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  • 1. Chen, Jiaying
    et al.
    Mittendorfer-Rutz, Ellenor
    Berg, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Nørredam, Marie
    Sijbrandij, Marit
    Klimek, Peter
    Association of common mental disorders and related multimorbidity with subsequent labor market marginalization among refugee and Swedish-born young adults2023Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, artikel-id 1054261Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Common mental disorders (CMDs), multimorbidity, and refugee status are associated with poor labor market outcome. Little is known about how these factors interact in young adults.

    Objective: We aimed to i) investigate whether the association of CMDs and multimorbidity with labor market marginalization (LMM) differs between refugee and Swedish-born young adults and ii) identify diagnostic groups with particularly high risk for LMM.

    Methods: This longitudinal registry-based study included individuals aged 20–25 years followed from 2012 to 2016 in Sweden (41,516 refugees and 207,729 age and sex-matched Swedish-born individuals). LMM was defined as granted disability pension (DP) or > 180 days of unemployment (UE). A disease co-occurrence network was constructed for all diagnostic groups from 2009 to 2011 to derive a personalized multimorbidity score for LMM. Multivariate logistic regression was used to estimate odds ratios of LMM in refugee and Swedish-born youth as a function of their multimorbidity score. The relative risk (RR, 95% CI) of LMM for refugees with CMDs compared to Swedish-born with CMDs was computed in each diagnostic group.

    Results: In total, 5.5% of refugees and 7.2% of Swedish-born with CMDs were granted DP; 22.2 and 9.4%, respectively received UE benefit during follow-up. While both CMDs and multimorbidity independently elevated the risk of DP considerably in Swedish-born, CMDs but not multimorbidity elevated the risk of UE. Regarding UE in refugees, multimorbidity with the presence of CMDs showed stronger estimates. Multimorbidity interacted with refugee status toward UE (p < 0.0001) and with CMDs toward DP (p = 0.0049). Two diagnostic groups that demonstrated particularly high RR of UE were schizophrenia, schizotypal and delusional disorders (RR [95% CI]: 3.46 [1.77, 6.75]), and behavioral syndromes (RR [95% CI]: 3.41 [1.90, 6.10]).

    Conclusion: To combat LMM, public health measures and intervention strategies need to be tailored to young adults based on their CMDs, multimorbidity, and refugee status.

  • 2. Airaksinen, Jaakko
    et al.
    Aaltonen, Mikko
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Latvala, Antti
    Associations Between Cohabitation, Marriage, and Suspected Crime: a Longitudinal Within-Individual Study2023Ingår i: Journal of developmental and life course criminology, ISSN 2199-4641, Vol. 9, nr 1, s. 54-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The effects of marriage on criminal behavior have been studied extensively. As marriages today are typically preceded by cohabiting relationships, there is a growing need to clarify how different relationship types are associated with criminality, and how these effects may be modified by relationship duration, partner's criminality, and crime type. We used Finnish longitudinal register data and between- and within-individual analyses to examine how cohabitation and marriage were associated with suspected crime. The data included 638,118 residents of Finland aged 0-14 in 2000 and followed for 17 years for a suspected crime: having been suspected of violent, drug, or any crime. Between-individual analyses suggested that those who were cohabiting or married had a 40-65% lower risk of being suspected of a crime compared to those who were single, depending on the type of crime. The within-individual analysis showed a 25-50% lower risk for suspected crime when people were cohabiting or married compared to time periods when they were single. Those in a relationship with a criminal partner had 11 times higher risk for suspected crime than those in a relationship with a non-criminal partner. Forming a cohabiting relationship with a non-criminal partner was associated with reduced criminality. The risk reduction was not fully explained by selection effects due to between-individual differences. Marriage did not introduce further reduction to criminality. Our findings demonstrate that selection effects partly explain the association between relationship status and criminality but are also compatible with a causal effect of cohabitation on reduced risk of being suspected of a crime.

  • 3. Chen, Hua
    et al.
    Janszky, Imre
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Wei, Dang
    Yang, Fen
    Li, Jiong
    László, Krisztina D.
    Bereavement in childhood and young adulthood and the risk of atrial fibrillation: a population-based cohort study from Denmark and Sweden2023Ingår i: BMC Medicine, E-ISSN 1741-7015, Vol. 21, artikel-id 8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Adverse childhood life events are associated with increased risks of hypertension, ischemic heart disease, and stroke later in life. Limited evidence also suggests that stress in adulthood may increase the risk of atrial fibrillation (AF). Whether childhood adversity may lead to the development of AF is unknown. We investigated whether the loss of a parent or sibling in childhood is associated with an increased risk of AF and compared this effect to that of similar losses in young adulthood.

    Methods We studied 6,394,975 live-born individuals included in the Danish (1973–2018) and Swedish Medical Birth Registers (1973–2014). We linked data from several national registers to obtain information on the death of parents and siblings and on personal and familial sociodemographic and health-related factors. We analyzed the association between bereavement and AF using Poisson regression.

    Results Loss of a parent or sibling was associated with an increased AF risk both when the loss occurred in childhood and in adulthood; the adjusted incident rate ratios and 95% confidence intervals were 1.24 (1.14–1.35) and 1.24 (1.16–1.33), respectively. Bereavement in childhood was associated with AF only if losses were due to cardiovascular diseases or other natural causes, while loss in adulthood was associated with AF not only in case of natural deaths, but also unnatural deaths. The associations did not differ substantially according to age at loss and whether the deceased was a parent or a sibling.

    Conclusions Bereavement both in childhood and in adulthood was associated with an increased AF risk.

  • 4.
    Hiyoshi, Ayako
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Örebro University, Sweden; University College London, UK; Osaka University Graduate School of Medicine, Japan.
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Fall, Katja
    Montgomery, Scott
    Grotta, Alessandra
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Caregiving and changes in health-related behaviour2023Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 322, artikel-id 115830Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Potential health risks for informal caregivers have been hypothesised to be partly related to adverse changes in health-related behaviour, but evidence is limited. We examined whether smoking, drinking, eating, physical activity or leisure pursuits change in relation to co-resident or out-of-home caregiving (for someone outside the household), and if associations differ by sex, educational attainment, and welfare state typology. We conducted a longitudinal study using six waves of the Survey of Health, Ageing and Retirement in Europe, collecting data repeatedly from 2004 to 2017 for adults aged 50 years and older living in 17 European countries (57,962 individuals). To control for measured and unmeasured within-individual time-invariant confounders, we used fixed effects logistic models to analyse the repeated measures of caregiving, behaviour and covariates and estimated odds ratios (OR) with 95% confidence intervals (95%CI). Among male participants, unhealthy eating increased while smoking decreased [ORs 1.26 (95%CI 1.01–1.58) and 0.53 (0.36–0.78), respectively] in survey waves in which they provided co-resident care, compared with the waves that they did not. Among female participants, there was little change in behaviour between waves with and without co-resident caregiving. When providing out-of-home care, lacks of physical activity and leisure pursuits declined. But in the same time, drinking increased both men and women, and especially among individuals with lower educational attainment and residing in non-Nordic countries. To conclude, overall, increased drinking when providing out-of-home care was most consistent, especially among individuals with lower educational attainment and residing in non-Nordic countries. Otherwise, the associations varied by the type of care, behaviour and population subgroups. These findings indicated that not all caregivers are susceptible to behavioural changes, and that not all behaviour may be involved similarly in linking caregiving to health risks. This opens possibilities to target specific behaviour and groups to prevent adverse changes in health behaviour in caregivers.

  • 5.
    Juárez, Sol Pia
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Cederström, Agneta
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Aradhya, Siddartha
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Differences in hospitalizations associated with severe COVID-19 disease among foreign- and Swedish-born2023Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, nr 3, s. 522-527Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Li, Baojing
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Brännström Almquist, Ylva
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Liu, Can
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Berg, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Disentangling the multigenerational transmissions of socioeconomic disadvantages and mental health problems by gender and across lineages: Findings from the Stockholm Birth Cohort Multigenerational Study2023Ingår i: SSM - Population Health, ISSN 2352-8273, Vol. 22, artikel-id 101357Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a paucity of research examining the patterning of socioeconomic disadvantages and mental health problems across multiple generations. The current study therefore aimed to investigate the interconnected transmissions of socioeconomic disadvantages and mental health problems from grandparents to grandchildren through the parents, as well as the extent to which these transmissions differ according to lineage (i.e., through matrilineal/patrilineal descent) and grandchild gender. Drawing on the Stockholm Birth Cohort Multigenerational Study, the sample included 21,416 unique lineages by grandchild gender centered around cohort members born in 1953 (parental generation) as well as their children (grandchild generation) and their parents (grandparental generation). Based on local and national register data, socioeconomic disadvantages were operationalized as low income, and mental health problems as psychiatric disorders. A series of path models based on structural equation modelling were applied to estimate the associations between low income and psychiatric disorders across generations and for each lineage-gender combination. We found a multigenerational transmission of low income through the patriline to grandchildren. Psychiatric disorders were transmitted through both the patriline and matriline, but only to grandsons. The patriline-grandson transmission of psychiatric disorder partially operated via low income of the fathers. Furthermore, grandparents' psychiatric disorders influenced their children's and grandchildren's income. We conclude that there is evidence of transmissions of socioeconomic disadvantages and mental health problems across three generations, although these transmissions differ by lineage and grandchild gender. Our findings further highlight that grandparents' mental health problems could cast a long shadow on their children's and grandchildren's socioeconomic outcomes, and that socioeconomic disadvantages in the intermediate generation may play an important role for the multigenerational transmission of mental health problems.

  • 7.
    Hjern, Anders
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Palacios, Jesus
    Vinnerljung, Bo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Early childhood adversity and non-affective psychosis: a study of refugees and international adoptees in Sweden2023Ingår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 53, nr 5, s. 1914-1923Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Previous Scandinavian studies have shown increased levels of psychiatric morbidity in young refugees and international adoptees with an origin outside Europe. This study investigated their risk of non-affective psychotic disorders (NAPD) and whether this risk is influenced by early childhood adversity, operationalised as age at adoption/residency, and/or gender.

    Methods. Register study in Swedish national cohorts born 1972-1990 including 21 615 non-European international adoptees, 42 732 non-European refugees that settled in Sweden at age 0-14 years and 1 610 233 Swedish born. The study population was followed from age 18 to year 2016 for hospitalisations with a discharge diagnosis of NAPD. Hazard ratios (HRs) were calculated in gender stratified Cox regression models, adjusted for household income at age 17.

    Results. The adjusted risks of NAPD were 2.33 [95% confidence interval (CI) 2.07-2.63] for the international adoptees and 1.92 (1.76-2.09) for the former child refugees, relative to the Swedish-born population. For the international adoptees there was a stepwise gradient for NAPD by age of adoption from adjusted HR 1.66 (1.29-2.03) when adopted during the first year of life to adjusted HR 4.56 (3.22-6.46) when adopted at ages 5-14 years, with a similar risk pattern in women and men. Age at residency did not influence the risk of NAPD in the refugees, but their male to female risk ratio was higher than in Swedish-born and the adoptees.

    Conclusion. The risk pattern in the international adoptees gives support to a link between early childhood adversity and NAPD. Male gender increased the risk of NAPD more among the refugees.

  • 8.
    Dunlavy, Andrea
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Gauffin, Karl
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Berg, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    De Montgomery, Christopher Jamil
    Europa, Ryan
    Eide, Ketil
    Ascher, Henry
    Hjern, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Stockholm, Sweden.
    Health outcomes in young adulthood among former child refugees in Denmark, Norway and Sweden: A cross-country comparative study2023Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 51, nr 3, s. 330-338Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: This study aimed at comparing several health outcomes in young adulthood among child refugees who settled in the different immigration and integration policy contexts of Denmark, Norway and Sweden. Methods: The study population included refugees born between 1972 and 1997 who immigrated before the age of 18 and settled in the three Nordic countries during 1986-2005. This population was followed up in national registers during 2006-2015 at ages 18-43 years and was compared with native-born majority populations in the same birth cohorts using sex-stratified and age-adjusted regression analyses. Results: Refugee men in Denmark stood out with a consistent pattern of higher risks for mortality, disability/illness pension, psychiatric care and substance misuse relative to native-born majority Danish men, with risk estimates being higher than comparable estimates observed among refugee men in Norway and Sweden. Refugee men in Sweden and Norway also demonstrated increased risks relative to native-born majority population men for inpatient psychiatric care, and in Sweden also for disability/illness pension. With the exception of increased risk for psychotic disorders, outcomes among refugee women were largely similar to or better than those of native-born majority women in all countries. Conclusions: The observed cross-country differences in health indicators among refugees, and the poorer health outcomes of refugee men in Denmark in particular, may be understood in terms of marked differences in Nordic integration policies. However, female refugees in all three countries had better relative health outcomes than refugee men did, suggesting possible sex differentials that warrant further investigation.

  • 9. Silventoinen, Karri
    et al.
    Lahtinen, Hannu
    Smith, George Davey
    Morris, Tim T.
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Helsinki, Finland; Max-Planck-Institute for Demographic Research, Rostock, Germany.
    Height, social position and coronary heart disease incidence: the contribution of genetic and environmental factors2023Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 77, nr 6, s. 384-390Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The associations between height, socioeconomic position (SEP) and coronary heart disease (CHD) incidence are well established, but the contribution of genetic factors to these associations is still poorly understood. We used a polygenic score (PGS) for height to shed light on these associations.

    Methods Finnish population-based health surveys in 1992–2011 (response rates 65–93%) were linked to population registers providing information on SEP and CHD incidence up to 2019. The participants (N=29 996; 54% women) were aged 25–75 at baseline, and there were 1767 CHD incident cases (32% in women) during 472 973 person years of follow-up. PGS-height was calculated based on 33 938 single-nucleotide polymorphisms, and residual height was defined as the residual of height after adjusting for PGS-height in a linear regression model. HRs of CHD incidence were calculated using Cox regression.

    Results PGS-height and residual height showed clear gradients for education, social class and income, with a larger association for residual height. Residual height also showed larger associations with CHD incidence (HRs per 1 SD 0.94 in men and 0.87 in women) than PGS-height (HRs per 1 SD 0.99 and 0.97, respectively). Only a small proportion of the associations between SEP and CHD incidence was statistically explained by the height indicators (6% or less).

    Conclusions Residual height associations with SEP and CHD incidence were larger than for PGS-height. This supports the role of material and social living conditions in childhood as contributing factors to the association of height with both SEP and CHD risk.

  • 10.
    Almquist, Ylva B
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Östberg, Viveca
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Modin, Bitte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Is there a peer status gradient in mortality? Findings from a Swedish cohort born in 1953 and followed to age 672023Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, nr 2, s. 184-189Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Similar to having a less advantaged socioeconomic position, children in lower peer status positions typically experience a situation characterized by less power, influence and command over resources, followed by worse health outcomes. The aim of this study was to examine whether peer status position is further associated with increased risks for premature all-cause mortality. Methods Data were drawn from a 1953 cohort born in Stockholm, Sweden. Peer status positions were established through survey data on peer nominations within the school class at age 13, whereas national registers were used to identify all-cause mortality across ages 14-67. Differences in hazard rates and median survival time, according to peer status position, were estimated with Cox regression and Laplace regression, respectively. Results Although differences in hazard rates were not large, they were consistent and clear, also after taking childhood socioeconomic status into account. Regarding median survival time, the number of years lost increased gradually as peer status decreased, with a difference of almost 6 years when comparing individuals in the lowest and highest positions. Conclusions Children's positions in the peer status hierarchy play a role for their chances of health and survival, pointing to the relevance of addressing opportunities for positive peer interaction and mitigating any adverse consequences that may stem from negative experiences within the peer context.

  • 11. Hegvik, Tor-Arne
    et al.
    Klungsøyr, Kari
    Kuja-Halkola, Ralf
    Remes, Hanna
    Haavik, Jan
    D'Onofrio, Brian M.
    Metsä-Simola, Niina
    Engeland, Anders
    Fazel, Seena
    Lichtenstein, Paul
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; Karolinska Institutet, Stockholm, Sweden; Max Planck Institute for Demographic Research, Germany.
    Larsson, Henrik
    Sariaslan, Amir
    Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder: a cross-national cohort study of 4.5 million individuals and their siblings2023Ingår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 228, nr 2, s. 233.e1-233.e12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A recent study has suggested that labor epidural analgesia may be associated with increased rates of offspring autism spectrum disorder. Subsequent replication attempts have lacked sufficient power to confidently exclude the possibility of a small effect, and the causal nature of this association remains unknown.

    Objective: This study aimed to investigate the extent to which exposure to labor epidural analgesia is associated with offspring autism spectrum disorder and attention-deficit/hyperactivity disorder following adjustments for unmeasured familial confounding.

    Study Design: We identified 4,498,462 singletons and their parents using the Medical Birth Registers in Finland (cohorts born from 1987–2005), Norway (1999–2015), and Sweden (1987–2011) linked with population and patient registries. These cohorts were followed from birth until they either had the outcomes of interest, emigrated, died, or reached the end of the follow-up (at mean ages 13.6–16.8 years), whichever occurred first. Cox regression models were used to estimate country-specific associations between labor epidural analgesia recorded at birth and outcomes (eg, at least 1 secondary care diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder or at least 1 dispensed prescription of medication used for the treatment of attention-deficit/hyperactivity disorder). The models were adjusted for sex, birth year, birth order, and unmeasured familial confounders via sibling comparisons. Pooled estimates across all the 3 countries were estimated using inverse variance weighted fixed-effects meta-analysis models.

    Results: A total of 4,498,462 individuals (48.7% female) were included, 1,091,846 (24.3%) of which were exposed to labor epidural analgesia. Of these, 1.2% were diagnosed with autism spectrum disorder and 4.0% with attention-deficit/hyperactivity disorder. On the population level, pooled estimates showed that labor epidural analgesia was associated with increased risk of offspring autism spectrum disorder (adjusted hazard ratio, 1.12; 95% confidence interval, 1.10–1.14, absolute risks, 1.20% vs 1.07%) and attention-deficit/hyperactivity disorder (adjusted hazard ratio, 1.20; 95% confidence interval, 1.19–1.21; absolute risks, 3.95% vs 3.32%). However, when comparing full siblings who were differentially exposed to labor epidural analgesia, the associations were fully attenuated for both conditions with narrow confidence intervals (adjusted hazard ratio [autism spectrum disorder], 0.98; 95% confidence interval, 0.93–1.03; adjusted hazard ratio attention-deficit/hyperactivity disorder, 0.99; 95% confidence interval, 0.96–1.02).

    Conclusion: In this large cross-national study, we found no support for the hypothesis that exposure to labor epidural analgesia causes either offspring autism spectrum disorder or attention-deficit/hyperactivity disorder.

  • 12.
    Wahlström, Joakim
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Magnusson, Charlotta
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutet för social forskning (SOFI).
    Brolin Låftman, Sara
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Svensson, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD).
    Parents’ drinking, childhood hangover? Parental alcohol use, subjective health complaints and perceived stress among Swedish adolescents aged 10–18 years2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, artikel-id 162Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Alcohol abuse is not only harmful to the consumer but may also negatively impact individuals in the drinker’s social environment. Alcohol’s harm to others is vital to consider when calculating the true societal cost of alcohol use. Children of parents who have alcohol use disorder tend to have an elevated risk of negative outcomes regarding, e.g., health, education, and social relationships. Research on the general youth population has established a link between parental drinking and offspring alcohol use. However, there is a lack of knowledge regarding other outcomes, such as health. The current study aimed to investigate the associations between parental drinking and children’s psychological and somatic complaints, and perceived stress.

    Methods Data were derived from a nationally representative sample, obtained from the 2010 Swedish Level-of-Living survey (LNU). Parents and adolescents (ages 10–18) living in the same households were interviewed independently. The final study sample included 909 adolescents from 629 households. The three outcomes, psychological and somatic complaints and perceived stress, were derived from adolescents’ self-reports. Parents’ selfreports of alcohol use, both frequency and quantity, were used to categorise adolescents as having abstaining, lowconsuming, moderate-drinking, or heavy-drinking parents. Control variables included adolescents’ gender, age, family structure, and household socioeconomic status. Linear and binary logistic regression analyses were performed.

    Results Parental heavy drinking was more common among adolescents living in more socioeconomically advantaged households and among adolescents living with two custodial parents or in reconstituted families. Adolescents with heavy-drinking parents reported higher levels of psychological and somatic complaints and had an increased likelihood of reporting stress, compared with those having moderate-drinking parents. These associations remained statistically significant when adjusting for all control variables.

    Conclusion The current study’s results show that parental alcohol consumption is associated with poorer offspring adolescent health. Public health policies that aim to reduce parental drinking or provide support to these adolescents may be beneficial. Further studies investigating the health-related outcomes among young people living with heavy-drinking parents in the general population are needed to gain more knowledge about these individuals and to implement adequate public health measures.

  • 13. Sariaslan, Amir
    et al.
    Fanshawe, Thomas
    Pitkänen, Joonas
    Cipriani, Andrea
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Fazel, Seena
    Predicting suicide risk in 137,112 people with severe mental illness in Finland: external validation of the Oxford Mental Illness and Suicide tool (OxMIS)2023Ingår i: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 13, nr 1, artikel-id 126Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Oxford Mental Illness and Suicide tool (OxMIS) is a standardised, scalable, and transparent instrument for suicide risk assessment in people with severe mental illness (SMI) based on 17 sociodemographic, criminal history, familial, and clinical risk factors. However, alongside most prediction models in psychiatry, external validations are currently lacking. We utilised a Finnish population sample of all persons diagnosed by mental health services with SMI (schizophrenia-spectrum and bipolar disorders) between 1996 and 2017 (n = 137,112). To evaluate the performance of OxMIS, we initially calculated the predicted 12-month suicide risk for each individual by weighting risk factors by effect sizes reported in the original OxMIS prediction model and converted to a probability. This probability was then used to assess the discrimination and calibration of the OxMIS model in this external sample. Within a year of assessment, 1.1% of people with SMI (n = 1475) had died by suicide. The overall discrimination of the tool was good, with an area under the curve of 0.70 (95% confidence interval: 0.69–0.71). The model initially overestimated suicide risks in those with elevated predicted risks of >5% over 12 months (Harrell’s Emax = 0.114), which applied to 1.3% (n = 1780) of the cohort. However, when we used a 5% maximum predicted suicide risk threshold as is recommended clinically, the calibration was excellent (ICI = 0.002; Emax = 0.005). Validating clinical prediction tools using routinely collected data can address research gaps in prediction psychiatry and is a necessary step to translating such models into clinical practice.

  • 14.
    Wahlström, Joakim
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Magnusson, Charlotta
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutet för social forskning (SOFI).
    Svensson, Johan
    Brolin Låftman, Sara
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Problematic familial alcohol use and adolescent outcomes: Do associations differ by parental education?2023Ingår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To investigate the associations between problematic familial alcohol use and adolescent subjective health, binge drinking, relationships with parents, school performance, and future orientation, and to study whether these associations differ in relation to parental education. Methods: Cross-sectional data from the Stockholm School Survey (SSS) collected among students in the 9th and 11th grades in 2018 and in 2020 were used (n = 19,415). Subjective health, parent-youth relationships, and school performance were coded as continuous variables; binge drinking and future orientation were coded as binary variables. Familial drinking included three categories: problematic; don't know/missing; and not problematic. Parental university education distinguished between adolescents with two, one, or no university-educated parent(s). Control variables included gender, grade, family structure, migration background, parental unemployment, and survey year. Linear and binary logistic regression analyses were performed. Results: Problematic familial alcohol use was associated with worsened subjective health, a higher likelihood of engaging in binge drinking, worse relationships with parents, and a higher likelihood of having a pessimistic future orientation, even when adjusting for all control variables. Having less than two university-educated parents was associated with a higher likelihood of reporting problematic familial alcohol use. Parental university education moderated the association between problematic familial alcohol use and binge drinking as this relationship was stronger for adolescents with no and one university-educated parent(s). Conclusions: Adolescents with problematic familial alcohol use fared worse with regards to all studied outcomes, except for school performance. Parental university education only moderated the association between problematic familial alcohol use and binge drinking. However, since problematic familial alcohol use was more common among adolescents with less than two university-educated parents, we argue that at the group level, this category may be more negatively affected by alcohol abuse in the family. Policy interventions could benefit from having a socioeconomic perspective on how children are affected by alcohol's harms to others.

  • 15.
    Olsson, Gabriella
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Modin, Bitte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Brolin Låftman, Sara
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    School collective efficacy and gambling: A multilevel study of 11th grade students in Stockholm2023Ingår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 40, nr 4, s. 327-338Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the present study was to investigate variations between schools when it comes to gambling and risk gambling, and, in particular, to analyse the links between school collective efficacy and student gambling and risk gambling. The data consists of official register information on schools as well as survey data collected in 2016 among 1,061 teachers and 5,191 students in 46 Stockholm upper secondary schools. School collective efficacy was operationalized on the basis of teacher responses, which were aggregated to the school level. Gambling and risk gambling were based on students’ self-reports. Two-level binary logistic regression analyses were performed. The results show that there is between-school variation in gambling and in all the study’s indicators of risk gambling. Both gambling and risk gambling were more commonly reported by students attending schools with weak collective efficacy, even when adjusting for student- and school-level sociodemographic characteristics. The findings suggest that conditions at school may counteract students’ engagement in gambling and risk gambling. 

  • 16. Brismar Wendel, Sophia
    et al.
    Liu, Can
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Stockholm, Sweden.
    Stephansson, Olof
    The association between episiotomy or OASIS at vacuum extraction in nulliparous women and subsequent prelabor cesarean delivery: A nationwide observational study2023Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 102, nr 3, s. 378-388Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Severe perineal injuries at childbirth affect women's postnatal health, including future childbirths. First births with vacuum extraction carry an increased risk of obstetric anal sphincter injuries (OASIS). Lateral or mediolateral episiotomy at vacuum extraction may decrease the risk of OASIS. Our aim was to assess whether lateral or mediolateral episiotomy, or OASIS, at vacuum extraction in nulliparous women is associated with prelabor cesarean delivery in the subsequent childbirth.

    Material and methods: This is a nationwide observational study using data from the Swedish Medical Birth Register, including women having a first birth with vacuum extraction and a second birth in 2000–2014. Both births were live, single, cephalic, ≥34 gestational weeks without malformations. The association between episiotomy or OASIS in the first birth and prelabor cesarean delivery in the second birth was examined using univariate and multivariate logistic regression with inverse probability of treatment weighting, and interaction analysis. Main outcome measure was prelabor cesarean delivery in the second birth.

    Results: In total, 44 656 women with vacuum extraction at their first birth were included. The rate of prelabor cesarean delivery in the second birth was 5.9% (824 of 13 950) in women with episiotomy, compared with 6.0% (1830 of 30 706) in women without episiotomy. Thus, women with episiotomy did not have an increased risk of prelabor cesarean delivery (adjusted odds ratio [aOR] 1.00, 95% confidence interval [95% CI] 0.83–1.20) compared with women without episiotomy. For comparison, the rate of prelabor cesarean delivery in the second birth was 20.6% (1275 of 6176) in women with OASIS, compared with 3.6% (1379 of 38 480) in women without OASIS (aOR 6.57, 95% CI 5.97–7.23). There was no interaction between episiotomy and OASIS.

    Conclusions: Lateral or mediolateral episiotomy at vacuum extraction in nulliparous women did not increase the risk of prelabor cesarean delivery in the subsequent childbirth. OASIS increased the odds of prelabor cesarean delivery more than sixfold.

  • 17.
    Heshmati, Amy
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Honkaniemi, Helena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Juárez, Sol Pia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    The effect of parental leave on parents’ mental health: a systematic review2023Ingår i: The Lancet Public Health, ISSN 2468-2667, Vol. 8, nr 1, s. e57-e75Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Mental health disorders during the post-partum period are a common morbidity, but parental leave might help alleviate symptoms by preventing or reducing stress. We aim to summarise available evidence on the effect of different types of parental leave on mental health outcomes among parents. For this systematic review, we searched Ovid MEDLINE, Web of Science, PsycINFO, CINAHL, and Scopus from database inception to Aug 29, 2022, for peer-reviewed, quantitative studies written in English. We included studies if the exposure was postnatal parental leave; a relevant comparison group was present (eg, paid vs unpaid leave); and if indicators related to general mental health, including depression, anxiety, stress, and suicide, for either parent were evaluated or recorded at any time after childbirth. The Review is registered with PROSPERO (registration number CRD42021227499). Of the 3441 records screened, 45 studies were narratively synthesised. Studies were done in high-income countries, and they examined generosity by any parental leave (n=5), benefit amount (n=13), and leave duration (n=31). 38 studies were of medium or high quality. Improved mental health was generally observed among women (referred to as mothers in this Review) with more generous parental leave policies (ie, leave duration and paid vs unpaid leave). For example, increased duration of leave was generally associated with reduced risk of poor maternal mental health, including depressive symptoms, psychological distress and burnout, and lower mental health-care uptake. However, the association between fathers’ leave and paternal mental health outcomes was less conclusive as was the indirect effect of parental leave use on partners’ mental health.

  • 18.
    Gurzo, Klara
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Östergren, Olof
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Modin, Bitte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    The Impact of Privileged Classroom Friends on Adult Income and Income Mobility: A Study of a Swedish Cohort Born in 19532023Ingår i: Social Forces, ISSN 0037-7732, E-ISSN 1534-7605Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Social relationships across and within generations are associated with intergenerational income mobility. Parents affect their children's future opportunities through socialization and by conveying various resources to the child during upbringing. However, self-acquired social contacts of children, such as friendships in school, might also affect long-term outcomes. Children from less privileged homes may gain access to additional resources through contact with privileged friends and their parents. This study examines whether having a classroom friend with high parental income (privileged friend) is associated with upward income mobility. Furthermore, it explores where in the parental income distribution a privileged friend matters most. We use data from the Stockholm Birth Cohort Multigenerational Study (n = 10,641), which is a prospective study of individuals born in 1953 who lived in the greater Stockholm area in 1963. We fit classroom fixed-effects models to estimate the association between having a privileged childhood friend and adult income as well as parental income and adult income along with the interaction of privileged friend and parental income. Results show that cohort members who had a privileged classroom friend had higher adult income, and that this income gain was greater among those whose parents belonged to the lowest income quartile, compared with those whose parents had higher incomes. These results are robust to adjustments for childhood socioeconomic background, personal attributes, and adult educational attainment. Our findings indicate that having an economically privileged friend in the school class bolsters adult income and upward income mobility of children from families with low income.

  • 19.
    Wahlström, Joakim
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Modin, Bitte
    Svensson, Johan
    Löfstedt, Petra
    Brolin Låftman, Sara
    There’s a tear in my beer: Bullying victimisation and young teenage drinking in Sweden2023Ingår i: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, s. 107123-107123, artikel-id 107123Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Victims of bullying are at an increased risk not only of developing adverse mental health, but also of engaging in health risk behaviours. One way in which adolescents may cope with the health-related consequences of bullying victimisation is through substance use such as alcohol and narcotics, as posited by the self-medication hypothesis. Indeed, previous research has found a link between traditional (face-to-face) bullying victimisation and alcohol use among adolescents, albeit with some inconsistencies. However, studies examining both traditional bullying and cyberbullying among youth often report an association only between cyberbullying victimisation and drinking. The current study seeks to add to this field of research by analysing the predictive capacity of traditional and cyberbullying victimisation for youth drinking whilst also adjusting for bullying perpetration and sociodemographic characteristics. In the analyses, we distinguished between occasional and frequent victimisation, and performed separate investigations of how specific types of traditional bullying and cyberbullying victimisation are related to youth drinking. Data were obtained from the Swedish Health Behaviour in School-aged Children (HBSC) survey, with pooled cross-sectional information from 2013/14 and 2017/18 collected among 13- and 15-year-old students (n =7126). Any alcohol use and drunkenness during the past 30 days were used as dependent variables. The respondents were categorised as non-victims, occasional victims, and frequent victims of traditional and cyberbullying, respectively. Binary logistic regression analyses were performed to examine the associations between bullying victimisation and youth drinking. The results showed that 21.2% of students reported that they had been bullied at least once or twice in the past months, either as victims of traditional bullying only (8.3%), cyberbullying only (7.8%), or both (5.1%). When both types of bullying victimisation were mutually adjusted for, only cyberbullying remained significantly associated with an increased risk of drinking. However, when specific types of face-to-face bullying victimisation were analysed, several statistically significant associations with youth drinking were found, even when controlling for cyberbullying victimisation. Associations with any alcohol use and drunkenness were overall very similar. To conclude, this study corroborates previous research which has shown youth drinking to be more consistently related with cyberbullying victimisation than with traditional bullying victimisation. The study also extends previous knowledge by showing that the association between traditional bullying victimisation and youth drinking differs depending on the operationalisation of victimisation. Future research might benefit from examining this more thoroughly. The findings highlight that interventions targeting bullying and its effects should consider both face-to-face and online victimisation. 

  • 20. Barmpas, Petros
    et al.
    Tasoulis, Sotiris
    Vrahatis, Aristidis G.
    Georgakopoulos, Spiros V.
    Anagnostou, Panagiotis
    Prina, Matthew
    Ayuso-Mateos, José Luis
    Bickenbach, Jerome
    Bayes, Ivet
    Bobak, Martin
    Caballero, Francisco Félix
    Chatterji, Somnath
    Egea-Cortés, Laia
    García-Esquinas, Esther
    Leonardi, Matilde
    Koskinen, Seppo
    Koupil, Ilona
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Paja̧k, Andrzej
    Prince, Martin
    Sanderson, Warren
    Scherbov, Sergei
    Tamosiunas, Abdonas
    Galas, Aleksander
    Haro, Josep Maria
    Sanchez-Niubo, Albert
    Plagianakos, Vassilis P.
    Panagiotakos, Demosthenes
    A divisive hierarchical clustering methodology for enhancing the ensemble prediction power in large scale population studies: the ATHLOS project2022Ingår i: Health Information Science and Systems, E-ISSN 2047-2501, Vol. 10, nr 1, artikel-id 6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The ATHLOS cohort is composed of several harmonized datasets of international groups related to health and aging. As a result, the Healthy Aging index has been constructed based on a selection of variables from 16 individual studies. In this paper, we consider additional variables found in ATHLOS and investigate their utilization for predicting the Healthy Aging index. For this purpose, motivated by the volume and diversity of the dataset, we focus our attention upon data clustering, where unsupervised learning is utilized to enhance prediction power. Thus we show the predictive utility of exploiting hidden data structures. In addition, we demonstrate that imposed computation bottlenecks can be surpassed when using appropriate hierarchical clustering, within a clustering for ensemble classification scheme, while retaining prediction benefits. We propose a complete methodology that is evaluated against baseline methods and the original concept. The results are very encouraging suggesting further developments in this direction along with applications in tasks with similar characteristics. A straightforward open source implementation for the R project is also provided (https://github.com/Petros-Barmpas/HCEP).

  • 21. Granlund, Anna
    et al.
    Soares, Fernanda Cunha
    Hjern, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Dahllöf, Göran
    Julihn, Annika
    Acculturation and 4-year caries increment among children of foreign-born mothers in Sweden: a register-based cohort study2022Ingår i: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 22, artikel-id 111Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To study the association of maternal age upon arrival and length of residence in Sweden with the 4-year caries increment in their children between ages 3 and 7 years in relation to the human development index (HDI) of the maternal country of origin.

    Method: This registry-based cohort study included all children born in 2000–2003 who resided in Stockholm County, Sweden, at age 3 years and who were followed up at age 7 (n = 63,931). Negative binomial regressions were used to analyze different models adjusted for sociodemographic factors.

    Results: Children of foreign-born mothers, regardless of the HDI of the maternal country of origin, had a higher risk of caries increment between ages 3 and 7 years than children of Swedish-born mothers. Furthermore, children of mothers who had arrived from a low or medium HDI country had a lower caries increment if their mothers arrived before age 7 compared with after age 7. Nearly half (44%) of the children whose mothers arrived in Sweden at age ≥ 20 years from a low HDI country had a caries increment compared to 22% of the children whose mothers had arrived in Sweden before 7 years of age. Furthermore, children whose mothers were born in a low HDI country and had resided in Sweden ≤ 19 years had approximately 1.5 times higher risk of caries increment compared to children of mothers who had resided in Sweden for more than 20 years.

    Conclusions: Caries increment in the children of foreign-born mothers was associated with the age of their mother when she arrived in Sweden and was lower when the mother had arrived before age 7 years. This indicates an intergenerational effect that carries over to the children and is greater the longer the mother has participated in Swedish dental healthcare.

  • 22.
    Gauffin, Karl
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Att ta framtiden i anspråk2022Ingår i: Tidskrift för politisk filosofi, ISSN 1402-2710, E-ISSN 2002-3383, Vol. 3Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [sv]

    Beslutet att inrätta ett slutförvar för använt kärnbränsle i Forsmark öppnar upp för frågor kring vår relation till den mycket avlägsna framtiden. Utifrån idéhistoriska och filosofiska texter resonerar denna artikel kring hur samtidens historiskt specifika förhållande till tid kan bidra till att vi tar framtiden i anspråk på det exempellösa sätt som kärnkraften och förvaret av dess restprodukter innebär. Artikelns huvudsakliga poäng är att vi, genom att få syn på vår specifika förståelse av framtiden och dess människor, kan skärpa blicken inför rimligheten i valet mellan korttids- och slutförvar.

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  • 23. Chen, Hua
    et al.
    Wei, Dang
    Janszky, Imre
    Dahlström, Ulf
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    László, Krisztina D.
    Bereavement and Prognosis in Heart Failure: A Swedish Cohort Study2022Ingår i: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 10, nr 10, s. 753-764Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The role of stress in the prognosis of heart failure (HF) is unclear. This study investigated whether the death of a close family member, a severe source of stress, is associated with mortality in HF.

    Objectives: This study assessed whether the death of a close family member is associated with mortality in HF.

    Methods: Patients from the Swedish Heart Failure Registry during 2000-2018 and/or in the Swedish Patient Register with a primary diagnosis of HF during 1987-2018 (N = 490,527) were included in this study. Information was obtained on death of family members (children, partner, grandchildren, siblings, and parents), mortality, sociodemographic variables, and health-related factors from several population-based registers. The association between bereavement and mortality was analyzed by using Poisson regression.

    Results: Loss of a family member was associated with an increased risk of dying (adjusted relative risk: 1.29; 95% CI: 1.27-1.30). The association was present not only in case of the family member's cardiovascular deaths and other natural deaths but also in case of unnatural deaths. The risk was higher for 2 losses than for 1 loss and highest in the first week after the loss. The association between bereavement and an increased mortality risk was observed for the death of a child, spouse/partner, grandchild, and sibling but not of a parent.

    Conclusions: Death of a family member was associated with an increased risk of mortality among patients with HF. Further studies are needed to investigate whether less severe sources of stress can also contribute to poor prognosis in HF and to explore the mechanisms underlying this association.

  • 24.
    Gauffin, Karl
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Spencer, Nick
    Climate crisis and child health inequity2022Ingår i: BMJ Paediatrics Open, E-ISSN 2399-9772, Vol. 6, nr 1, artikel-id e001357Artikel i tidskrift (Övrigt vetenskapligt)
  • 25. Chen, Hua
    et al.
    Li, Jiong
    Wei, Dang
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Janszky, Imre
    Forsell, Yvonne
    Hemmingsson, Tomas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Institute of Environmental Medicine, Karolinska Institutet, Sweden.
    László, Krisztina D.
    Death of a Parent and the Risk of Ischemic Heart Disease and Stroke in Denmark and Sweden2022Ingår i: JAMA Network Open, E-ISSN 2574-3805, Vol. 5, nr 6, artikel-id e2218178Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IMPORTANCE Increasing evidence suggests that parental death is associated with unhealthy behaviors and mental ill-health. Knowledge regarding the link between parental death and the risk of ischemic heart disease (IHD) and stroke remains limited.

    OBJECTIVES To investigate whether parental death is associated with an increased risk of IHD and stroke and whether these associations differ by the characteristics of the loss.

    DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study, involving linkages between several nationwide registers, included 3 766 918 individuals born between 1973 and 1998 in Denmark and between 1973 and 1996 in Sweden. Participants were followed up until 2016 in Denmark and 2014 in Sweden. Data were analyzed from December 2019 to May 2021.

    EXPOSURES Death of a parent.

    MAIN OUTCOMES AND MEASURES Diagnosis with or death due to IHD or stroke. Poisson regression was used to analyze the associations between parental death and IHD and stroke risk.

    RESULTS Altogether, 48.8% of the participants were women, and 42.7% were from Denmark. A total of 523 496 individuals lost a parent during the study period (median age at loss, 25 years; IQR, 17-32 years). Parental death was associated with a 41% increased risk of IHD (incidence rate ratio [IRR], 1.41; 95% CI, 1.33-1.51) and a 30% increased risk of stroke [IRR, 1.30; 95% CI, 1.21-1.38). The associations were observed not only if the parent died because of cardiovascular or other natural causes but also in cases of unnatural deaths. The associations were stronger when both parents had died (IHD: IRR, 1.87; 95% CI, 1.59-2.21; stroke: IRR, 1.64; 95% CI, 1.35-1.98) than when 1 parent had died (IHD: IRR, 1.37; 95% CI, 1.28-1.47; stroke: IRR, 1.27; 95% CI, 1.19-1.36) but did not differ substantially by the offspring's age at loss or the deceased parents' sex. The risk of acute myocardial infarction was highest in the first 3 months after loss.

    CONCLUSIONS AND RELEVANCE In this cohort study, parental death in the first decades of life was associated with an increased risk of IHD and stroke. The associations were observed not only in cases of parental cardiovascular and other natural deaths but also in cases of unnatural deaths. Family members and health professionals may need to pay attention to the cardiovascular disease risk among parentally bereaved individuals.

  • 26.
    Kanamori, Mariko
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. The University of Tokyo, Japan; Kyoto University, Japan.
    Kondo, Naoki
    Juárez, Sol Pia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Cederström, Agneta
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Stickley, Andrew
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Does increased migration affect the rural-urban divide in suicide? A register-based repeated cohort study in Sweden from 1991 to 20152022Ingår i: Population, Space and Place, ISSN 1544-8444, E-ISSN 1544-8452, Vol. 28, nr 1, artikel-id e2503Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Some countries have high suicide rates in rural areas with a potentially stronger impact of rural context on foreign-born residents. In Sweden, where immigration has been increasing, dispersion policies have directed refugees/migrants to settle in rural areas. We examined whether trends in suicide mortality vary by nativity and rurality. A repeated cohort study was designed using Swedish national register data between 1991 and 2015. Our three-level analysis found that male suicide rates in rural areas were 1.2 times higher than in urban areas, with the rate decreasing over time in both urban and rural areas. We observed fluctuations in suicide mortality among foreign-born men residing in small rural communities, with high suicide rates in the 2000s. The proportion of unemployed was linked to the excess rate of suicide in rural municipalities. Dispersion policies moving migrants to rural areas should take into account the regional characteristics both within municipalities (e.g., income distribution) and between municipalities (e.g., labour market characteristics).

  • 27.
    Brännström Almquist, Ylva
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    S. Straatmann, Viviane
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Drivers of Inequalities among Families Involved with Child Welfare Services: A General Overview2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 13, artikel-id 7881Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    When parents are unable to raise their children or to meet the minimum acceptable standards for their care, this can lead to involvement with child welfare services. In some cases, children are separated from their families and taken into out-of-home care (OHC). For good reason, prior research has primarily focused on the lifelong development of these children, and there is now extensive evidence showing that the experience of placement in OHC is predictive of worse outcomes in almost every dimension of adult life [1,2,3,4,5,6]. It is nonetheless likely that the treatment of OHC as a risk factor at the level of the individual child greatly underestimates the scope of the issue from a public health perspective. Here, we argue that gaining more knowledge about the familial circumstances under which the child welfare services enter—and, in many cases, later on exit—the scene would not only facilitate the understanding of why experiences of OHC tend to leave such long-lasting marks on children, but also how they reflect and contribute to inequalities at the population level.

  • 28.
    Juárez, Sol P.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Honkaniemi, Helena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Gustafsson, Nina-Katri
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Berg, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis2022Ingår i: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 67, artikel-id 1604437Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence.

    Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence.

    Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I2 = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I2 = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I2 = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence.

    Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contex

  • 29. Junna, Liina
    et al.
    Moustgaard, Heta
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Health-related selection into employment among the unemployed2022Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, nr 1, artikel-id 657Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Successful transitions from unemployment to employment are an important concern, yet little is known about health-related selection into employment. We assessed the association of various physical and psychiatric conditions with finding employment, and employment stability.

    Methods: Using total population register data, we followed Finnish residents aged 30–60 with an unemployment spell during 2009–2018 (n = 814,085) for two years from the onset of unemployment. We predicted any, stable, and unstable employment by health status using Cox proportional hazards models. The data on specialized health care and prescription reimbursement were used to identify any alcohol-related conditions and poisonings, psychiatric conditions and self-harm, injuries, and physical conditions. We further separated physical conditions into cancer, diabetes, heart disease, and neurological conditions, and psychiatric conditions into depression, anxiety disorders and substance use disorders.

    Results: The likelihood of any employment was lower among those who had any of the assessed health conditions. It was lowest among those with alcohol-related or psychiatric conditions with an age-adjusted hazard ratio of 0.45 (95% confidence interval 0.44, 0.46) among men and 0.39 (0.38, 0.41) among women for alcohol-related and 0.64 (0.63, 0.65) and 0.66 (0.65, 0.67) for psychiatric conditions, respectively. These results were not driven by differences in socioeconomic characteristics or comorbidities. All the included conditions were detrimental to both stable and unstable employment, however alcohol-related and psychiatric conditions were more harmful for stable than for unstable employment.

    Conclusions: The prospects of the unemployed finding employment are reduced by poor health, particularly alcohol-related and psychiatric conditions. These two conditions may also lead to unstable career trajectories. The selection process contributes to the health differentials between employed and unemployed people. Unemployed people with health problems may therefore need additional support to improve their chances of employment.

  • 30.
    Aradhya, Siddartha
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen. Lund University, Sweden.
    Katikireddi, Srinivasa Vittal
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Glasgow, Glasgow, UK.
    Juárez, Sol Pia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Immigrant ancestry and birthweight across two generations born in Sweden: an intergenerational cohort study2022Ingår i: BMJ Global Health, E-ISSN 2059-7908, Vol. 7, nr 4, artikel-id e007341Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Differences in birthweight are often seen between migrants and natives. However, whether migrant-native birthweight inequalities widen, narrow or remain persistent across generations when comparing the descendants of immigrants and natives remains understudied. We examined inequalities in birthweight of mothers (G2) and daughters (G3) of foreign-born grandmothers (G1) compared with those of Swedish-born grandmothers.

    Methods We used population registers with multigenerational linkages to identify 314 415 daughters born in Sweden during the period 1989–2012 (G3), linked to 246 642 mothers (G2) born in Sweden during 1973–1996, and to their grandmothers (G1) who were Swedish or foreign-born. We classified migrants into non-western, Eastern European, the rest of Nordic and Western. We used multivariable methods to examine mean birthweight and low birthweight (<2500 g; LBW).

    Results Birthweight between individuals with Swedish background (G1) and non-western groups increased from -80 g to -147 g between G2 (mothers) and G3 (daughters), respectively. Furthermore, the odds of LBW increased among the G3 non-western immigrants compared with those with Swedish grandmothers (OR: 1.38, 95% CI 1.12 to 1.69). Birthweight increased in both descendants of Swedes and non-western immigrants, but less so in the latter (83 g vs 16 g).

    Conclusion We observed an increase in birthweight inequalities across generations between descendants of non-western immigrants and descendants of Swedes. This finding is puzzling considering Sweden has been lauded for its humanitarian approach to migration, for being one of the most egalitarian countries in the world and providing universal access to healthcare and education.

  • 31. Mattsson, Kristina
    et al.
    Juárez, Sol
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Malmqvist, Ebba
    Influence of Socio-Economic Factors and Region of Birth on the Risk of Preeclampsia in Sweden2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 7, artikel-id 4080Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate the association between socio-economic factors and the risk of preeclampsia in Sweden, specifically investigating if this relationship is confounded by maternal region of birth. Study design: All singleton births between 1999 and 2009 in an ethnically diverse area in southern Sweden, totaling 46,618 pregnancies, were included in this study. The data on maternal pregnancy outcomes were retrieved from a regional birth register and socio-economic variables from Statistics Sweden. The risk ratios for preeclampsia were calculated for educational level and household disposable income, adjusting for maternal region of birth, maternal age, body mass index, parity, and smoking. Results: Low income levels were associated with a higher risk for preeclampsia, adjusted risk ratio (aRR) = 1.25 (95% confidence interval [CI]: 0.99, 1.59) and aRR = 1.36 (95% CI: 1.10, 1.68) for the two lowest quintiles, respectively, compared to the highest. There was an educational gradient in preeclampsia risk, although not all categories reached statistical significance: aRR = 1.16, (95% CI: 0.89–1.50) for low educational attainment and aRR = 1.23 (95% CI: 1.08, 1.41) for intermediate educational attainment compared to women with highest education. The socio-economic gradient remained after adjusting for region of birth. There was a lower risk for preeclampsia for women born in Asia, aRR = 0.60 (95% CI: 0.47, 0.75), regardless of socio-economic position. Conclusion: An increased risk for preeclampsia was seen for women with measures of lower socio-economic position, even in a universal, government-funded healthcare setting. The relationship was not explained by region of birth, indicating that the excess risk is not due to ethnically differential genetic pre-disposition but rather due to modifiable factors.

  • 32.
    Dunlavy, Andrea
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Cederström, Agneta
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Katikireddi, Srinivasa Vittal
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Glasgow, Scotland.
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Juárez, Sol P.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Investigating the salmon bias effect among international immigrants in Sweden: a register-based open cohort study2022Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, nr 2, s. 226-232Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Studies of migration and health have hypothesized that immigrants may emigrate when they develop poor health (salmon bias effect), which may partially explain the mortality advantage observed among immigrants in high-income countries. We evaluated the salmon bias effect by comparing the health of immigrants in Sweden who emigrated with those who remained, while also exploring potential variation by macro-economic conditions, duration of residence and region of origin. Methods: A longitudinal, open cohort study design was used to assess risk of emigration between 1992 and 2016 among all adult (18+ years) foreign-born persons who immigrated to Sweden between 1965 and 2012 (n = 1 765 459). The Charlson Comorbidity Index was used to measure health status, using information on hospitalizations from the Swedish National Patient Register. Poisson regression models were used to estimate incidence rate ratios (RRs) with 95% confidence intervals (CIs) for emigrating from Sweden. Results: Immigrants with low (RR = 0.83; 95% CI: 0.76-0.90) moderate (RR = 0.70; 95% CI: 0.62-0.80) and high (RR = 0.62; 95% CI: 0.48-0.82) levels of comorbidities had decreased risk of emigration relative to those with no comorbidities. There was no evidence of variation by health status in emigration during periods of economic recession or by duration of residence. Individuals with low to moderate levels of comorbidities from some regions of origin had an increased risk of emigration relative to those with no comorbidities. Conclusions: The study results do not support the existence of a salmon bias effect as a universal phenomenon among international immigrants in Sweden.

  • 33. Silventoinen, Karri
    et al.
    Korhonen, Kaarina
    Lahtinen, Hannu
    Jelenkovic, Aline
    Havulinna, Aki S.
    Ripatti, Samuli
    Salomaa, Veikko
    Davey Smith, George
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; Max-Planck-Institute for Demographic Research, Germany.
    Joint associations of depression, genetic susceptibility and the area of residence for coronary heart disease incidence2022Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 76, nr 3, s. 281-284Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Depression is a risk factor for coronary heart disease (CHD), but less is known whether genetic susceptibility to CHD or regional-level social indicators modify this association.

    Methods Risk factors of CHD including a Polygenic Risk Score (PRS) were measured for 19 999 individuals residing in Finland in 1997, 2002, 2007 and 2012 (response rates 60%–75%). During the register-based follow-up until 2015, there were 1381 fatal and non-fatal incident CHD events. Unemployment rate, degree of urbanisation and crime rate of the municipality of residence were used as regional level social indicators. HRs were calculated using register-based antidepressant purchases as a non-reversible time-dependent covariate.

    Results Those having depression and in the highest quartile of PRS had somewhat higher CHD risk than predicted only by the main effects of depression and PRS (HR for interaction 1.53, 95% CI 0.95 to 2.45). Depression was moderately associated with CHD in high crime (HR 1.51, 95% CI 1.20 to 1.90) and weakly in low crime regions (HR 1.07, 95% CI 0.86 to 1.33; p value of interaction=0.087). Otherwise, we did not found evidence for interactions.

    Conclusions Those having both depression and high genetic susceptibility need a special attention in healthcare for CHD.

  • 34. de Montgomery, Christopher Jamil
    et al.
    Norredam, Marie
    Krasnik, Allan
    Holm Petersen, Jørgen
    Björkenstam, Emma
    Berg, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Hjern, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Sijbrandij, Marit
    Klimek, Peter
    Mittendorfer-Rutz, Ellenor
    Labour market marginalisation in young refugees and their majority peers in Denmark and Sweden: The role of common mental disorders and secondary school completion2022Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 17, nr 2, artikel-id e0263450Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Due to the circumstances of their early lives, young refugees are at risk of experiencing adverse labour market and health outcomes. The post-settlement environment is thought to play a decisive role in determining how this vulnerability plays out. This study compared trends in labour market marginalisation in young refugees and their majority peers during early adulthood in two national contexts, Denmark and Sweden, and explored the mediating role of common mental disorders and secondary school completions.

    Methods

    Using registry data, 13,390/45,687 refugees were included in Denmark/Sweden and 1:5 matched to majority peers. Inequalities in labour market marginalisation were investigated during 2012-2015 in each country using linear probability models and mediation analysis. Country trends were standardised to account for differences in observed population characteristics.

    Results

    The risk of marginalisation was 2.1-2.3 times higher among young refugees compared with their majority peers, but the risk decreased with age in Sweden and increased in Denmark for refugees. Birth-cohort differences drove the increase in Denmark, while trends were consistent across birth-cohorts in Sweden. Differences in population characteristics did not contribute to country differences. Common mental disorders did not mediate the inequality in either country, but secondary school completions did (77-85% of associations eliminated).

    Conclusions

    The findings document both the vulnerability of young refugees to labour market marginalisation and the variability in this vulnerability across post-settlement contexts. While the contrast in policy climates in Denmark and Sweden sharpened over time, the risk of marginalisation appeared more similar in younger cohorts, pointing to the importance of factors other than national immigration and integration policies. Institutional efforts to assist young refugees through secondary education are likely to have long-lasting consequences for their socio-economic trajectories.

  • 35. Silventoinen, Karri
    et al.
    Lahtinen, Hannu
    Korhonen, Kaarina
    Smith, George Davey
    Ripatti, Samuli
    Morris, Tim
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; Max-Planck-Institute for Demographic Research, Germany.
    Marital status and genetic liability independently predict coronary heart disease incidence2022Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: Married individuals have a lower coronary heart disease (CHD) risk than non-married, but the mechanisms behind this are not fully understood. We analyzed whether genetic liability to CHD may affect these associations. Methods: Marital status, a polygenic score of CHD (PGS-CHD), and other risk factors for CHD were measured from 35,444 participants (53% female) in Finnish population-based surveys conducted between 1992 and 2012. During the register-based follow-up until 2020, there were 2439 fatal and non-fatal incident CHD cases. The data were analyzed using linear and Cox regression models. Results: Divorced and cohabiting men and women had a higher genetic risk of CHD than married individuals, but the difference was very small (0.023–0.058 standard deviation of PGS-CHD, p-values 0.011–0.429). Both marital status and PGS-CHD were associated with CHD incidence, but the associations were largely independent. Adjusting for behavioral and metabolic risk factors for CHD explained part of these associations (11–20%). No interaction was found between marital status and PGS-CHD for CHD incidence. Conclusions: We showed minor differences between the marital status categories in PGS-CHD and demonstrated that marital status and genetic liability predicted CHD incidence largely independently. This emphasizes the need to measure multiple risk factors when predicting CHD risk.

  • 36.
    Honkaniemi, Helena
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Juárez, Sol Pia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Mental health by native-immigrant intermarriage in Sweden: a register-based retrospective cohort study2022Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, nr 6, s. 877-883Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Native–immigrant intermarriage is often regarded as a proxy for integration, given that intermarried immigrants are more socioeconomically and culturally similar to natives than intramarried immigrants. This study aimed to assess whether integration affects mental health and care-seeking behaviours, examining prescription hazards for psychotropic medications by native–immigrant marital composition in Sweden.

    Methods: Total population register data were used to identify first-time married couples residing in Sweden between 31 December 2005 and 31 December 2016. Index persons were distinguished by gender and partners’ origin (native vs. immigrant), as well as by immigrants’ regions of origin, with intramarried natives as references. Using Cox regression, hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated for antidepressant and anxiolytic prescriptions and adjusted for socioeconomic factors, presence of children and length and quality of marriage.

    Results: Intramarried immigrant women had higher psychotropic prescription hazards than intramarried native references (HR 1.11, 95% CI 1.10–1.12), whereas intermarried immigrant women had equal hazards. Immigrant women’s hazards were lower than native references after adjustment. Intramarried immigrant men had the greatest prescription hazards (HR 1.33, 95% CI 1.32–1.34), and intermarried immigrant men slightly higher hazards (HR 1.11, 95% CI 1.10–1.13), than intramarried natives. All were partly attenuated after adjustment. Intermarriage hazards increased by similarities in regions of origin, especially among men.

    Conclusions: Integration indicated by intermarriage appears to be protective for the mental health of immigrants, especially for immigrant men. Future research should empirically disentangle the social, cultural and socioeconomic mechanisms underlying these health differences.

  • 37.
    Berg, Lisa
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    de Montgomery, Edith
    Brendler-Lindquist, Monica
    Mittendorfer-Rutz, Ellenor
    Hjern, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Parental post-traumatic stress and psychiatric care utilisation among refugee adolescents2022Ingår i: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 31, nr 12, s. 1953-1962Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Parental psychiatric morbidity related to experiences of war and trauma has been associated with adverse psychological outcomes for children. The aim of this study was to investigate parental post-traumatic stress in relation to psychiatric care utilization among children of refugees with particular attention on the child's own refugee status, sex of both child and parents, and specific psychiatric diagnoses. This was a register study in a population of 16 143 adolescents from refugee families in Stockholm County born 1995-2000 and followed between 2011 and 2017 (11-18 years old). Parental post-traumatic stress, identified in three levels of care, was analysed in relation to child and adolescent psychiatric care use. Cox regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusted for duration of residence and demographic and socioeconomic variables. Having a mother with post-traumatic stress was associated with higher psychiatric care utilization, with adjusted HR 2.44 (95% CI 1.90-3.14) among foreign-born refugee children and HR 1.77 (1.33-2.36) among Swedish-born children with refugee parents, with particularly high risks for children with less than five years of residence (HR 4.03; 2.29-7.10) and for diagnoses of anxiety and depression (HR 2.71; 2.11-3.48). Having a father with post-traumatic stress was not associated with increased HRs of psychiatric care utilization. Similar results were seen for boys and girls. Treatment for post-traumatic stress should be made available in refugee reception programmes. These programmes should use a family approach that targets both parents and children.

  • 38.
    Berg, Lisa
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Brendler-Lindquist, Monica
    de Montgomery, Edith
    Mittendorfer-Rutz, Ellenor
    Hjern, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Karolinska Institutet, Sweden.
    Parental Posttraumatic Stress and School Performance in Refugee Children2022Ingår i: Journal of Traumatic Stress, ISSN 0894-9867, E-ISSN 1573-6598, Vol. 35, nr 1, s. 138-147Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Refugee children in the Nordic countries have been reported to perform poorly in school and carry a high burden of familial posttraumatic stress. The present study aimed to investigate the impact of maternal and paternal posttraumatic stress on the school performance of refugee children. We used national register data on school grades at age 15-16 along with demographic and migration indicators during 2011-2017 in a population of 18,831 children in refugee families in Stockholm County, Sweden. Parental posttraumatic stress was identified in regional data from three levels of care, including a tertiary treatment center for victims of torture and war. Multivariable linear and logistic regression models were fitted to analyze (a) mean grade point averages as Z scores and (b) eligibility for upper secondary school. In fully adjusted models, children exposed to paternal posttraumatic stress had a lower mean grade point average, SD = -0.14, 95% CI [-0.22, -0.07], and higher odds of not being eligible for upper secondary education, OR = 1.37, 95% CI [1.14, 1.65]. Maternal posttraumatic stress had a similar crude effect on school performance, SD = -0.15, 95% CI [-0.22, -0.07], OR = 1.25, 95% CI [1.00, 1.55], which was attenuated after adjusting for single-parent households and the use of child psychiatric services. The effects were similar for boys and girls as well as for different levels of care. Parental posttraumatic stress had a small negative effect on school performance in refugee children, adding to the intergenerational consequences of psychological trauma.

  • 39.
    Honkaniemi, Helena
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Katikireddi, Srinivasa Vittal
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Juárez, Sol P.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Psychiatric consequences of a father’s leave policy by nativity: a quasi-experimental study in Sweden2022Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 76, nr 4, s. 367-373Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Parental leave use has been found to promote maternal and child health, with limited evidence of mental health impacts on fathers. How these effects vary for minority populations with poorer mental health and lower leave uptake, such as migrants, remains under-investigated. This study assessed the effects of a Swedish policy to encourage fathers’ leave, the 1995 Father’s quota, on Swedish-born and migrant fathers’ psychiatric hospitalisations.

    Methods We conducted an interrupted time series analysis using Swedish total population register data for first-time fathers of children born before (1992–1994) and after (1995–1997) the reform (n=198 589). Swedish-born and migrant fathers’ 3-year psychiatric hospitalisation rates were modelled using segmented negative binomial regression, adjusting for seasonality and autocorrelation, with stratified analyses by region of origin, duration of residence, and partners’ nativity.

    Results From immediately pre-reform to post-reform, the proportion of fathers using parental leave increased from 63.6% to 86.4% of native-born and 37.1% to 51.2% of migrants. Swedish-born fathers exhibited no changes in psychiatric hospitalisation rates post-reform, whereas migrants showed 36% decreased rates (incidence rate ratio (IRR) 0.64, 95% CI 0.47 to 0.86). Migrants from regions not predominantly consisting of Organisation for Economic Cooperation and Development countries (IRR 0.50, 95% CI 0.19 to 1.33), and those with migrant partners (IRR 0.23, 95% CI 0.14 to 0.38), experienced the greatest decreases in psychiatric hospitalisation rates.

    Conclusion The findings of this study suggest that policies oriented towards promoting father’s use of parental leave may help to reduce native–migrant health inequalities, with broader benefits for family well-being and child development.Data availability statement

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  • 40. Oliveira, Aldair J.
    et al.
    Lopes, Claudia S.
    de Albuquerque Maranhão Neto, Geraldo
    Mota de Sousa, Gustavo
    Paravidino, Vitor
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Mediano, Mauro Felippe Felix
    Harter Griep, Rosane
    Souza do Vale, Wesley
    Frota da Rocha Morgado, Fabiane
    Psychosocial and environmental determinants of physical activity in a Brazilian public university employees - ELDAF: A prospective cohort study protocol2022Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 17, nr 2, artikel-id e0263385Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Increased physical activity levels and their determinations are essential issues worldwide. The Longitudinal Study of Physical Activity Determinants (ELDAF) aims to understand the roles of psychosocial and environmental factors in workers’ physical activity levels.

    Methods

    A prospective cohort study of non-faculty civil servants from a public university (approximately 1,200 individuals) will start in 2022 (baseline). The primary measurements will be accelerometer- and questionnaire-based physical activity, social support, social network, socioeconomic status, bereavement, job stress, body image, common mental disorders, depression, and neighborhood satisfaction. Additional measurements will include necessary sociodemographic, physical morbidity, lifestyle and anthropometric information. Participants’ places of residence will be geocoded using complete addresses. All participants will furnish written, informed consent before the beginning of the study. Pilot studies were performed to identify and correct potential problems in the data collection instruments and procedures. ELDAF will be the first cohort study conducted in Latin America to investigate physical activity and its determinants.

  • 41.
    Liu, Can
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Grotta, Alessandra
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Hiyoshi, Ayako
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Örebro University, Sweden; University College London, England.
    Berg, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    School Outcomes Among Children Following Death of a Parent2022Ingår i: JAMA Network Open, E-ISSN 2574-3805, Vol. 5, nr 4, artikel-id e223842Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance  To better support children with the experience of parental death, it is crucial to understand whether parental death increases the risk of adverse school outcomes.

    Objectives  To examine whether parental death is associated with poorer school outcomes independent of factors unique to the family, and whether children of certain ages are particularly vulnerable to parental death.

    Design, Setting, and Participants  This population-based sibling cohort study used Swedish national register-based longitudinal data with linkage between family members. Register data were collected from January 1, 1990, to December 31, 2016. Data analyses were performed on July 14, 2021. The participants were all children born between 1991 and 2000 who lived in Sweden before turning age 17 years (N = 908 064).

    Exposure  Parental death before finishing compulsory school.

    Main Outcomes and Measures  Mean school grades (year-specific z scores) and ineligibility for upper secondary education on finishing compulsory school at age 15 to 16 years. Population-based cohort analyses were conducted to examine the association between parental death and school outcomes using conventional linear and Poisson regression models, after adjustment for demographic and parental socioeconomic and health indicators measured before childbirth. Second, using fixed-effect linear and Poisson regression models, children who experienced parental death before finishing compulsory school were compared with their siblings who experienced the death after. Third, the study explored the age-specific associations between parental death and school outcomes.

    Results  In the conventional population-based analyses, bereaved children (N = 22 634; 11 553 boys [51.0%]; 11 081 girls [49.0%]; mean [SD] age, 21.0 [2.8] years) had lower mean school grade z scores (adjusted β coefficient, −0.19; 95% CI, −0.21 to −0.18; P < .001) and a higher risk of ineligibility for upper secondary education than the nonbereaved children (adjusted risk ratio, 1.36; 95% CI, 1.32-1.41; P < .001). Within-sibling comparisons using fixed-effects models showed that experiencing parental death before finishing compulsory school was associated with lower mean school grade z scores (−0.06; 95% CI, −0.10 to −0.01; P = .02) but not with ineligibility for upper secondary education (adjusted risk ratio, 1.07; 95% CI, 0.93-1.23; P = .34). Independent of birth order, losing a parent at a younger age was associated with lower grades within a family.

    Conclusions and Relevance  In this cohort study, childhood parental death was associated with lower school grades after adjustment for familial confounders shared between siblings. Children who lost a parent may benefit from additional educational support that could reduce the risk of adverse socioeconomic trajectories later in life.

  • 42. Nilsen, Sondre Aasen
    et al.
    Bergström, Malin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institute, Sweden.
    Sivertsen, Børge
    Stormark, Kjell Morten
    Hysing, Mari
    Sleep in adolescence: Considering family structure and family complexity2022Ingår i: Journal of Marriage and Family, ISSN 0022-2445, E-ISSN 1741-3737, Vol. 84, nr 4, s. 1152-1174Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate associations between family structure, family complexity, and sleep in adolescence.

    Background: Family structure may be associated with sleep patterns and sleep problems among adolescents. Yet, research documenting this association has not captured the complexity of modern families and used crude measures of sleep.

    Method: The youth@hordaland study (N = 8833) of adolescents aged 16-19 conducted in 2012 in Norway provided a detailed assessment of family structure, family complexity (i.e., living with half-/stepsiblings), and multiple sleep parameters. Insomnia and delayed sleep-wake phase disorder (DSWPD) were defined in alignment with diagnostic criteria. Ordinary least squares and Poisson regression analyses were used to assess associations between family structure, family complexity, and sleep outcomes.

    Results: Adolescents in joint physical custody (JPC) had more similar sleep parameters as peers in nuclear families than in single-and stepparent families. Adolescents in single- and stepparent families had a higher risk of short sleep duration on weekdays, long sleep onset latency, long wake after sleep onset, oversleeping, insomnia, and DSWPD than peers in nuclear families. Family complexity was also associated with a higher risk of sleep problems, but the risk attenuated when considered jointly with family structure. Socioeconomic status and depressive symptoms partly attenuated the differences between the groups.

    Conclusion: Inequalities in sleep exist by family structure and, in part, family complexity. Despite alternating between two homes and often experiencing family complexity, sleep among adolescents in JPC was more similar to peers in nuclear families than in single- and stepparent families.

  • 43.
    Brännström Almquist, Ylva
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Miething, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    The impact of an unemployment insurance reform on incidence rates of hospitalisation due to alcohol-related disorders: a quasi-experimental study of heterogeneous effects across ethnic background, educational level, employment status, and sex in Sweden2022Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, artikel-id 1847Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Many Western countries have scaled back social and health expenditure, including decreases in the generosity and coverage of unemployment insurance, resulting in negative effects on general health and well-being at the aggregate level. Yet, research has not sufficiently looked into heterogeneity of such effects across different subgroups of the population. In Sweden, the 2006 unemployment insurance reform, implemented on the 1st of January 2007, encompassed a drastic increase of insurance fund membership fees, reduced benefit levels, and stricter eligibility requirements. As this particularly affected already socioeconomically disadvantaged groups in society, such as foreign-born and low-educated individuals, the current study hypothesise that the reform would also have a greater impact on health outcomes in these groups.

    Methods: Based on register data for the total population, we utilise a quasi-experimental approach to investigate heterogeneous health effects of the reform across ethnic background, educational level, employment status, and sex. Due to behaviourally caused diseases having a relatively shorter lag time from exposure, hospitalisation due to alcohol-related disorders serves as the health outcome. A series of regression discontinuity models are used to analyse monthly incidence rates of hospitalisation due to alcohol-related disorders among individuals aged 30–60 during the study period (2001–2012), with the threshold set to the 1st of January 2007.

    Results: The results suggest that, in general, there was no adverse effect of the reform on incidence rates of hospitalisation due to alcohol-related disorders. A significant increase is nonetheless detected among the unemployed, largely driven by Swedish-born individuals with Swedish-born or foreign-born parents, low-educated individuals, and men.

    Conclusions: We conclude that the Swedish 2006 unemployment insurance reform generally resulted in increasing incidence rates of hospitalisation due to alcohol-related disorders among unemployed population subgroups known to have higher levels of alcohol consumption.

  • 44. Mikkonen, Janne
    et al.
    Savolainen, Jukka
    Aaltonen, Mikko
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Using age difference and sex similarity to detect evidence of sibling influence on criminal offending2022Ingår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 52, nr 10, s. 1892-1900Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Sibling resemblance in crime may be due to genetic relatedness, shared environment, and/or the interpersonal influence of siblings on each other. This latter process can be understood as a type of 'peer effect' in that it is based on social learning between individuals occupying the same status in the social system (family). Building on prior research, we hypothesized that sibling pairs that resemble peer relationships the most, i.e., same-sex siblings close in age, exhibit the most sibling resemblance in crime.

    Methods. Drawing on administrative microdata covering Finnish children born in 1985-97, we examined 213 911 sibling pairs, observing the recorded criminality of each sibling between ages 11 and 20. We estimated multivariate regression models controlling for individual and family characteristics, and employed fixed-effects models to analyze the temporal co-occurrence of sibling delinquency.

    Results. Among younger siblings with a criminal older sibling, the adjusted prevalence estimates of criminal offending decreased from 32 to 25% as the age differences increased from less than 13 months to 25-28 months. The prevalence leveled off at 23% when age difference reached 37-40 months or more. These effects were statistically significant only among same-sex sibling pairs (p < 0.001), with clear evidence of contemporaneous offending among siblings with minimal age difference.

    Conclusions. Same-sex siblings very close in age stand out as having the highest sibling resemblance in crime. This finding suggests that a meaningful share of sibling similarity in criminal offending is due to a process akin to peer influence, typically flowing from the older to the younger sibling.

  • 45.
    Hiyoshi, Ayako
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Örebro University, Sweden; University College London, United Kingdom; Osaka University Graduate School of Medicine, Japan.
    Sato, Yuki
    Grotta, Alessandra
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Fall, Katja
    Montgomery, Scott
    Visual Acuity and the Risk of Cycling Injuries Register-Based Cohort Study From Adolescence to Middle-age2022Ingår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 33, nr 2, s. 246-253Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Cycling is increasingly encouraged in many countries as an inexpensive and healthy choice of transportation. Operating any vehicle on the road requires high visual acuity, but few studies to our knowledge have examined the association between vision and cycling injuries.

    Methods: We examined whether poorer visual acuity is associated with increased risk of fatal and nonfatal cycling injuries. We used prospectively recorded register data for 691,402 men born between 1970 and 1992 in Sweden. We followed these men from an average age of 18 years, when visual acuity was assessed during the conscription assessment, to age 45 at the latest. We identified fatal and nonfatal cycling and car injuries using Patient and Cause of Death registers. Cox regression models were used to estimate hazard ratios and 95% confidence intervals.

    Results: Based on visual acuity for the eye with the best vision, moderately impaired acuity 0.9 to 0.6 when wearing refractive correction was associated with increased risk for cycling injuries (hazard ratio = 1.44 [95% confidence interval = 1.16, 1.79]) compared with unimpaired vision (uncorrected visual acuity 1.0) and after adjustment for a wide range of potential confounders. This association remained consistent across various sensitivity analyses. Visual acuity was not associated with car injury risk.

    Conclusions: In this cohort study, poorer vision was specifically associated with a higher rate of cycling injuries.

  • 46. Diaconu, Viorela
    et al.
    van Raalte, Alyson
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    Why we should monitor disparities in old-age mortality with the modal age at death2022Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 17, nr 2, artikel-id e0263626Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Indicators based a fixed “old” age threshold have been widely used for assessing socioeconomic disparities in mortality at older ages. Interpretation of long-term trends and determinants of these indicators is challenging because mortality above a fixed age that in the past would have reflected old age deaths is today mixing premature and old-age mortality. We propose the modal (i.e., most frequent) age at death, M, an indicator increasingly recognized in aging research, but which has been infrequently used for monitoring mortality disparities at older ages. We use mortality and population exposure data by occupational class over the 1971-2017 period from Finnish register data. The modal age and life expectancy indicators are estimated from mortality rates smoothed with penalized B-splines. Over the 1971-2017 period, occupational class disparities in life expectancy at 65 and 75 widened while disparities in M remained relatively stable. The proportion of the group surviving to the modal age was constant across time and occupational class. In contrast, the proportion surviving to age 65 and 75 has roughly doubled since 1971 and showed strong occupational class differences. Increasing socioeconomic disparities in mortality based on fixed old age thresholds may be a feature of changing selection dynamics in a context of overall declining mortality. Unlike life expectancy at a selected fixed old age, M compares individuals with similar survival chances over time and across occupational classes. This property makes trends and differentials in M easier to interpret in countries where old-age survival has improved significantly. 

  • 47. Howe, Laurence J.
    et al.
    Nivard, Michel G.
    Morris, Tim T.
    Hansen, Ailin F.
    Rasheed, Humaira
    Cho, Yoonsu
    Chittoor, Geetha
    Ahlskog, Rafael
    Lind, Penelope A.
    Palviainen, Teemu
    van der Zee, Matthijs D.
    Cheesman, Rosa
    Mangino, Massimo
    Wang, Yunzhang
    Li, Shuai
    Klaric, Lucija
    Ratliff, Scott M.
    Bielak, Lawrence F.
    Nygaard, Marianne
    Giannelis, Alexandros
    Willoughby, Emily A.
    Reynolds, Chandra A.
    Balbona, Jared
    Andreassen, Ole A.
    Ask, Helga
    Baras, Aris
    Bauer, Christopher R.
    Boomsma, Dorret
    Campbell, Archie
    Campbell, Harry
    Chen, Zhengming
    Christofidou, Paraskevi
    Corfield, Elizabeth
    Dahm, Christina C.
    Dokuru, Deepika R.
    Evans, Luke M.
    de Geus, Eco J. C.
    Giddaluru, Sudheer
    Gordon, Scott D.
    Harden, K. Paige
    Hill, W. David
    Hughes, Amanda
    Kerr, Shona M.
    Kim, Yongkang
    Kweon, Hyeokmoon
    Latvala, Antti
    Lawlor, Deborah A.
    Li, Liming
    Lin, Kuang
    Magnus, Per
    Magnusson, Patrik K. E.
    Mallard, Travis T.
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Mills, Melinda C.
    Njolstad, Pal Rasmus
    Overton, John D.
    Pedersen, Nancy L.
    Porteous, David J.
    Reid, Jeffrey
    Silventoinen, Karri
    Southey, Melissa C.
    Stoltenberg, Camilla
    Tucker-Drob, Elliot M.
    Wright, Margaret J.
    Hewitt, John K.
    Keller, Matthew C.
    Stallings, Michael C.
    Lee, James J.
    Christensen, Kaare
    Kardia, Sharon L. R.
    Peyser, Patricia A.
    Smith, Jennifer A.
    Wilson, James F.
    Hopper, John L.
    Hagg, Sara
    Spector, Tim D.
    Pingault, Jean-Baptiste
    Plomin, Robert
    Havdahl, Alexandra
    Bartels, Meike
    Martin, Nicholas G.
    Oskarsson, Sven
    Justice, Anne E.
    Millwood, Iona Y.
    Hveem, Kristian
    Naess, Oyvind
    Willer, Cristen J.
    Asvold, Bjorn Olav
    Koellinger, Philipp D.
    Kaprio, Jaakko
    Medland, Sarah E.
    Walters, Robin G.
    Benjamin, Daniel J.
    Turley, Patrick
    Evans, David M.
    Smith, George Davey
    Hayward, Caroline
    Brumpton, Ben
    Hemani, Gibran
    Davies, Neil M.
    Within-sibship genome-wide association analyses decrease bias in estimates of direct genetic effects2022Ingår i: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 54, nr 5, s. 581-592Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Estimates from genome-wide association studies (GWAS) of unrelated individuals capture effects of inherited variation (direct effects), demography (population stratification, assortative mating) and relatives (indirect genetic effects). Family-based GWAS designs can control for demographic and indirect genetic effects, but large-scale family datasets have been lacking. We combined data from 178,086 siblings from 19 cohorts to generate population (between-family) and within-sibship (within-family) GWAS estimates for 25 phenotypes. Within-sibship GWAS estimates were smaller than population estimates for height, educational attainment, age at first birth, number of children, cognitive ability, depressive symptoms and smoking. Some differences were observed in downstream SNP heritability, genetic correlations and Mendelian randomization analyses. For example, the within-sibship genetic correlation between educational attainment and body mass index attenuated towards zero. In contrast, analyses of most molecular phenotypes (for example, low-density lipoprotein-cholesterol) were generally consistent. We also found within-sibship evidence of polygenic adaptation on taller height. Here, we illustrate the importance of family-based GWAS data for phenotypes influenced by demographic and indirect genetic effects. Within-sibship genome-wide association analyses using data from 178,076 siblings illustrate differences between population-based and within-sibship GWAS estimates for phenotypes influenced by demographic and indirect genetic effects.

  • 48. Chen, Jiaying
    et al.
    Mittendorfer-Rutz, Ellenor
    Berg, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Norredam, Marie
    Sijbrandij, Marit
    Klimek, Peter
    Associations between Multimorbidity Patterns and Subsequent Labor Market Marginalization among Refugees and Swedish-Born Young Adults-A Nationwide Registered-Based Cohort Study2021Ingår i: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 11, nr 12, artikel-id 1305Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Young refugees are at increased risk of labor market marginalization (LMM). We sought to examine whether the association of multimorbidity patterns and LMM differs in refugee youth compared to Swedish-born youth and identify the diagnostic groups driving this association. Methodology: We analyzed 249,245 individuals between 20–25 years, on 31 December 2011, from a combined Swedish registry. Refugees were matched 1:5 to Swedish-born youth. A multimorbidity score was computed from a network of disease co-occurrences in 2009–2011. LMM was defined as disability pension (DP) or >180 days of unemployment during 2012–2016. Relative risks (RR) of LMM were calculated for 114 diagnostic groups (2009–2011). The odds of LMM as a function of multimorbidity score were estimated using logistic regression. Results: 2841 (1.1%) individuals received DP and 16,323 (6.5%) experienced >180 annual days of unemployment during follow-up. Refugee youth had a marginally higher risk of DP (OR (95% CI): 1.59 (1.52, 1.67)) depending on their multimorbidity score compared to Swedish-born youth (OR (95% CI): 1.51 (1.48, 1.54)); no differences were found for unemployment (OR (95% CI): 1.15 (1.12, 1.17), 1.12 (1.10, 1.14), respectively). Diabetes mellitus and influenza/pneumonia elevated RR of DP in refugees (RRs (95% CI) 2.4 (1.02, 5.6) and 1.75 (0.88, 3.45), respectively); most diagnostic groups were associated with a higher risk for unemployment in refugees. Conclusion: Multimorbidity related similarly to LMM in refugees and Swedish-born youth, but different diagnoses drove these associations. Targeted prevention, screening, and early intervention strategies towards specific diagnoses may effectively reduce LMM in young adult refugees.

  • 49. Airaksinen, Jaakko
    et al.
    Aaltonen, Mikko
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; Max-Planck-Institute for Demographic Research, Germany.
    Latvala, Antti
    Associations of neighborhood disadvantage and offender concentration with criminal behavior: Between-within analysis in Finnish registry data2021Ingår i: Journal of criminal justice, ISSN 0047-2352, E-ISSN 1873-6203, Vol. 74, artikel-id 101813Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The association between neighborhood disadvantage and crime has been extensively studied, but most studies have relied on cross-sectional data and have been unable to separate potential effects of the neighborhood from selection effects. We examined how neighborhood disadvantage and offender concentration are associated with criminal behavior while accounting for selection effects due to unobserved time-invariant characteristics of the individuals. We used a registry-based longitudinal dataset that included all children aged 0-14 living in Finland at the end of year 2000 with follow-up until the end of 2017 for criminal offences committed at ages 18-31 years (n = 510,189). Using multilevel logistic regression with a between-within approach we examined whether neighborhoods differed in criminal behavior and whether within-individual changes in neighborhood disadvantage and offender concentration were associated with within-individual changes in criminal behavior. Our results indicated strong associations of most measures of neighborhood disadvantage and offender concentration with criminal behavior between individuals. The within-individual estimates accounting for selection related to unobserved individual characteristics were mostly non-significant with the exception of higher neighborhood disadvantage being associated with increased risk for violent crimes. Our findings suggest that criminal behavior is better explained by individual characteristics than by causal effects of neighborhoods.

  • 50. Mona, Hatem
    et al.
    Andersson, Lena M. C.
    Hjern, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institute, Sweden.
    Ascher, Henry
    Barriers to accessing health care among undocumented migrants in Sweden-a principal component analysis2021Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, nr 1, artikel-id 830Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Undocumented migrants face many hardships in their everyday life such as poor living conditions, discrimination, and lack of access to healthcare. Previous studies have demonstrated considerable health care needs for psychiatric disorders as well as physical diseases. The aim of this paper was to find out the main barriers that undocumented migrants experience in accessing the Swedish healthcare system and to explore their relation with socioeconomic factors.

    Methods: A cross-sectional study with adult undocumented migrants was performed in the three largest cities of Sweden in 2014–2016. Sampling was done via informal networks. A socioeconomic questionnaire was constructed including 22 barriers to health care. Trained field workers conducted the interviews. A principal component analysis was conducted of all barriers to reveal central components. Then, Pearson’s chi-squared test was used to explore the characteristics of undocumented migrants experiencing barriers to care.

    Results: Two main components/barriers were extracted: “Fear of being taken by police/authorities”, which was related to fear of disclosure by or in relation to seeking health care, and “Structural and psychosocial factors” which was related to practical obstacles or shame of being ill. Lower age (74.1 % vs 56.0 %), lower level of education (75.0 % vs. 45.1 %), and having no children (70.3 % vs. 48.1 %) were significantly related to a higher likelihood of experiencing a barrier.

    Conclusion: Fear of deportation and practical and psychosocial factors constitute hinderance of access to healthcare for undocumented migrants in Sweden. This highlights the importance of clear instructions, both to undocumented migrants and health professionals about the right to health care according to the international law on human rights as well as the law of confidentiality.

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