Objectives Neighbourhood migrant density is increasingly recognised as a social determinant of health. However, its association with hospitalised patients with cancer outcomes, such as mortality and readmission rates, remains understudied. This study examined whether neighbourhood migrant density influenced these outcomes and whether these associations varied before and during the COVID-19 pandemic.

Design Retrospective cohort study.

Setting Swedish national registers.

Participants Hospitalised patients with cancer (ICD code C00–C97) from 2014 to 2019 (before the pandemic) and 2020–2021 (during the pandemic).

Outcomes 90-day mortality and readmission rates. Independent variables were neighbourhood migrant density—categorised as total, Western and non-Western migrants (as a proportion of the total area population).

Results We identified 243 357 hospitalised patients with cancer before the pandemic and 112 935 during the pandemic. Swedish-born individuals and Western migrants residing in high migrant density neighbourhoods had higher rates of 90-day mortality (incidence rate ratio, IRR: 1.15, 95% CI 95% CI 1.12 to 1.19 and IRR: 1.09, 95% CI 1.00 to 1.18) and readmission (IRR: 1.16, 95% CI 1.13 to 1.19 and IRR: 1.14, 95% CI 1.07 to 1.22). During the pandemic, 90-day mortality rates significantly increased among Western migrants and 90-day readmission rates increased for all patients from high migrant density neighbourhoods.

Conclusions High neighbourhoods migrant density was associated with increased 90-day mortality and readmission among Swedish-born individuals and Western migrants before the pandemic. These outcomes were exacerbated during the pandemic, particularly among migrants. Cancer care for residents in neighbourhoods with high migrant density needs to be improved, especially during public health crises.

Background Evidence shows that both the mortality advantage and the lower income inequalities in mortality that characterise recent international migrants tend to disappear with time spent in the receiving country. This study examines whether absolute and relative income inequalities in mortality also increase by migrant generation in Sweden.

Methods Longitudinal data from Sweden’s population registries (2004–2018) was used to identify residents aged 25–64. An open cohort design was employed using slope (SII) and relative (RII) indices of inequality from negative binomial regressions to estimate associations between income rank position and all-cause mortality among majority population Swedes and individuals with a foreign background, classified by generation and by European or non-European origin. Sub-analyses assessed the contribution of external causes to income inequalities in mortality.

Findings Male descendants of migrants with non-European backgrounds exhibited higher relative income inequalities in mortality (ranging from RII_G2.₅: 6.72 to RII_G2: 11.47) than first generation non-European migrant (RII: 1.7; 95% confidence interval (CI): 1.28–2.26) and majority population men (RII: 4.73; 95% CI: 4.36–5.12). External causes accounted for 56–60% of these inequalities in mortality. Absolute income inequalities in mortality among men showed similar patterns to those observed for relative inequalities. Women showed lower absolute and relative inequalities compared to men across origins and by generation.

Interpretation Income-related inequalities in mortality appear to increase by migrant generation, particularly among men with non-European backgrounds, with external causes playing a significant role. Health and non-health targeted interventions focusing on social determinants are needed to address income inequalities in mortality.

Background Loss in life expectancy (LLE) by socioeconomic position (SEP) is obtained to explore cancer disparities. Often education or income are used to determine SEP. However, the low income of some older individuals or females within households with greater overall resources may not accurately reflect their SEP, potentially leading to biased estimates. Our study investigates how various conceptualizations of SEP influence the extent of these disparities.

Methods Data included all colon cancer diagnoses in Sweden between 2008-2016. We estimated LLE using different SEP indicators: education, individual income, part of household income. Household income accounts for individuals with low individual income but within high-income households. We allocated patients to income groups creating quartiles, overall or separately by sex, age-groups, or both, to account for SEP misclassification. We analysed data using flexible parametric survival models. 

Results Standardised LLE varied from 5.05 to 5.62 years for the lowest to the highest education, resulting in a 0.57-year difference. When income was used to determine SEP, LLE was similar with disparities ranging from 0.29 to 0.77 across definitions. Age and sex specific LLE disparities varied more across definitions. Disparities between 60-year-old females in the highes-lowest income groups were 0.94 when using household income and -0.17 when using individual income. Conclusions When studying LLE by SEP, thoughtful consideration must be given to selecting the most suitable indicator for conceptualizing SEP. The choice should align with the specific SEP pathway of interest and address potential misclassification concerns relevant to the study population.

Background: Differences in the prognosis after colorectal cancer (CRC) by socioeconomic position (SEP) have been reported previously; however, most studies focused on survival differences at a particular time since diagnosis. We quantified the lifetime impact of CRC and its variation by SEP, using individualised income to conceptualise SEP.

Methods: Data included all adults with a first-time diagnosis of colon or rectal cancers in Sweden between 2008 and 2021. The analysis was done separately for colon and rectal cancers using flexible parametric models. For each cancer and income group, we estimated the life expectancy in the absence of cancer, the life expectancy in the presence of cancer and the loss in life expectancy (LLE).

Results: We found large income disparities in life expectancy after a cancer diagnosis, with larger differences among the youngest patients. Higher income resulted in more years lost following a cancer diagnosis. For example, 40-year-old females with colon cancer lost 17.64 years if in the highest-income group and 13.68 years if in the lowest-income group. Rectal cancer resulted in higher LLE compared with colon cancer. Males lost a larger proportion of their lives. All patients, including the oldest, lost more than 30% of their remaining life expectancy. Based on the number of colon and rectal cancer diagnoses in 2021, colon cancer results in almost double the number of years lost compared with rectal cancer (24 669 and 12 105 years, respectively).

Conclusion: While our results should be interpreted in line with what individualised income represents, they highlight the need to address inequalities.

Background: Studies have shown that, compared with the general native population, immigrants display weaker or absent income gradients in mortality. The aim of this study is to examine the extent to which the income gradient is modified by immigrants' duration of residence in Sweden.

Methods: Swedish register data from 2004 to 2016 were used to study the association between individual income and all-cause mortality among foreign-born and Swedish-born individuals at ages 25-64 years. Based on relative indices of inequality (RIIs) and slope indices of inequality (SIIs) derived from Poisson regressions, we measured relative and absolute mortality differentials between the least and most advantaged income ranks. The analyses were stratified by sex, immigrants' European or non-European origin, and immigrants' duration of residence in Sweden.ResultsThe relative income inequality in mortality among immigrant men was less than half (RII: 2.32; 95% CI: 2.15 to 2.50) than that of Swedish-born men (RII: 6.25; 95% CI: 6.06 to 6.44). The corresponding RII among immigrant women was 1.23 (95% CI: 1.13 to 1.34) compared with an RII of 2.75 (95% CI: 2.65 to 2.86) among Swedish-born women. Inequalities in mortality were lowest among immigrants who resided for less than 10 years in Sweden, and most pronounced among immigrants who resided for more than 20 years in the country. Corresponding analyses of absolute income inequalities in mortality based on the SII were largely consistent with the observed relative inequalities in mortality.

Conclusions: Income inequalities in mortality among immigrants differ by duration of residence in Sweden, suggesting that health inequalities develop in the receiving context.

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.

Purpose: We examined changes in the burden of depressive symptoms between 2006 and 2014 in 18 European countries across different age groups.

Methods: We used population-based data drawn from the European Social Survey (N = 64.683, 54% female, age 14–90 years) covering 18 countries (Austria, Belgium, Denmark, Estonia, Finland, France, Germany, Great Britain, Hungary, Ireland, The Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland) from 2006 to 2014. Depressive symptoms were measured via the CES-D 8. Generalized additive models, multilevel regression, and linear regression analyses were conducted.

Results: We found a general decline in CES-D 8 scale scores in 2014 as compared with 2006, with only few exceptions in some countries. This decline was most strongly pronounced in older adults, less strongly in middle-aged adults, and least in young adults. Including education, health and income partially explained the decline in older but not younger or middle-aged adults.

Conclusions: Burden of depressive symptoms decreased in most European countries between 2006 and 2014. However, the decline in depressive symptoms differed across age groups and was most strongly pronounced in older adults and least in younger adults. Future studies should investigate the mechanisms that contribute to these overall and differential changes over time in depressive symptoms.

The study explores how social network determinants relate to the prevalence and frequency of alcohol use among peer dyads. It is studied how similar alcohol habits co-exist amongpersons (egos) and their peers (alters) when socio-demographic similarity (e.g., in ethnicorigin), network composition and other socio-cultural aspects were considered. Data was ego-based responses derived from a Swedish national survey with a cohort of 23-year olds.The analytical sample included 7987 ego-alter pairs, which corresponds to 2071 individuals(egos). A so-called dyadic design was applied i.e., all components of the analysis refer to ego-alter pairs (dyads). Multilevel multinomial-models were used to analyse similarity in alcohol habits in relation to ego-alter similarity in ethnic background, religious beliefs, age, sex, risk-taking, educational level, closure in network, duration, and type of relationship, as well as interactions between ethnicity and central network characteristics. Ego-alter similarity in terms of ethnic origin, age and sex was associated with ego-alter similarity in alcohol use. That both ego and alters were non-religious and were members of closed networks also had an impact on similarity in alcohol habits. It was concluded that network similarity might be an explanation for the co-existence of alcohol use among members of peer networks.

There has been an abundance of research discussing the health implications of generalised trust and happiness over the past two decades. Both attitudes have been touted as independent predictors of morbidity and mortality, with strikingly similar trajectories and biological pathways being hypothesised. To date, however, neither trust nor happiness have been considered simultaneously as predictors of mortality. This study, therefore, aims to investigate the effects of generalised trust and happiness on all-cause and cause-specific mortality. The distinction between different causes of death (i.e. cardiovascular vs. cancer-related mortality) allowed us to assess if psychosocial mechanisms could account for associations between generalised trust, happiness and mortality. The study sample was derived from US General Social Survey data from 1978 to 2010 (response rates ranged from 70 to 82 per cent), and combined with death records from the National Death Index. The analytical sample comprised 23,933 individuals with 5382 validated deaths from all-cause mortality by 2014. Analyses were performed with Cox regression models and competing-risk models. In final models, generalised trust, but not happiness, showed robust and independent associations with all-cause mortality. Regarding cause-specific mortality, trust only showed a significant relationship with cardiovascular mortality. The distinct patterns of association between generalised trust and all-cause/cause-specific mortality suggest that their relationship could be being driven by cardiovascular mortality. In turn, this supports the feasibility of psychosocial pathways as possible biological mechanisms from distrust to mortality.