However, there is a paucity of studies on uptake among the potentially vulnerable group of refugees.

    Methods

    The study population consisted of all refugee children arriving to Denmark between 1993 and 2010, and Danish-born children matched 1:6 on age and sex to the refugee children. Those included in the study had to be eligible for vaccination or CHE, i.e. have the recommended age for an investigated outcome during the observation period, which was January 1993 - May 2012. These criteria were met by 17,701 refugees and 106,206 Danish-born children. Information on vaccinations and CHE's from the Danish National Health Service Register was used to compare uptake among the two groups. Information on refugee status, duration of residence, region of origin and equivalised family income was used to examine predictors of uptake among refugee children. Analyses were made using a Cox regression model.

    Results

    For all unadjusted vaccination outcomes refugee children had lower uptake than Danish-born children. However, after adjusting for income only the DTwP remained significant (HR = 0.61; 95%CI: 0.58-0.63). All results for the CHE's remained significant after adjustment for income, with the biggest difference observed for the last CHE at age 5 (HR = 0.48; 95%CI:0.47-0.50). Both refugee status, duration of residence, region of origin and equivalised family income were identified as predictors of uptake among refugee children.

    Conclusion

    The findings that refugee children do not have the same uptake of the investigated services as Danish-born children, suggest that refugees face barriers in the Danish health care system, and that newly arrived families are especially vulnerable. This indicates a need for improvements in the information on health services for newly arrived families.

  • 74.
    Nilsen, Charlotta
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Andel, Ross
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Work-related stress in midlife and all-cause mortality: can sense of coherence modify this association?2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 6, p. 1055-1061Article in journal (Refereed)
    Abstract [en]

    Background: Survival reflects the accumulation of multiple influences experienced over the life course. Given the amount of time usually spent at work, the influence of work may be particularly important. We examined the association between work-related stress in midlife and subsequent mortality, investigating whether sense of coherence modified the association. Methods: Self-reported work-related stress was assessed in 1393 Swedish workers aged 42-65 who participated in the nationally representative Level of Living Survey in 1991. An established psychosocial job exposure matrix was applied to measure occupation-based stress. Sense of coherence was measured as meaningfulness, manageability and comprehensibility. Mortality data were collected from the Swedish National Cause of Death Register. Data were analyzed with hazard regression with Gompertz distributed baseline intensity. Results: After adjustment for socioeconomic position, occupation-based high job strain was associated with higher mortality in the presence of a weak sense of coherence (HR, 3.15; 1.62-6.13), a result that was stronger in women (HR, 4.48; 1.64-12.26) than in men (HR, 2.90; 1.12-7.49). Self-reported passive jobs were associated with higher mortality in the presence of a weak sense of coherence in men (HR, 2.76; 1.16-6.59). The link between work stress and mortality was not significant in the presence of a strong sense of coherence, indicating that a strong sense of coherence buffered the negative effects of work-related stress on mortality. Conclusions: Modifications to work environments that reduce work-related stress may contribute to better health and longer lives, especially in combination with promoting a sense of coherence among workers.

  • 75.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Razvodovsky, Yury
    Per capita alcohol consumption and alcohol-related harm in Belarus, 1970-20052010In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 20, no 5, p. 564-568Article in journal (Refereed)
    Abstract [en]

    Background: Although alcohol seems to be an important determinant of the mortality crisis in the former Soviet Republic of Belarus, little systematic research has been done on the relationship between alcohol consumption and harm at the aggregate level. The aims of the present study were to estimate the effect of per capita alcohol consumption on all-cause mortality, mortality from alcohol poisoning and hospital admissions for alcohol psychosis in Belarus. Methods: Annual data on the three outcomes and alcohol sale per capita for the period 1970–2005 were analysed using the Box–Jenkins technique. Female mortality was included as a control variable and regarded as a proxy for other causal factors. To incorporate the lag structure, a weighted input was used in which a geometrical lag-scheme was applied. Results: The outcomes suggest that a 1 l increase in consumption was associated with an increase in male all-cause mortality of ∼2.3%. The corresponding figures for alcohol poisoning mortality and alcohol psychosis admissions are 12 and 25%. Conclusions: The present study strengthens the notion of alcohol consumption as an important determinant of population health in this part of the world, and thus the notion that alcohol control must be a key priority for Belorussian public health policy.

  • 76.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Stickley, Andrew
    Alcohol tax, consumption and mortality in tsarist Russia: is a public health perspective applicable?2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 2, no 23, p. 340-344Article in journal (Refereed)
    Abstract [en]

    Background: The public health perspective on alcohol comprises two main tenets: (i) population drinking impacts on alcohol-related harm and (ii) population drinking is affected by the physical and economic availability of alcohol, where alcohol taxes are the most efficient measure for regulating consumption. This perspective has received considerable empirical support from analyses of contemporary data mainly from Europe and North America. However, as yet, it has been little examined in a historical context. The aims of the present article are to use data from tsarist Russia to explore (i) the relation between changes in the tax on alcohol and per capita alcohol consumption and (ii) the relation between per capita alcohol consumption and alcohol mortality. Methods: The material comprised annual data on alcohol taxes, alcohol consumption and alcohol mortality. The tax and alcohol consumption series spanned the period 1864–1907 and the mortality data covered the period 1870–94. The data were analysed by estimating autoregressive integrated moving average models on differenced data. Results: Changes in alcohol taxes were significantly associated with alcohol consumption in the expected direction. Increases in alcohol consumption, in turn, were significantly related to increases in alcohol mortality. Conclusion: This study provides support for the utility of the public health perspective on alcohol in explaining changes in consumption and alcohol-related harm in a historical context. We discuss our findings from tsarist Russia in the light of experiences from more recent alcohol policy changes in Russia.

  • 77.
    Pimouguet, Clement
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lagergren, Mårten
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Living alone and unplanned hospitalizations among older adults: a population-based longitudinal study2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 2, p. 251-256Article in journal (Refereed)
    Abstract [en]

    Background: The association of living alone with hospitalization among the general elderly population has been rarely investigated, and the influence of common disorders on this association remains unknown. Methods: We used data on participants in the Swedish National study on Aging and Care in Kungsholmen (n = 3130). Risk and number of unplanned hospitalizations and length of hospital stays were studied over a period of 2 years. We used Cox proportional hazard models to estimate hazard ratios (HRs) of incident hospitalization and zero-inflated negative binomial regression models adjusted for potential confounders to estimate incident rate ratios (IRR) of the number of hospitalizations and total length of stay associated with living alone. Results: A total of 1768 participants (56.5%) lived alone. Five hundred and sixty-one (31.7%) of those who lived alone had at least one unplanned hospitalization. In the multivariate analyses, living alone was significantly associated with the risk of unplanned hospitalization (HR = 1.21, 95% confidence interval [CI] 1.01-1.45) and the number of hospitalizations (IRR = 1.35, 95% CI 1.04-1.76) but not with the length of hospital stays. In stratified analyses, the association between living alone and unplanned hospitalizations remained statistically significant only among men (HR = 1.52, 95% CI 1.17-1.99). Conclusions: Living alone is associated with higher risks of unplanned hospitalization in elderly, especially for men.

  • 78.
    Pimouguet, Clement
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). INSERM, ISPED, Centre INSERM, France; University of Bordeaux, France.
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Schön, Pär
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Shakersain, Behnaz
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Angleman, Sara
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lagergren, Marten
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Impact of living alone on institutionalization and mortality: a population-based longitudinal study2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1, p. 182-187Article in journal (Refereed)
    Abstract [en]

    Background: Living alone is common among elderly people in Western countries, and studies on its relationship with institutionalization and all-cause mortality have shown inconsistent results. We investigated that the impact of living alone on institutionalization and mortality in a population-based cohort of elderly people. Methods: Data originate from the Swedish National study on Aging and Care-Kungsholmen. Participants aged >= 66 years and living at home (n = 2404) at baseline underwent interviews and clinical examination. Data on living arrangements were collected in interviews. All participants were followed for 6 years; survival status and admission into institutions were tracked continuously through administrative registers from 2001 to 2007. Data were analysed using Cox proportional hazard models, competing risk regressions and Laplace regressions with adjustment for potential confounders. Results: Of the 2404 participants, 1464 (60.9%) lived alone at baseline. During the follow-up, 711 (29.6%) participants died, and 185 (15.0%) were institutionalized. In the multi-adjusted Cox model, the hazard ratio (HR) of mortality in those living alone was 1.35 (95% confidence interval [CI] 1.18 to 1.54), especially among men (HR = 1.44, 95% CI 1.18 to 1.76). Living alone shortened survival by 0.6 years and was associated with the risk of institutionalization (HR = 1.74, 95% CI 1.10 to 2.77) after taking death into account as a competing risk. Conclusions: Living alone is associated with elevated mortality, especially among men and an increased risk of institutionalization. Over a 6-year period, living alone was related to a half year reduction in survival among elderly people in Sweden.

  • 79.
    Platts, Loretta G.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Gerry, Christopher J.
    Social inequalities in self-rated health in Ukraine in 2007: the role of psychosocial, material and behavioural factors2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 2, p. 211-217Article in journal (Refereed)
    Abstract [en]

    Background: Despite Ukraine's large population, few studies have examined social inequalities in health. This study describes Ukrainian educational inequalities in self-rated health and assesses how far psychosocial, material and behavioural factors account for the education gradient in health. Methods: Data were analyzed from the 2007 wave of the Ukrainian Longitudinal Monitoring Survey. Education was categorized as: lower secondary or less, upper secondary and tertiary. In logistic regressions of 5451 complete cases, stratified by gender, declaring less than average health was regressed on education, before and after adjusting for psychosocial, material and behavioural factors. Results: In analyses adjusted for socio-demographic characteristics, compared with those educated up to lower secondary level, tertiary education was associated with lower risk of less than average health for both men and women. Including material factors (income quintiles, housing assets, labour market status) reduced the association between education and health by 55-64% in men and 35-47% in women. Inclusion of health behaviours (physical activity, smoking, alcohol consumption and body mass index) reduced the associations by 27-30% in men and 19-27% in women; in most cases including psychosocial factors (marital status, living alone, trust in family and friends) did not reduce the size of the associations. Including all potential explanatory factors reduced the associations by 68-84% in men and 43-60% in women. Conclusions: The education gradient in self-rated health in Ukraine was partly accounted for by material and behavioural factors. In addition to health behaviours, policymakers should consider upstream determinants of health inequalities, such as joblessness and poverty

  • 80. Ploederl, Martin
    et al.
    Pichler, Eva-Maria
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Cognitive psychology. Stockholm Health Care services, Sweden.
    Niederseer, David
    Fartacek, Clemens
    Daylight saving time was not associated with a change in suicide rates in Austria, Switzerland and Sweden2024In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360XArticle in journal (Refereed)
    Abstract [en]

    Background: Some studies have reported an increase in suicides after the start of daylight saving time (DST), but the evidence is mixed and more research about proposed mechanisms (disrupted sleep, changing light exposure) is needed. Methods: In our preregistered study, we analyzed change in suicide rates in the 2 weeks before/after DST, based on data between 1980 and 2022 from Austria, Switzerland and Sweden, using Poisson regression models and changepoint analyses. To explore the impact of disrupted sleep, we repeated the analysis for retired people who are likely less bound to DST, and for younger people. To explore the effect of changed daylight exposure, we repeated the analysis for northern and southern regions because twilight and daylight exposure varies by latitude. Results: Suicide rates did not significantly increase after the start of DST (adjusted incidence rate ratio IRR = 0.98, 95% CI 0.91-1.06, P = 0.66, n = 13 362 suicides) or after DST ended (adjusted IRR = 0.99, 95% CI 0.91-1.07, P = 0.76, n = 12 319 suicides). There were no statistically significant findings among younger or older subgroups and also not in Sweden and Austria/Switzerland. No changepoints were detected. Conclusions: There were no significant changes in suicide rates associated with DST and no clear evidence to support proposed mechanisms (light exposure, disruption of sleep). Our study is one of the largest and was adequately powered. Nonetheless, even larger studies to detect smaller effects could be important to inform the debate about harms and benefits of DST.

  • 81. Raffetti, Elena
    et al.
    Donato, Francesco
    Triolo, Federico
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Andersson, Filip
    Forsell, Yvonne
    Galanti, Maria Rosaria
    Country differences in the cross-sectional associations between smoking and depressive symptoms in adolescence2022In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 6, p. 913-918Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the present study was to compare the cross-sectional association between smoking and depressive symptoms among adolescents between Sweden and Italy, two countries historically characterized by different norms about tobacco use and different tobacco control efforts. Methods: A cross-sectional study including 3283 adolescents 15–16 years of age participating in the Swedish KUPOL study and 1947 same-age adolescents from the Italian BE-TEEN study. Current smoking was defined as any smoking in the past 30 days. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) and the internalizing score of the Strengths and Difficulties Questionnaire (SDQ). Country differences were explored in stratified and interaction analyses. Results: Current smoking was associated with a 2- to 3-fold increased odds of depressive symptoms among Swedish adolescents using both CES-DC and SDQ internalizing scale. Among Italian adolescents, slightly lower increased odds of 1.5–2.5 for depressive symptoms with smoking were found using the CES-DC but not the SDQ scale. Both multiplicative and additive interactions for country were significant. The association between smoking and depressive symptoms was weaker among Italian compared with Swedish adolescents for both scores. Conclusions: Countries with different tobacco norms and control show different associations between smoking and depressive symptoms in adolescence, probably due to different psychosocial profiles of smokers. These findings need to be considered when planning tobacco prevention programmes, e.g. by focusing on early detection of mental health distress among adolescents in settings with declining smoking prevalence and restrictive tobacco control environments.

  • 82.
    Rajaleid, Kristiina
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nummi, Tapio
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Virtanen, Pekka
    Gustafsson, Per E.
    Hammarström, Anne
    Social adversities in adolescence predict unfavourable trajectories of internalized mental health symptoms until middle age: results from the Northern Swedish Cohort2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1, p. 23-29Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experiencing adversities during upbringing has short-term and long-term effects on mental health. This study aims to explore how social adversities in adolescence predict trajectories of internalized mental health symptoms (IMHS), from adolescence and onward until middle age.

    METHODS: Based on 1040 individuals from the Northern Swedish Cohort Study, a community-based cohort with 27 years of follow-up. We applied latent class growth analysis to extract trajectories of IMHS between ages 16 and 43. Multinomial logistic regression was used to study the association of social adversities (residential mobility, residential crowding, parental loss, unemployment of a parent, physical illness of a parent, mental illness or alcohol problems of a parent) in adolescence with IMHS trajectories.

    RESULTS: Five trajectory classes were identified: 'very low stable' (26% of the sample), 'low stable' (58%), 'moderate stable' (5%), 'increasing' (8%) and 'high decreasing' (3%). Both in men and women, reporting social adversities at the age of 16 increased the risk of belonging to the classes with less favourable development of IMHS. Reporting adversities was positively associated with the initial level of the IMHS trajectories. Thus it seems that the influence of adversities is more pronounced during the early years of follow-up and is attenuated over time.

    CONCLUSION: Experiencing social adversities in adolescence increases the risk of entering unfavourable developmental trajectories of mental health until middle age.

  • 83.
    Ramstedt, Mats
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Stockholm, Sweden; The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden.
    Raninen, Jonas
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Livingston, Michael
    Children with problem-drinking parents in a Swedish national sample: is the risk of harm related to the severity of parental problem drinking? 2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 2, p. 312-316Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this paper is to examine the link between severity in exposure to parental problem drinking in a Swedish national population sample of children aged 15–16 years. Specifically, we assessed whether the risk of poor health, poor relationships and a problematic school situation increase with severity in exposure to parental problem drinking.

    Methods: National population survey from 2017 with a representative sample of 5 576 adolescents born in 2001. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs). A short version of The Children of Alcoholics Screening Test, CAST-6, was used to identify children with problem-drinking parents. Health status, social relations and school situation were assessed by well-established measures.

    Results: The risk of having poor health, poor school performance and poor social relations increased with severity of parental problem drinking. The risk was lowest among children least severely affected (Crude models ranged from OR: 1.2, 95% CI 1.0–1.4 to OR: 2.2, 95% CI 1.8–2.6) and highest among children most severely affected (Crude models ranges from OR: 1.7, 95% CI 1.3–2.1 to OR: 6.6, 95% CI 5.1–8.6). The risk became lower when adjusting for gender and socioeconomic position but were still higher compared to children without problem-drinking parents.

    Conclusions: Appropriate screening and intervention programs are necessary for children with problem-drinking parents especially when exposure is severe but also at mild forms of exposure.

  • 84.
    Romelsjö, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenbacka, Marlene
    Lundberg, Michael
    Upmark, Marianne
    A population study of the association between hospitalisation for alcoholism among employed in different socio-economic classes and the risk of mobility out of or within the working force2004In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 14, no 1, p. 53-57Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Alcohol problems can increase the risk of downward mobility within, or mobility out of, the workforce. The magnitude of this risk has been unclear, as has also been the question whether the risk is different for men and women, for different socio-economic classes, and for single-living compared with co-habiting people. METHODS: The study period was 1970-1980, when unemployment was low in Sweden. Information about socio-economic status from censuses was linked to hospitalization for alcoholism, alcohol psychosis and alcohol intoxication (AAA) over the period 1970-1975 in Stockholm County in persons aged 20-49 years in 1970 and gainfully employed in the same socio-economic category in both 1970 and 1975, and to general population data. The standardized rate ratio for mobility out of the workforce and for downward socio-economic mobility was calculated for those hospitalized with AAA. RESULTS: There was a statistically significant risk of mobility out of the workforce over the period 1976-1980 in both sexes and in all socio-economic groups. The relative risk was 6.63 for male skilled and semi-skilled manual workers and 9.52 for non-manual employees at medium and high level, while the corresponding figures were lower for women. The absolute risk of leaving the workforce was lowest in non-manual employees at medium and high level. The relative risk was reduced in persons who were co-habiting. CONCLUSIONS: Severe alcohol problems are powerful determinants of downward mobility within, or mobility out of, the workforce in both sexes and in all socio-economic categories.

  • 85.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Heroin maintenance and attraction to treatment: [Commentary]2002In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 12, no 3, p. 234-235Article in journal (Refereed)
  • 86.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, J.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Sibling death in childhood predicts mortality in young adults – a Swedish national cohort study2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no Suppl. 3, p. 53-53Article in journal (Refereed)
    Abstract [en]

    Background

    Previous studies have found that the loss of a family member increases mortality among bereaved family members. Although, some previous evidence have found associations between loss of a sibling in adulthood and subsequent mortality few studies have studied whether sibling deaths in childhood is associated with all-cause and cause-specific mortality in young adulthood.

    Methods

    A national cohort born during 1973–1982 (N= 871 402) was followed prospectively in the Swedish Cause of Death Register from age 18 to 30–35. Multivariate Cox analyses of proportional hazards with adjustment for socio-demographic confounders were used to test the association between sibling loss and all-cause and cause-specific mortality in young adulthood. Sibling deaths were divided into deaths caused by external causes and natural causes and we studied mortality from CVD, cancer, other diseases, suicides and accidents among bereaved siblings.

    Results

    In men, the mortality risk for bereaved persons versus non bereaved persons during childhood/adolescence was 1.48 (95% CI: 1.17, 1.86), and in women it was 1.45 (95% CI: 1.01, 2.09) after adjustment for socio-demographic confounders. Losing anon-infant sibling (>1 years) was most detrimental for both men (HR: 1.65, 95% CI: 1.23, 2.23) and women (HR: 1.54,95% CI: 0.95, 2.50) while bereaved men (HR: 1.86, 95% CI:1.28, 2.72) and women (HR: 1.75, 95% CI: 0.97, 3.18) were most vulnerable when exposed to loss of a sibling inadolescence (12-18 years). Further, preliminary analyses showed that external causes of death were most detrimental for mortality among bereaved siblings.

    Conclusions

    Sibling death during childhood predicts mortality in young adulthood, particularly when persons are exposed in adolescence. Men and women are about equally vulnerable to sibling deaths at different stages of childhood.

  • 87.
    Rostila, Mikael
    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).
    Saarela, Jan
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Experience of sibling death in childhood and risk of psychiatric care in adulthood2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Sibling loss has received scant attention in the bereavement literature. A previous study suggested an overall increased risk of mortality in siblings bereaved during childhood. However, the underlying disease pattern behind increased mortality is unclear. We studied the influence of sibling loss during childhood on in and outpatient care with an underlying psychiatric diagnosis in adulthood.

    Methods

    A national cohort born in Sweden in 1973-1982 (N = 717,723) was followed prospectively in the Cause of Death Register until 2013, i.e. from ages 18 years to 31-40 years of age. Cox proportional hazards models were used to analyse the association between sibling loss during childhood and psychiatric in- and outpatient care during follow-up.

    Results

    After adjustment for socio-demographic confounders and parental psychosocial covariates, HR for psychiatric inpatient-and outpatient care in bereaved siblings versus non- bereaved siblings was fairly small and non-significant in women. Bereaved men had increased HR for both psychiatric inpatient- (HR 1.17, 95% CI 1.00-1.36) and outpatient care (HR 1.21, 95% CI 1.10-1.33). Risks were however more pronounced when exposed to loss of a sibling in adolescence (i.e. in the ages 12-18 years) in both men and women.

    Conclusions

    The death of a sibling in childhood was associated with slightly increased risk of psychiatric in and out-patient care in surviving siblings in adulthood in men but not in women. Individuals experiencing the loss of a sibling in childhood may need particular attention from health care services.

  • 88.
    Rydwik, Elisabeth
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm City Council .
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University.
    Angleman, Sara
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Adherence to physical exercise recommendations in people over 65 - The SNAC-Kungsholmen study2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 5, p. 799-804Article in journal (Refereed)
    Abstract [en]

    Background: There is limited knowledge regarding to what extent the older population meet the recommendations of physical exercise, especially fitness-enhancing exercise. This study assessed participation in health- and fitness-enhancing exercises in people aged >65, and explored to what extent the possible differences in meeting current recommendations differs by age, gender and education. Methods: The study population was derived from the Swedish National study on Aging and Care, and consisted of a random sample of 2593 subjects, aged 65+ years. Participation in health- and fitness-enhancing exercise according to the WHO and the American College of Sports Medicine's recommendations in relation to age, gender and education was evaluated using multinomial logistic regression adjusted for health indicators and physical performance. Results: According to the recommendations, 46% of the participants fulfilled the criteria for health-enhancing and 16% for fitness-enhancing exercises. Independent of health indicators and physical performance, women <80 years of age were less likely than men to participate in fitness-enhancing exercise, but they participated more in health-enhancing exercise. In the advanced age group (80+ years), women were less likely to participate both in fitness- and health-enhancing exercise. Advanced age and low education were negatively related to participation in both health- and fitness-enhancing exercise independent of health indicators, but the association was not observed among people with fast walking speed. Conclusion: Promoting physical exercise and encouraging participation among older adults with lower education, especially among those with initial functional decline, may help to reduce adverse health outcomes.

  • 89. Saarela, Jan
    et al.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Mortality after the death of a parent in adulthood: a register-based comparison of two ethno-linguistic groups2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 3, p. 582-587Article in journal (Refereed)
    Abstract [en]

    Background: Most research on parental bereavement and health have analysed health consequences of parental loss in childhood, while collateral health in adulthood has been less studied. Methods: Using register-based population data from Finland, we analyse adult offspring aged 18-50 years with discrete-time hazard models that adjust for offspring and parental socioeconomic and demographic characteristics. In focus are adult children whose parents were alive and lived together at the beginning of the observation period. We compare two culturally distinct but otherwise similar ethno-linguistic groups, Finnish speakers and Swedish speakers. Results: The results suggest that bereaved men have an approximately 30% higher death risk than non-bereaved men, while there is practically no difference in women. Associations between parental and child deaths are, as expected, stronger for concordant causes of death than for discordant causes of death. However, some associations for discordant causes of death remain, which may indicate causality. Among Swedish speakers, who have notably higher family stability than Finnish speakers, the death of one or both parents shows a stronger association with own mortality. Conclusions: The estimated associations found are generally larger than in the neighbouring country Sweden, which may be due to a stronger obedience to traditional family values and patriarchal family roles in Finland. These findings suggest that the association between parental death and mortality in adult offspring may depend on the societal context as well as on cultural practices. These factors should be increasingly acknowledged in future studies on collateral health.

  • 90. Sidorchuk, A
    et al.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, United Kingdom .
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Social class, social mobility and alcohol-related disorders in four generations of Swedish families2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl. 1, p. 117-117Article in journal (Refereed)
  • 91. Sovio, U.
    et al.
    Dibden, A.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    ‘‘Low birth weight paradox’’ revisited: Persisting social inequalities early in life and evolving role of maternal smoking2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, p. 42-43Article in journal (Other academic)
  • 92. Stubbe Østergaard, Liv
    et al.
    Norredam, Marie
    Mock-Munoz de Luna, Claire
    Blair, Mitch
    Goldfeld, Sharon
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Restricted health care entitlements for child migrants in Europe and Australia2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 5, p. 869-873Article in journal (Refereed)
    Abstract [en]

    Background

    More than 300 000 asylum seeking children were registered in Europe alone during 2015. In this study, we examined entitlements for health care for these and other migrant children in Europe and Australia in a framework based on United Nations Convention of the Rights of the Child (UNCRC).

    Methods

    Survey to child health professionals, NGO's and European Ombudspersons for Children in 30 EU/EEA countries and Australia, supplemented by desktop research of official documents. Migrant children were categorised as asylum seekers and irregular/undocumented migrants.

    Results

    Five countries (France, Italy, Norway, Portugal and Spain) explicitly entitle all migrant children, irrespective of legal status, to receive equal health care to that of its nationals. Sweden and Belgium entitle equal care to asylum seekers and irregular non-EU migrants, while entitlements for EU migrants are unclear. Twelve European countries have limited entitlements to health care for asylum seeking children, including Germany that stands out as the country with the most restrictive health care policy for migrant children. In Australia entitlements for health care are restricted for asylum seeking children in detention and for irregular migrants. The needs of irregular migrants from other EU countries are often overlooked in European health care policy.

    Conclusion

    Putting pressure on governments to honour the obligations of the UNCRC and explicitly entitle all children equal rights to health care can be an important way of advocating for better access to primary and preventive care for asylum seeking and undocumented children in Australia and the EU.

  • 93.
    Sundberg, Louise
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Trends in health expectancies among the oldest old in Sweden, 1992-20112016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 6, p. 1069-1074Article in journal (Refereed)
    Abstract [en]

    Background: Information on the extent to which older people's increasing life expectancy is characterized by good or poor health is important for policy and fiscal planning. This study explores trends in health expectancies among the oldest old in Sweden from 1992 to 2011. Methods: Cross-sectional health expectancy estimates at age 77 were obtained for 1992, 2002, 2004 and 2011 by Sullivan's method. Health expectancy was assessed by severe disability, mild disability and mobility problems. Changes in health expectancies were decomposed into the contributions attributed to changes of mortality rates, and changes in disability and mobility prevalence. Mortality data were obtained from Statistics Sweden and prevalence data from two nationally representative surveys, the Swedish Panel Study of Living Conditions of the Oldest Old and the Survey of Health, Ageing and Retirement in Europe. Results: Years free from severe disability, mild disability and mobility problems increased in both men and women. Decomposition analysis indicates that the increase was mainly driven by the change in health status rather than change in mortality. In relation to total life expectancy, the general patterns suggest that women had a compression of health problems and men an expansion. Conclusion: Men's life expectancy increased more than women's; however, the increased life expectancy among men was mainly characterized by disability and mobility problems. The results suggest that the gender gap in health expectancy is decreasing.

  • 94. Svedberg, Pia
    et al.
    Mather, L.
    Bergström, G.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Blom, V.
    Are time pressure and sleep problems due to thoughts about work risk factors for future sick leave?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no S3, p. 252-252, article id ckx187.667Article in journal (Refereed)
    Abstract [en]

    Background: Previous research indicates that long working hours, time pressure and overtime work relate to a range of adverse outcomes including poor recovery and health complaints. But, findings are inconclusive and limited, especially regarding the associations to sick leave. The aim was to study if time pressure or sleep problems due to thoughts about work were associated with future sick leave, when adjusting for confounders including familial factors, and stratifying by occupational sector. Methods: The study sample included 23,777 twin individuals (54.5% women), aged 19-47 years who participated in a survey in 2005 including questions on time pressure, sleep, work and health. Register data on sick-leave spells lasting >14 days were obtained from the National Social Insurance Agency. Individuals were followed from date of survey response until 12/31/2013. Associations between time pressure, sleep problems due to thoughts about work and future sick leave were investigated using logistic regression analyses to assess Odds Ratios (OR) with 95% Confidence Intervals (CI). Results: Thirty-five percent of the individuals had an incident sick leave spell during the 8-years of follow-up. Sleep problems due to thoughts about work once a month or more often were associated with sick leave in the fully adjusted model (OR 1.22, CI 1.10-1.36). Stratified by sector, the highest estimate was shown for state employees (OR 1.54, CI 1.11-2.13). Familial factors did not seem to influence the associations. We found no statistically significant associations between time pressure and sick leave. No sex differences were found. Conclusions: Results indicate that sleep problems due to thoughts about work is a risk factor for future sick leave. This follows previous research showing that sleep length and disturbances, regardless of their reasons, are associated with sick leave. But, experiences of work-related time pressure seem not to be associated with sick leave.

  • 95.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Jood, Katarina
    Slunga Järvholm, Lisbeth
    Vingård, Eva
    Perk, Joep
    Östergren, Per Olov
    Hall, Charlotte
    A systematic review of studies in the contributions of the work environment to ischaemic heart disease development2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 3, p. 470-477Article, review/survey (Refereed)
    Abstract [en]

    Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system. Methods: Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed. Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence. Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.

  • 96. Thern, Emelie
    et al.
    Ramstedt, Mats
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. The Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden.
    The associations between unemployment at a young age and binge drinking and alcohol-related problems2020In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, no 2, p. 368-373Article in journal (Refereed)
    Abstract [en]

    Background: Youth unemployment remains at a high stable level in many countries making it a public health problem of importance. The aim was to examine the short-term effect of unemployment at a young age (aged 17-29 years) on self-reported binge drinking and alcohol-related problems. Methods: We used data from a cross-sectional national study that took place in 2013, with a follow-up in 2014. A sample of young adults aged 17-29 years (n = 1188, response rate of 46.3%) that completed both surveys served as the study sample in the current study. The same self-reported questionnaire, consisting of questions regarding their alcohol habits and sociodemographic information, was used on both occasions. Information on the outcomes of binge drinking and alcohol-related harm were obtained from the 2014 survey. From the 2013 survey, information on individual and family level covariates were collected. Odds ratios (ORs) with 95% confidence intervals (CIs) with employed individuals as the reference group were estimated by logistic regression analysis. Results: At baseline, results indicate that employed individuals reported the greatest prevalence of weekly binge drinking. In the fully adjusted models, unemployment appeared to be associated with an increased risk of alcohol-related problems (OR 1.37, 95% CI 0.77-2.45); however, this was not the case for weekly binge drinking (OR 0. 94, 95% CI 0.45-1.96). Conclusion: Unemployment at a young age may be a risk factor for later alcohol-related problems. Thus, targeting youth unemployment could be one element in an effective health policy aimed at reducing rates of alcohol use disorders.

  • 97. Urquia, Marcelo L.
    et al.
    Janevic, Teresa
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Smoking during pregnancy among immigrants to Sweden, 1992-2008: the effects of secular trends and time since migration2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 1, p. 122-127Article in journal (Refereed)
    Abstract [en]

    Background: Smoking during pregnancy has been declining in the past decades in high-income countries, including Sweden. Paradoxically, increasing trends associated with duration of residence have been reported among immigrants. We aimed to clarify how these two contrasting trends have shaped smoking patterns among immigrants. Methods: We conducted a population-based study of 1 598 433 pregnancies in Sweden in the period 1992–2008. We used multinomial logistic regression to estimate the odds of mild and heavy smoking relative to no smoking associated with year of delivery, years since migration, maternal region of birth and their interaction, after controlling for potential confounders. Results: The prevalence of smoking decreased for the Swedish-born and for immigrants during the study period. Among immigrants, duration of residence was independently associated with increases in smoking and varied according to maternal region of birth (P-value for interaction <0.001). The odds ratio associated with a 10-year increase in duration of residence was weakest for mild smoking among former Yugoslav women (adjusted odds ratio; 95% confidence interval: 1.10; 1.04–1.17) and those from other Nordic countries (1.22; 1.17–1.26) and strongest for heavy smoking among East African (4.46; 3.23–6.16) and sub-Saharan African (3.56; 2.68–4.72) women. The association between duration of residence and smoking was attenuated after stratifying by cohorts of arrival among European but not among non-European immigrants. Conclusions: Declines in smoking during pregnancy among immigrants from various regions of the world were differentially affected by opposite increasing trends throughout their residence in Sweden.

  • 98. Virtanen, Marianna
    et al.
    Heikkilä, Katriina
    Vahtera, Jussi
    Kivimäki, Mika
    Halonen, Jaana I.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Finnish Institute for Health and Welfare, Helsinki, Finland.
    Alexanderson, Kristina
    Rautiainen, Simo
    Lallukka, Tea
    Mittendorfer-Rutz, Ellenor
    Clustering of disability pension and socioeconomic disadvantage in Sweden: a geospatial analysis 2022In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 5, p. 703-708Article in journal (Refereed)
    Abstract [en]

    Background: To characterize geospatial patterning of disadvantage in Sweden, we examined whether municipal-level indicators of socioeconomic disadvantage and disability pension (DP) rate were clustered, whether the different geospatial clusters were overlapping and whether the findings were similar among women and men. Methods: Administrative national data from all 290 Swedish municipalities were used to determine the prevalence of DP and socioeconomic disadvantage [poverty, long-term unemployment, income inequality (GINI Index) and income inequality between women and men]. Geospatial cold spots (clusters of municipalities with a DP/socioeconomic disadvantage prevalence lower than the nationwide prevalence) and hot spots (clusters of municipalities with a DP/socioeconomic disadvantage higher than the nationwide prevalence) were identified, and whether a hot spot was overlapping with another hot spot and a cold spot overlapping with another cold spot were analysed using the Getis-Ord Gi statistics. Results: Among women and men, cold spots of DP were most consistently located in the Stockholm area. Hot spots of DP were found in the mid-south Sweden, characterized by mid-sized urban centres in rural territories. High DP rate and socioeconomic disadvantage were overlapping, except for income inequality. Clusters of gender income inequality and women’s high DP rate were observed in mid-south Sweden. Conclusion: DP and socioeconomic disadvantage are not randomly distributed in Sweden. Geospatial analyses revealed clusters of municipalities with high risk of both DP and socioeconomic disadvantage in certain areas and low risk in other areas. Further research is needed to identify preventive actions to decrease regional inequalities in work capacity.

  • 99.
    Vågerö, Denny
    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).
    Does unemployment cause long-term mortality? Selection and causation after the 1992–96 deep Swedish recession2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 5, p. 778-783Article in journal (Refereed)
    Abstract [en]

    Background: Mass unemployment in Europe is endemic, especially among the young. Does it cause mortality? Methods: We analyzed long-term effects of unemployment occurring during the deep Swedish recession 1992–96. Mortality from all and selected causes was examined in the 6-year period after the recession among those employed in 1990 (3.4 million). Direct health selection was analyzed as risk of unemployment by prior medical history based on all hospitalizations 1981–91. Unemployment effects on mortality were estimated with and without adjustment for prior social characteristics and for prior medical history. Results: A prior circulatory disease history did not predict unemployment; a history of alcohol-related disease or suicide attempts did, in men and women. Unemployment predicted excess male, but not female, mortality from circulatory disease, both ischemic heart disease and stroke, and from all causes combined, after full adjustment. Adjustment for prior social characteristics reduced estimates considerably; additional adjustment for prior medical history did not. Mortality from external and alcohol-related causes was raised in men and women experiencing unemployment, after adjustment for social characteristics and medical history. For the youngest birth cohorts fully adjusted alcohol mortality HRs were substantial (male HR = 4.44; female HR = 5.73). The effect of unemployment on mortality was not uniform across the population; men, those with a low education, low income, unmarried or in urban employment were more vulnerable. Conclusions: Direct selection by medical history explains a modest fraction of any increased mortality risk following unemployment. Mass unemployment imposes long-term mortality risk on a sizeable segment of the population.

  • 100.
    Wallace, Matthew
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Khlat, Myriam
    Guillot, Michel
    Infant mortality among native-born children of immigrants in France, 2008-17: results from a socio-demographic panel survey2021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no 2, p. 326-333Article in journal (Refereed)
    Abstract [en]

    Background: Within Europe, France stands out as a major country that lacks recent and reliable evidence on how infant mortality levels vary among the native-born children of immigrants compared with the native-born children of two parents born in France. Methods: We used a nationally representative socio-demographic panel consisting of 296 400 births and 980 infant deaths for the period 2008-17. Children of immigrants were defined as being born to at least one parent born abroad and their infant mortality was compared with that of children born to two parents born in France. We first calculated infant mortality rates per 1000 live births. Then, using multi-level logit models, we calculated odds ratios of infant mortality in a series of models adjusting progressively for parental origins (M1), core demographic factors (M2), father's socio-professional category (M3) and area-level urbanicity and deprivation score (M4). Results: We documented a substantial amount of excess infant mortality among those children born to at least one parent from Eastern Europe, Northern Africa, Western Africa, Other Sub-Saharan Africa and the Americas, with variation among specific origin countries belonging to these groups. In most of these cases, the excess infant mortality levels persisted after adjusting for all individual-level and area-level factors. Conclusions: Our findings, which can directly inform national public health policy, reaffirm the persistence of longstanding inequality in infant mortality according to parental origins in France and add to a growing body of evidence documenting excess infant mortality among the children of immigrants in Europe.

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