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  • 51. Remes, Hanna
    et al.
    Moustgaard, Heta
    Kestilä, Laura M.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute of Demographic Research, Germany.
    Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems?2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 3, p. 225-231Article in journal (Refereed)
    Abstract [en]

    Background Adolescent health problems are more prevalent in families with low socioeconomic position, but few studies have assessed the role of parental health in this association. This study examines the extent to which parental health problems, particularly those related to high-risk health behaviour, might explain the association between parental education and adolescent health problems due to violence, self-harm and substance use.

    Methods We used longitudinal register data on a 20% representative sample of all families with children aged 0-14 years in 2000 in Finland with information on parental social background and parental and offspring health problems based on hospital discharge data. We estimated discrete-time survival models with the Karlson-Holm-Breen method on hospital admissions due to violence, self-harm and substance use among adolescents aged 13-19 years in 2001-2011 (n=145 404).

    Results Hospital admissions were 2-3 times more common among offspring of basic educated parents than tertiary educated parents. Similar excess risks were observed among those with parental mental health problems and parental health problems due to violence, self-harm and substance use. The OR for offspring of basic educated parents was attenuated from OR 2.73 (95% CI 2.34 to 3.18) to OR 2.38 (2.04 to2.77) with adjustment for parental health problems, particularly those due to violence, self-harm and substance use. Having both low parental education and parental health problems showed simple cumulative effects.

    Conclusions The excess risks of hospital admissions due to violence, self-harm and substance use among adolescents with lower educated parents are largely independent of severe parental health problems.

  • 52.
    Rojas, Yerko
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Stenberg, Sten-Åke
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Evictions and suicide: a follow up study of almost 22,000 Swedish households in the wake of the global financial crisis2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 4, p. 409-413Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Millions of families across the world are evicted every year. However, very little is known about the impact that eviction has on their lives. This lack of knowledge is also starting to be noticed within the suicidological literature, and prominent scholars are arguing that there is an urgent need to explore the extent to which suicides may be considered a plausible consequence of being faced with eviction.

    METHOD: The present study's sample consists of all persons served with an application for execution of an eviction order during 2009-2012. This group is compared to a random 10% sample of the general Swedish population, ages 16 years and over. The analysis is based on penalised maximum likelihood logistic regressions.

    RESULTS: Those who had lost their legal right to their dwellings and for whom the landlord had applied for the eviction to be executed were approximately four times more likely to commit suicide than those who had not been exposed to this experience (OR=4.42), controlling for several demographic, socioeconomic and mental health conditions prior to the date of the judicial decision.

    CONCLUSIONS: Home evictions have a significant and detrimental impact on individuals' risk of committing suicide, even when several other well-known suicidogenic risk factors are controlled for. Our results reinforce the importance of ongoing attempts to remove the issue of evictions from its status as a hidden and neglected social problem.

  • 53.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, Jan
    Kawachi, Ichiro
    Mortality in parents following the death of a child: a nationwide follow-up study from Sweden2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 10, p. 927-933Article in journal (Refereed)
    Abstract [en]

    Background: The death of a young child is so devastating that it can increase the risk of mortality in the grieving parent. Little is known about the impact of an adult child's death on the health of parents. Methods: The authors conducted a follow-up study between 1980 and 2002 based on a linked-registers database that contains the total Swedish population. The authors examined mortality from all causes, natural causes and unnatural causes among parents following the death of children aged 10-49 years. Results: An increased mortality risk (RR 1.31, 95% CI 1.02 to 1.68) in mothers following the death of a minor child (10-17 years) was found and especially following unnatural deaths (primarily accidents and suicides). Mothers also experienced elevated mortality following the death of an adult child aged 18-25 years (RR 1.15, 95% CI 1.03 to 1.29). Bereavement effects among fathers were more attenuated and chiefly found after >8 years of follow-up. From a short-term perspective (1-3 years), the death of an adult child (>25 years) was somewhat protective for parents. However, over longer follow-up periods, it approached (4-8 years) and exceeded (>8 years) the death risk of the general population. Conclusions: These findings corroborate and extend earlier findings suggesting elevated mortality risks also following the death of an adult child.

  • 54. Ruiz, Milagros
    et al.
    Hu, Yaoyue
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    Bobak, Martin
    Life course socioeconomic position and incidence of mid-late life depression in China and England: a comparative analysis of CHARLS and ELSA2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 9, p. 817-824Article in journal (Refereed)
    Abstract [en]

    Background Despite the growing prevalence of depression in the Chinese elderly, there is conflicting evidence of life course socioeconomic position (SEP) and depression onset in China, and whether this association is akin to that observed in Western societies. We compared incident risk of mid-late life depression by childhood and adulthood SEP in China and England, a country where mental health inequality is firmly established. Methods Depression-free participants from the China Health and Retirement Longitudinal Study (N=8508) and the English Longitudinal Study of Ageing (N=6184) were studied over 4 years. Depressive symptoms were classified as incident cases using the Center for Epidemiologic Studies Depression Scale criteria. Associations between SEP (education, wealth, residence ownership and childhood/ adolescent deprivation) and depression symptom onset were assessed using Cox proportional hazards models. In China, we also investigated children's government employment status as a SEP marker. Results Higher education and wealth predicted lower incidence of depression in both countries. The association with non-ownership of residence appeared stronger in England (HR 1.61, 95% CI 1.41 to 1.86) than in China (HR 1.11, 95% CI 0.95 to 1.29), while that with childhood/adolescent deprivation was stronger in China (HR 1.43, 95% CI 1.29 - 1.60) than in England (HR 1.33, 95% CI 0.92 to 1.92). Chinese adults whose children were employed in high-status government jobs, had lower rates of depression onset. Conclusions Consistent findings from China and England demonstrate that SEP is a pervasive determinant of mid-late life depression in very diverse social contexts. Together with conventional measures of SEP, the SEP of children also affects the mental health of older Chinese.

  • 55. Santacroce, Adriana
    et al.
    Wastesson, Jonas W.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Höhn, Andreas
    Christensen, Kaare
    Oksuzyan, Anna
    Gender differences in the use of anti-infective medications before and after widowhood: a register-based study2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 6, p. 526-531Article in journal (Refereed)
    Abstract [en]

    Background Recent findings suggest that bereavement due to spousal loss is associated with a decline in general immune functions, and thus to increased susceptibility to infections among widowed individuals. The present study aims to investigate whether spousal loss weakens immune defences more among men than among women using a 5% random sample of the total Danish population, and anti-infective medication use as a proxy for immune response.

    Methods We followed 6076 Danish individuals (67% women) aged 50 from 5years before and up to 5years after widowhood to examine changes in prescriptions of anti-infectives for systemic use.

    Results Women used more anti-infective drugs both before and after spousal loss (women: OR= 1.31; 95% CI 1.21 to 1.42). The age-related changes in the use of anti-infective medications in the period before widowhood were similar to that in the period after widowhood among both men and women. Also, age-related changes in the use of anti-infective medications were similar in both genders.

    Conclusions The present study shows that individuals are more likely to use anti-infective medication after being widowed than before being widowed, but this change is likely to be related to increasing age and it is similar in both genders.

  • 56. Shkolnikov, Vladimir M.
    et al.
    Andreev, Evgueni M.
    Jdanov, Dmitri A.
    Jasilionis, Domantas
    Kravdal, Øystein
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Valkonen, Tapani
    Increasing absolute mortality disparities by education in Finland, Norway and Sweden, 1971-20002012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 4, p. 372-378Article in journal (Refereed)
    Abstract [en]

    Background and objectives Studies on socioeconomic health disparities often suffer from a lack of uniform data and methodology. Using high quality, census-linked data and sensible inequality measures, this study documents the changes in absolute and relative mortality differences by education in Finland, Norway and Sweden over the period 1971 to 2000.

    Methods The age-standardised mortality rates and the population exposures for three educational categories were computed from detailed data provided by the national statistical offices. Mortality disparities by education were assessed using two range measures (rate differences and rate ratios), and two Gini-like measures (the average inter-group difference (AID) and the Gini coefficient (G)). The formulae for the decomposition of the change in the AID into (1) the contribution of change in population composition by education, and (2) the contribution of mortality change were introduced.

    Results Mortality decreases were often greater for high than for medium and low education. Both relative and absolute mortality disparities tend to increase over time. The magnitude and timing of the increases in absolute disparities vary by country. Both the rate differences and the AIDs have increased since the 1970s in Norway and Sweden, and since the 1980s in Finland. The contributions of the changes in population composition to the total AID increase were substantial in all countries, and for both sexes. The mortality contributions were substantial for males in Norway and Sweden.

    Conclusions The study reports increases in absolute mortality disparity, and its components. This trend needs to be further studied and addressed by policies.

  • 57. Sjölund, Sara
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Gustafsson, Jan-Eric
    Allebeck, Peter
    IQ and alcohol-related morbidity and mortality among Swedish men and women: the importance of socioeconomic position2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 9, p. 858-864Article in journal (Refereed)
    Abstract [en]

    Aims To investigate the association between intelligence in childhood and later risk of alcohol-related disease and death by examining (1) the mediating effect of social position as an adult and (2) gender as a possible moderator. Design Cohort study. Setting and participants 21 809 Swedish men and women, born in 1948 and 1953, from the Swedish Evaluation Through Follow-up database were followed until 2006/2007. Measurements IQ was measured in school at the age of 13 and alcohol-related disease and death (International Classification of Disease codes) were followed from 1971 and onwards. Findings We found an increased crude HR of 1.23 (95% CI 1.18 to 1.29) for every decrease in group of IQ test results for alcohol-related admissions and 1.14 (95% CI 1.04 to 1.24) for alcohol-related death. Social position as an adult was found to mediate both outcomes. Gender was not found to moderate the association. However, adjusting for socioeconomic position lowered the risk more among men than among women. Conclusions There was an inverse, graded association between IQ and alcohol-related disease and death, which at least partially was mediated by social position as an adult. For alcohol-related death, complete mediation by socioeconomic position as an adult was found. Gender does not moderate this association. The role of socioeconomic position may differ between the genders.

  • 58. Stenholm, Sari
    et al.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Salo, Paula
    Hyde, Martin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Pentti, Jaana
    Head, Jenny
    Kivimäki, Mika
    Vahtera, Jussi
    Age-related trajectories of physical functioning in work and retirement: the role of sociodemographic factors, lifestyle and disease2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 6, p. 503-509Article in journal (Refereed)
    Abstract [en]

    Background Loss of physical functioning is an early marker of declining health in older people. The objective of this study was to examine the age-related trajectories of physical functioning among those in full-time work and retirement. Methods Based on the Health and Retirement Study, participants who were working full-time or were in full-time retirement and 65-85 years of age during the follow-up period from 1992 to 2010 were included (n=17 844, n of observations from repeated measures in full-time work 5891 and in retirement 57 117). Details of physical functioning were asked about at all study phases and 10 items related to mobility and activities of daily living were summed to obtain a physical functioning score (0-10). Results The number of physical functioning difficulties increased every 10 years by 0.17 (95% CI 0.04 to 0.29) when in full-time work and by 0.46 (95% CI 0.41 to 0.50) in retirement after adjusting for age, sex, race, education, total wealth, Body Mass Index, smoking, physical activity and number of diseases. Factors that were associated with a significantly greater increase in number of physical functioning difficulties in full-time work and retirement include lifestyle-related risks and chronic conditions. Conclusions Physical functioning declines faster in retirement than in full-time work in employees aged 65 years or older and the difference is not explained by absence of chronic diseases and lifestyle-related risks.

  • 59. Sund, Reijo
    et al.
    Lahtinen, Hannu
    Wass, Hanna
    Mattila, Mikko
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; University of Eastern Finland, Finland; Max Planck Institute for Demographic Research, Germany .
    How voter turnout varies between different chronic conditions? A population-based register study2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 5, p. 475-479Article in journal (Refereed)
    Abstract [en]

    Background While poor self-rated health is known to decrease an individual's propensity to vote, disaggregation of the components of health on turnout has thus far received only little attention. This study deepens on the understanding of such relationships by examining the association between chronic diseases and voting. Methods The study uses an individual-level register-based data set that contains an 11% random sample of the entire electorate in the 1999 Finnish parliamentary elections. With information on hospital discharge diagnoses and reimbursements for drugs prescribed, we identify persons with chronic hospital-treated diseases (coronary heart disease, chronic obstructive pulmonary disease (COPD) and asthma, depression, cancer, psychotic mental disease, diabetes, cerebrovascular disease, rheumatic disease, epilepsy, arthrosis, alcoholism, dementia, atherosclerosis, Parkinson's disease, other degenerative brain diseases, multiple sclerosis and kidney disease). Results After adjusting for gender, age, education, occupational class, income, partnership status, cohabitation with underaged children and hospitalisation during Election Day, neurodegenerative brain diseases had the strongest negative relationship with voting (dementia OR = 0.20, 95% CI 0.18 to 0.22; others up to OR = 0.70). Alcoholism (OR = 0.66) and mental disorders also had a negative association (depression OR = 0.91; psychotic mental disease OR = 0.79), whereas cancer and COPD/asthma had a positive association (both OR = 1.05). Having more than one condition at a time further decreased voting probability. Conclusions By showing how different health conditions are related to voter turnout, this study provides essential information for identifying gaps in the potential for political participation and for further inquiries aiming to develop models that explain the link between health and voting probability.

  • 60. Sörberg Wallin, Alma
    et al.
    Lundin, Andreas
    Melin, Bo
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Fathers' intelligence measured at age 18-20 years is associated with offspring smoking: linking the Swedish 1969 conscription cohort to the Swedish Survey of Living Conditions2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 4, p. 396-401Article in journal (Refereed)
    Abstract [en]

    Background An association between lower IQ of parents, measured early in life, and smoking among their offspring has been reported. The extent to which other background factors account for this association is unknown. Methods Data on IQ, smoking, mental health, social class, parental divorce and social problems in a cohort of men born during 1949-1951 and conscripted for military service in 1969 were linked to smoking data on 682 offspring interviewed in the Swedish Surveys of Living Conditions 1984-2009. Results In an age-adjusted model, a one-step decrease on a stanine scale was associated with an OR of 1.19 (95% CI 1.04 to 1.35) for offspring smoking. Adjusting for father's socioeconomic background and smoking, mental illness and social problems in youth only marginally lowered the OR's. Conclusions Lower IQ among fathers measured at ages 18-20years was associated with smoking in their offspring. The association was not explained by father's social class in childhood or a higher prevalence of mental illness, social problems or smoking measured among the fathers in their late adolescence.

  • 61.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Gustafsson, Per E.
    Magnusson Hanson, Linda
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Janlert, Urban
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Job strain and depressive symptoms in men and women: a prospective study of the working population in Sweden2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 1, p. 78-82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several prospective studies have indicated increased risk of developing depressive symptoms in employees who report psychologically demanding and uncontrollable work (job strain). There are diverging findings regarding gender differences in this relationship. The aim was to analyse whether men and women differ with regard to the prospective relationship between adverse psychosocial work environment and depressive symptoms during a 2-year period.

    METHOD: The Swedish Longitudinal Occupational Survey of Health cohort based on representative recruitment of working men and women in Sweden was used. 2731 men and 3446 women had answered questions regarding work environment and mental health in 2008 and 2010. Psychological demands, decision authority, age and income as well as depressive symptoms in 2008 were used as predictors of depressive symptoms in 2010.

    RESULTS: Women reported less decision authority at work and their demand level developed more unfavourably than did men's-resulting in increased job strain gap between men and women from 2008 to 2010. The relationship between demand and decision authority (and job strain) on one hand and depressive symptoms on the other hand was not statistically different in men and women.

    CONCLUSIONS: Overall, women reported higher levels of job strain than men. In Sweden, job strain was as strongly related to depressive symptoms among men as among women.

  • 62. Thern, Emelie
    et al.
    de Munter, Jeroen
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Rasmussen, Finn
    Long-term effects of youth unemployment on mental health: does an economic crisis make a difference?2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 4, p. 344-349Article in journal (Refereed)
    Abstract [en]

    Background Ill health is a risk factor and a consequence of unemployment, which might vary depending on the national rate of unemployment. We investigated the long-term effect of youth unemployment on mental health and explored the possible interaction during periods of high (economic crisis) and low (non-crisis) unemployment rates. Methods A register-linked population-based cohort study was conducted including individuals aged 1724 years. The crisis cohort (n= 6410) took part in the Labour Force Survey during the economic crisis (1991-1994) in Sweden and the non-crisis cohort (n= 8162) took part in the same survey before the crisis (1983-1986). Follow-up was 19 years. Adjusted HRs and 95% CIs for an inpatient care discharge mental diagnosis with employed people as the reference group were calculated by Cox regressions models. Results In fully adjusted models, <3 months (HR: 1.69; 95% CI 1.14 to 2.49), 3-6 months (2.19; 1.43 to 3.37) and > 6 months (2.70; 1.71 to 4.28) of unemployment were associated with increased risks of getting a mental diagnosis in the crisis cohort. In the non-crisis cohort the risks were: 1.92; 1.40 to 2.63, 2.60; 1.72 to 3.94 and 3.33; 2.00 to 5.57, respectively. No interactions between labour force status and level of unemployment were found. Conclusions Youth unemployment is related to mental health problems, independent of the overall national rate of unemployment, which is important as the youth unemployment rates are currently at stable high level.

  • 63. Thern, Emelie
    et al.
    Jia, Ting
    Willmer, Mikaela
    de Munter, Jeroen
    Norström, Thor
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Ramstedt, Mats
    Smith, George Davey
    Tynelius, Per
    Rasmussen, Finn
    No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 11, p. 1072-1077Article in journal (Refereed)
    Abstract [en]

    Background A strict high legal age limit for alcohol purchases decreases adolescents' access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality. Methods A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%-5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14-20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis. Results In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found. Conclusion The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.

  • 64.
    Tiikkaja, Sanna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rahu, K.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rahu, M.
    Maternal social characteristics and mortality from injuries among infants and toddlers in Estonia2009In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 63, no 8, p. 633-638Article in journal (Refereed)
  • 65.
    Torssander, Jenny
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Erikson, Robert
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Martial partner and mortality: The effects of the social positions of both spouses2009In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 63, p. 992-998Article in journal (Refereed)
    Abstract [en]

    Background: Dimensions of the individual socioeconomic position-education, social class, social status and income-are associated with mortality. Inequalities in death also related to the social position of the household. It is, however, less clear how the socioeconomic position of one marital/cohabiting partner influences the mortality of the other partner. We examine the independent effect on mortality of own and partner's positions regarding these four socioeconomic factors. Methods: Register data on education, social class, social status and income of both marital/cohabiting partners were collected from the 1990 Census of the employed Swedish population aged 30-59 (N = 1 502 148). Data on all-cause mortality and deaths from cancer and circulatory disease for the subsequent period 1991-2003 were collected from the Cause of Death Register. Relative mortality risks for different socioeconomic groups were estimated by Cox regression. Results: All-cause mortality of both men and women differs by women's education and status and by men's social class and income. For men, the wife's education is more important for the mortality risk than his own education when the man's social class is included in the model. For women, the husband's social class yields larger mortality differences than own occupational measures. Women's education and men's social class and income are particularly important for women's deaths from circulatory diseases. Conclusion: The partner's social position has a clear independent association with individual mortality, and women's education and men's social class seem to be particularly important. Suggested explanations of health inequality are not always compatible with the observed relationship between partners' social and economic resources and mortality.

  • 66.
    Uggla, Caroline
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Billingsley, Sunnee
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Unemployment, intragenerational social mobility and mortality in Finland: heterogeneity by age and economic context2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 11, p. 1003-1008Article in journal (Refereed)
    Abstract [en]

    Background We explore how mortality is related to unemployment and intragenerational social mobility in Finland. Unemployment and social mobility are two labour market experiences that are largely studied separately, despite the fact that selection processes into unemployment and downward mobility are intertwined. Because both causal and health selection mechanisms may vary depending on the timing of these experiences, we consider heterogeneity by age and economic context.

    Methods We run discrete time event history analysis for death (at age 30–75 years) in two periods (economic recession and growth) and analyse younger and older individuals and men and women separately.

    Results The odds of mortality were particularly high for individuals experiencing unemployment and when unemployment occurred during economic growth (OR ranging between 1.39 and 2.77). Younger men had high odds of mortality following unemployment (OR 1.86–2.77). In contrast, downward mobility was associated with higher odds of mortality only among older men and women and only during economic growth. The benefits of upward mobility were experienced mainly by younger men (OR ranging between 0.86 and 0.87) and were not experienced by women at all.

    Conclusion Results show that when in an individual’s life and the economic cycle unemployment and social mobility occur matters for whether these experiences are associated with mortality.

  • 67. Vadimovna Permyakova, Natalia
    et al.
    Billingsley, Sunnee
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Men's health and co-residence with older generations in Russia: better or worse?2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 3, p. 179-184Article in journal (Refereed)
    Abstract [en]

    Background Previous studies show contradictory findings on the relationship between health and intergenerational living arrangements (ILAs), which may be due to variation in who selects themselves into and out of ILA. Addressing the selectivity into ILA and the health of the older generation, we assess whether there is a health-protective or health-damaging effect of ILA. We locate our study in the Russian context, where ILA is prevalent and men's health has become a public health issue.

    Methods We apply a fixed-effects logistic regression to self-rated health status of 11546 men aged 25 years or older who participated in at least two waves in the Russian Longitudinal Monitoring Survey from 1994 to 2015. To further isolate the health effect of ILA, we observe only associations after transitioning into or out of ILA.

    Results A transition into co-residence with an unhealthy older generation increases men's odds of reporting poor health (OR=0.64, CI 0.44 to 0.93). A transition out of co-residence with a healthy older generation decreases men's odds of reporting fine health by 63% (OR=0.37, CI 0.28 to 0.50), whereas continuing to live with an unhealthy older generation decreases the odds by half (OR=0.49, CI 0.38 to 0.63).

    Conclusions We reveal a health interlinkage between co-residing generations by finding a detrimental health effect of co-residence with an unhealthy older generation. No longer living with an older generation who was in fine health also negatively affects men's health. Future studies should address heterogeneity related to the health of older generations, unobserved time-constant characteristics of younger generations and selectivity into/out of ILA.

  • 68. Vahtera, Jussi
    et al.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ferrie, Jane E
    Head, Jenny
    Melchior, Maria
    Singh-Manoux, Archana
    Zins, Marie
    Goldberg, Marcel
    Alexanderson, Kristina
    Kivimäki, Mika
    All-cause and diagnosis-specific sickness absence as a predictor of sustained suboptimal health: a 14-year follow-up in the GAZEL cohort2010In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 64, no 4, p. 311-7Article in journal (Refereed)
    Abstract [en]

    background: Previous studies show that sickness absence predicts health, but it is unclear whether this association is persistent over time and whether specific diseases underlie long-term associations. The aim of this study was to investigate overall and diagnosis-specific sickness absences as predictors of sustained suboptimal health. METHODS: Prospective occupational cohort study of 15 320 employees (73% men) aged 37-51. Sickness absence records in 1990-1992, including 13 diagnostic categories, were examined in relation to self-rated health measured annually for the years 1993-2006. RESULTS: 3385 employees (22%) had >30 days of sickness absence and 5564 (36%) 1-30 days during the 3-year exposure window. Repeated-measures logistic regression analysis adjusted for age, sex, occupational status and chronic diseases show that employees with >30 absence days, compared with those with no absences, had 2.14 (95% CI 2.00 to 2.29) times higher odds for suboptimal health over the 14 years of follow-up. Retirement did not dilute this association. Nine sickness absence diagnostic categories, such as diseases of the nervous, circulatory, metabolic, musculoskeletal, sensory and gastrointestinal systems, cancer, mental disorders and external causes, independently predicted increased risk of sustained suboptimal health. CONCLUSIONS: There is a remarkably persistent association between sickness absence and future long-term self-rated health status for the majority of diagnostic categories for sickness absence. This suggests that the association between sickness absence and health is ubiquitous and not driven by a limited number of rare and severe diseases.

  • 69. Wallin, Alma Sorberg
    et al.
    Falkstedt, Daniel
    Allebeck, Peter
    Melin, Bo
    Janszky, Imre
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Does high intelligence improve prognosis?: The association of intelligence with recurrence and mortality among Swedish men with coronary heart disease2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 4, p. 347-353Article in journal (Refereed)
    Abstract [en]

    Background Lower intelligence early in life is associated with increased risks for coronary heart disease (CHD) and mortality. Intelligence level might affect compliance to treatment but its prognostic importance in patients with CHD is unknown. Methods A cohort of 1923 Swedish men with a measure of intelligence from mandatory military conscription in 1969-1970 at age 18-20, who were diagnosed with CHD 1991-2007, were followed to the end of 2008. Primary outcome: recurrent CHD event. Secondary outcome: case fatality from the first event, cardiovascular and all-cause mortality. National registers provided information on CHD events, comorbidity, mortality and socioeconomic factors. Results The fully adjusted HRs for recurrent CHD for medium and low intelligence, compared with high intelligence, were 0.98, (95% CIs 0.83 to 1.16) and 1.09 (0.89 to 1.34), respectively. The risks were increased for cardiovascular and all-cause mortality with lower intelligence, but were attenuated in the fully adjusted models (fully adjusted HRs for cardiovascular mortality 1.92 (0.94 to 3.94) and 1.98 (0.89 to 4.37), respectively; for all-cause mortality 1.63 (1.00 to 2.65) and 1.62 (0.94 to 2.78), respectively). There was no increased risk for case-fatality at the first event (fully adjusted ORs 1.06 (0.73 to 1.55) and 0.97 (0.62 to 1.50), respectively). Conclusions Although we found lower intelligence to be associated with increased mortality in middle-aged men with CHD, there was no evidence for its possible effect on recurrence in CHD.

  • 70. Wallin, Alma Sörberg
    et al.
    Allebeck, Peter
    Gustafsson, Jan-Eric
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Childhood IQ and mortality during 53 years' follow-up of Swedish men and women2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 10, p. 926-932Article in journal (Refereed)
    Abstract [en]

    BackgroundThe association between childhood cognitive ability measured with IQ tests and mortality is well documented. However, studies on the association in women are few and conflicting, and the mechanisms underlying the association are unclear.MethodsData on IQ were collected at school at age 13 among 19 919 men and women born in 1948 and 1953. Information on childhood socioeconomic position, the participants' socioeconomic and social circumstances in middle age and mortality up to 2013 was collected through national registers.ResultsLower IQ was associated with an increased risk of all-cause mortality among men (1070 cases, HR 1.31, 95% CI 1.23 to 1.39 for one SD decrease in IQ) and among women (703 cases, HR 1.16, 95%CI 1.08 to 1.25). IQ was associated with mortality from several causes of death in men, and cancer and cardiovascular disorder mortality in women. Adjustment for socioeconomic factors in childhood and, in particular, in adulthood attenuated the associations considerably in men and near completely in women.ConclusionLower IQ was associated with an increased risk of mortality in men and women. The explanatory effects of socioeconomic factors in adulthood suggest that they constitute an important pathway in the association between IQ and mortality, especially in women.

  • 71. Wall-Wieler, Elizabeth
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Karolinska Institutet, Sweden.
    Liu, Can
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Roos, Leslie L.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Avoidable mortality among parents whose children were placed in care in Sweden: a population-based study2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 12, p. 1091-1098Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Separation from one's child can have significant consequences for parental health and well-being. We aimed to investigate whether parents whose children were placed in care had higher rates of avoidable mortality.

    METHODS: Data were obtained from the Swedish national registers. Mortality rates among parents whose children were placed in care between 1990 and 2012 (17 503 mothers, 18 298 fathers) were compared with a 1:5 matched cohort of parents whose children were not placed. We computed rate differences and HRs of all-cause and avoidable mortality.

    RESULTS: Among mothers, deaths due to preventable causes were 3.09 times greater (95% CI 2.24 to 4.26) and deaths due to amenable causes were 3.04 times greater (95% CI 2.03 to 4.57) for those whose children were placed in care. Among fathers, death due to preventable causes were 1.64 times greater (95% CI 1.32 to 2.02) and deaths due to amenable causes were 1.84 times greater (95% CI 1.33 to 2.55) for those whose children were placed in care. Avoidable mortality rates were higher among mothers whose children were young when placed in care and among parents whose children were all placed in care.

    CONCLUSIONS: Parents who had a child placed in out-of-home care are at higher risk of avoidable mortality. Interventions targeting mothers who had a child aged less than 13 placed in care, and parents whose children were all placed in care could have the greatest impact in reducing avoidable mortality in this population.

  • 72. Wennerstad, Karin Modig
    et al.
    Silventoinen, Karri
    Tynelius, Per
    Bergman, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rasmussen, Finn
    Association between intelligence and type-specific stroke: a population-based cohort study of early fatal and non-fatal stroke in one million Swedish men2010In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 64, no 10, p. 908-912Article in journal (Refereed)
    Abstract [en]

    Background Inverse associations between IQ and stroke have been reported in a few studies, but none have investigated subtypes of stroke, nor have they studied fatal and non-fatal stroke separately. Stroke is a heterogenic disease and strength of associations with IQ and putative causal pathways cannot be assumed to be identical for different subtypes. Methods IQ was measured for 1.1 million Swedish men, born 1951 to 1976. Data from several national registers were linked and the cohort followed until the end of 2006 for non-fatal, and 2004 for fatal stroke. HRs with 95% CIs adjusted for age, body mass index, blood pressure and socioeconomic factors were estimated using Cox proportional hazards models. Results Inverse associations were found between IQ and all stroke subtypes. The strength of the associations differed by subtype, with the strongest RR found for haemorrhagic stroke. In adjusted models using IQ as a continuous variable over a standard nine point scale, HR for mortality in all stroke was 0.89 (95% CI 0.85 to 0.93), that is an 11% decrease in stroke risk per unit increase in IQ. For non-fatal stroke, the corresponding HR was 0.92 (95% CI 0.91 to 0.93). The results were based on a rather young cohort, and results should therefore be generalised to early stroke events rather than the general population. Conclusions Inverse associations were found between IQ and all stroke subtypes, fatal and non-fatal. For all types of non-fatal stroke, the inverse associations with IQ remained after adjustments for childhood and adult socioeconomic position.

  • 73.
    Westerlund, Hugo
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Gustafsson, Per E
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Janlert, Urban
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå.
    Hammarström, Anne
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå.
    Parental academic involvement in adolescence, academic achievement over the life course and allostatic load in middle age: a prospective population-based cohort study.2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 76, no 6, p. 508-513Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict academic achievement, and is thus a candidate modifiable factor influencing life course socioeconomic circumstances. Socioeconomic disadvantage is thought to impact on health over the life course partly by allostatic load, that is, cumulative biological risk. We sought to elucidate the role of parental involvement at age 16 on the life course development of allostatic load. METHODS: In a population-based cohort (365 women and 352 men, 67% of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16 and an allostatic load index summarising 12 physiological risk markers at age 43. Mediation through life course academic and occupational achievement was assessed by entering school grades, adult educational achievement and socioeconomic position at age 43 in a linear regression analysis in a stepwise manner and testing for mediation. RESULTS: Parental interest in their offspring's studies during the last year of compulsory school-rather than the parent's social class or availability of practical academic support-was found to predict adult allostatic load (β=-0.12, 95% CI -0.20 to -0.05). Further adjustments indicated that academic achievement over the life course mediated a large part of the effect of parental interest on allostatic load. CONCLUSIONS: Parental interest in their offspring's studies may have protective effects by decreasing the likelihood of a chain of risk involving low academic achievement, low socioeconomic position and high accumulated physiological stress.

  • 74. Yang, Lei
    et al.
    Korhonen, Kaarina
    Moustgaard, Heta
    Silventoinen, Karri
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Pre-existing depression predicts survival in cardiovascular disease and cancer2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 7, p. 617-622Article in journal (Refereed)
    Abstract [en]

    Background Previous studies have found depression to be negatively associated with the prognosis of both cardiovascular disease (CVD) and cancer, but this may partly reflect reverse causality. We limited the possibility of reverse causality by measuring depression before the first diagnosis of CVD or cancer.

    Methods We used an 11% longitudinal random sample of the Finnish population aged 25 years or older who are residents of Finland for at least 1year between 1987 and 2007, with an 80% oversample of those who died during this period. Those who had their first incidence of coronary heart disease (CHD) (n=107966), stroke (n=68685) or cancer (n=113754) between 1998 and 2012 were followed up for cause-specific mortality from the date of diagnosis until the end of 2012. Depression was defined as having antidepressant purchases two to three calendar years before the incidence. Logistic and Cox regression models were used to examine short-term and long-term mortality by depression status.

    Results Long-term mortality after diagnosis was 1.34 (95% CI 1.25 to 1.44) for CHD, 1.26 (95% CI 1.15 to 1.37) for stroke and 1.10 (95% CI 1.04 to 1.16) for cancer in those who had used antidepressants in two consecutive calendar years as compared with those with no purchases. Short-term mortality from CHD was elevated among persons with depression (OR=1.30; 95%CI 1.06 to 1.61), but no association was found for stroke.

    Conclusion Pre-existing depression is associated with a worse prognosis of CHD, stroke and cancer. More attention in the healthcare system is needed for patients with chronic diseases who have a history of depression.

  • 75.
    Östergren, Olof
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Tarkiainen, Lasse
    Elstad, Jon Ivar
    Brønnum-Hansen, Henrik
    Contribution of smoking and alcohol consumption to income differences in life expectancy: evidence using Danish, Finnish, Norwegian and Swedish register data2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 4, p. 334-339Article in journal (Refereed)
    Abstract [en]

    Background Despite being comparatively egalitarian welfare states, the Nordic countries have not been successful in reducing health inequalities. Previous studies have suggested that smoking and alcohol contribute to this pattern. Few studies have focused on variations in alcohol-related and smoking-related mortality within the Nordic countries. We assess the contribution of smoking and alcohol to differences in life expectancy between countries and between income quintiles within countries.

    Methods We collected data from registers in Denmark, Finland, Norway and Sweden comprising men and women aged 25–79 years during 1995–2007. Estimations of alcohol-related mortality were based on underlying and contributory causes of death on individual death certificates, and smoking-related mortality was based on an indirect method that used lung cancer mortality as an indicator for the population-level impact of smoking on mortality.

    Results About 40%–70% of the between-country differences in life expectancy in the Nordic countries can be attributed to smoking and alcohol. Alcohol-related and smoking-related mortality also made substantial contributions to income differences in life expectancy within countries. The magnitude of the contributions were about 30% in Norway, Sweden and among Finnish women to around 50% among Finnish men and in Denmark.

    Conclusions Smoking and alcohol consumption make substantial contributions to both between-country differences in mortality among the Nordic countries and within-country differences in mortality by income. The size of these contributions vary by country and sex.

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