Purpose: The study examined whether poor emotional control shown at a young age increases the risk of having stroke and/or ischemic heart disease (IHD) later in life among Swedish men. The risk of stroke and IHD was also compared between smokers and non-smokers.

Methods: The study was based on data from an historical nationwide survey of Swedish men aged 18–20 years who underwent mandatory military conscription. Psychologists assessed emotional control based on semi-structured interviews with the conscripts. A total of 45,169 men were followed up for a first event of ischemic stroke and IHD approximately 40 to 70 years of age. Cox’ regression estimated hazard ratios (HR) and 95% confidence intervals (95%CI).

Results: Poor emotional control was associated with increased stroke risk, which remained statistically significant after adjusting for covariates (HR: 1.22, 95%CI: 1.08–1.39). No significant association with IHD was found after adjusting for covariates. In the comparison between smokers and non-smokers (at military conscription), poor emotional control was significantly associated with later stroke risk only among the smokers (HR: 1.31, 95%CI: 1.12–1.54).

Conclusion: Findings of this study do not provide evidence for an effect of poor emotional control on long-term risk of stroke and IHD independent of smoking.

Aims To investigate the association between high occupational physical workload in mid-life and subsequent ischaemic heart disease (IHD), and if this association is influenced by cardiorespiratory fitness assessed in youth.Methods and results A total of 284 436 men, born 1951-61, were compared in terms of occupational physical workload assessed with a job exposure matrix in 2005 (age 44-54) and followed up regarding IHD incidence and mortality, between 2006 and 2020 (age 45-69). Cardiorespiratory fitness in youth was assessed during military conscription, using a maximal cycle test. Cox regression and additive interaction modelling, using the synergy index (SI), were applied. High occupational physical workload in mid-life was associated with an increased risk of incident IHD [hazard ratio (HR) 1.34, 95% CI 1.29-1.39] and IHD mortality (HR 1.93, 95% CI 1.75-2.14), compared to having low occupational physical workload. The associations attenuated with adjustments for early life factors, e.g. socioeconomic position, body mass index, blood pressure, and highest attained education. However, they remained statistically significant; HR 1.06 (95% CI 1.02-1.11) for incident IHD and HR 1.38 (95% CI 1.23-1.55) for IHD mortality. Having both low cardiorespiratory fitness in youth and later high physical workload showed the highest risk, indicating an additive interaction, but the SI was non-significant.Conclusion High occupational physical workload in mid-life was associated with increased risks of IHD incidence and mortality. The combination of low fitness and high workload showed the highest risks. These results encourage both workplace and public health interventions for variation in occupational physical workload and improvement in cardiorespiratory fitness. This large observational study showed that exposure to high occupational physical workload in mid-life was associated with an increased risk of ischaemic heart disease (IHD) incidence and mortality, and the associations were strongest when high occupational physical workload was combined with low cardiorespiratory fitness assessed in youth.High occupational physical workload in mid-life, compared to low physical workload, was associated with an increased risk of incident IHD and IHD mortality, even when accounting for several potential confounders. The strongest association was seen for IHD mortality.The combination of having low cardiorespiratory fitness in youth and later high occupational physical workload was associated with the highest risk of both incident IHD and IHD mortality. In addition, it could be seen that low cardiorespiratory fitness in youth was more common among those who later had physically demanding occupations.

Introduction: Many studies have examined physicians' risk of suicide, but studies of other healthcare occupations have been fewer. Suicide attempts have also rarely been studied. We aimed to determine the risks of suicide and suicide attempts among healthcare workers in comparison with non-healthcare workers, according to occupational qualification level. Methods: This population-based cohort study linking Swedish national registers included 243,183 healthcare workers in high-qualified occupations (e.g., physicians); 1,789,076 workers in other high-qualified occupations; 514,726 healthcare workers in low-qualified occupations (e.g., assistant nurses); and 2,026,890 workers in low-qualified occupations residing in Sweden in 2005 and followed them until the latest December 31, 2020. We estimated adjusted hazard ratios (aHR) for suicide and first suicide attempt. Results: Compared to non-healthcare workers, higher risks for suicide were observed for several healthcare occupations, primarily those working with patient care (e.g., aHR physicians 1.57, 95% CI: 1.23–2.00, registered nurses 1.61, 95% CI: 1.37–1.88, assistant nurses 1.25, 95% CI: 1.17–1.34), rather than those in administrative roles (aHR high-qualified healthcare administrators 1.01 95% CI: 0.76–1.35). Among physicians, the risk was most apparent for psychiatrists (aHR 2.70, 95% CI: 1.21–6.03). For suicide attempts, the risks were primarily observed among registered nurses (aHR 1.22, 95% CI: 1.15–1.29) and assistant nurses (aHR 1.15, 95% CI: 1.12–1.18). Among healthcare workers, assistant nurses had the highest incidence rates for suicide (18.7/100,000 person-years) and suicide attempts (175.1/100,000 person-years). Conclusions: Workers in several healthcare occupations showed a higher risk of suicide relative to non-healthcare workers with a similar occupational qualification level. Interventions may need to be developed to reduce the risk of suicidal behavior in these groups.

Objectives This study aimed to investigate the impact of low job control on labor market participation expressed through working life expectancy (WLE) and working years lost (WYL) among men and women in Sweden.

Methods A random sample of 100 000 individuals was drawn from the Swedish Work, Illness, and labor market Participation (SWIP) cohort of the registered Swedish population in 2005 born 1945 to 1975. The multi-state estimated labor market affiliation method was used to estimate WLE and WYL due to unemployment, sickness absence, other, disability pension, early old-age pension, and death over a 15-year period (2006–2020). Job control was assessed through a job exposure matrix.

Results Men and women in high-control jobs had a longer WLE at each age. At age 30, the WLE for men in high-control jobs was 26.3 years while for men in low-control jobs this was 2.5 years shorter. For women, WLE at 30 was 25.8 years for high-control jobs but nearly five years shorter for low-control jobs. For both men and women, these differences were mostly due to disability pension and unemployment. Those in lower control jobs could expect to lose more working years according to nearly all other states besides active employment.

Conclusions Higher job control is linked to longer WLE, while low job control is an important determinant of WYL in the Swedish workforce. Addressing low job control could extend working lives and reduce inequities in labor market outcomes.

Few previous studies have investigated how socioeconomic differences in labour market exit have changed after restrictions in social insurance policies. The aim of this register-based study is to investigate how early labour market exit pathways among older men and women with different levels of education changed after major restrictive social insurance and retirement policy reforms in Sweden. Cohort 1 (pre-reform) consisted of individuals who were 60 or 61 years old in 2005 (N = 186,145) and Cohort 2 (post-reform) consisted of individuals who were 60 or 61 years old in 2012 (N = 176,216). Educational differences in four labour market exit pathways were investigated using Cox proportional hazards regression; the exit pathways were disability pension, early old-age pension with and without income respectively, and no income for two consecutive years. As expected, exits through disability pension were rarer in Cohort 2. Lower education was also more strongly associated with disability pension in Cohort 2. Parallel to this, lower education showed a stronger association with both early old-age pension types in Cohort 2. Additionally, a tendency towards a relatively higher likelihood of earning no income was seen among the less educated. Increases in inequalities tended to be greater for women. Our results indicate that educational inequalities in labour market exit have grown significantly after restrictions in social insurance and changes in retirement policies, which can have negative financial repercussions for those already in a vulnerable position. These results indicate that careful analyses of effects on disparities are needed before making major changes in welfare systems.

Social inequalities in alcohol-related morbidity and mortality are well-established, but the reasons are not fully understood. One possible reason is labor market difficulties stemming from lower educational qualifications, leading to alcohol-related harm. The present study aims to investigate the extent to which differences in labour market marginalization (LMM) (including differences in timing and type of LMM) explain educational differences in alcohol-related mortality, and whether this is independent of pre-labor market selection factors. A register-based cohort study included all men born between 1949 and 1951 who underwent Swedish military conscription in 1969/70 and were alive at age 55 (n = 45 168). Nationwide registers provided data on education level and alcohol-related mortality. LMM was measured by unemployment, sickness absence, and disability pension. Pre-labor market factors included health behaviors, cognitive ability, and health from conscription exams. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI). The explanatory role of LMM was assessed by percentage attenuation of HR. Men with primary and secondary education had higher risks of alcohol-related mortality (HR: 4.23, HR: 2.92) compared to those with university education. LMM explained a substantial part of these differences (42% and 37%). However, LMM's effect was smaller (18% and 7%) when pre-labor market factors were considered. Men with lower education levels in Sweden are more likely to die from alcohol-related causes compared to higher educated men. While differences in LMM contribute to these disparities, its explanatory power diminishes when considering pre-labor market factors, suggesting potential selection effects.

Person-related work requires interaction with individuals not employed at the workplace, such as clients and patients, and can result in emotional labour, emotional demands, and confrontation. These stressors may increase workers’ risk of cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, whereas colleagues’ support may help buffer their impact. We aimed to examine the association between person-related work and the risk of CVD, and effect modification of social support at work. The study included around two million CVD-free workers aged 40–60 years in Sweden in 2006. Three dimensions of person-related work, including general contact with people, emotional demands, and confrontation, and job control and social support were respectively assessed using job exposure matrices. CVDs in 2007–20 were recorded in patient and death registers. Multivariable Cox regression models were used. A total of 114 404 individuals developed CVD (65 857 CHD and 48 547 stroke). High exposures to the three dimensions were associated with 4%–12% increased risks of CVD (7%–20% for CHD and 2%–7% for stroke) in women and 2%–8% (2%–7% for CHD and 3%–10% for stroke) in men. Adjusting for job control attenuated the associations for general contact with people in women. The increased risks related to emotional demands and confrontation in women and general contact with people and confrontation in men were not present in those more likely to receive high social support. In conclusion, person-related work is associated with an increased risk of CVD, and social support at work seems to modify the magnitude of this association.

Previous studies have identified educational differences in early labour market exits, yet the mechanisms behind these disparities remain unclear. This study aims to examine to what extent common mental disorders (CMD) and alcohol-related morbidity can explain educational differences in early labour market exit. This cohort study included all men born 1951–53 who underwent conscription examination for military service in Sweden at age 18–20 (n = 136 466). The highest level of educational attainment and early labour market exit, using five different exit routes, was obtained from nationwide registers. Mediation analysis was used to examine the contribution of CMD and alcohol-related morbidity to the educational differences in early labour market exit. Factors measured in childhood, late adolescence, and early adulthood were included as confounders. Lower-educated men were at higher risk of leaving the labour market early. CMD contributed marginally to the educational differences in early exit due to disability pension, long-term sickness absence, and long-term unemployment, explaining up to 4%. Alcohol-related morbidity explained up to 12% of the educational differences in disability pension, long-term sickness absence, and long-term unemployment. Neither CMD nor alcohol-related morbidity were associated with early old-age retirement with and without income. Alcohol-related morbidity appears to be of importance when trying to understand educational differences in some but not all early labour market exit routes. Thus, reducing the negative effects of alcohol consumption could reduce educational inequalities in early exits from the labour market and prolong working life for all individuals regardless of socioeconomic position.

Objectives 

The aim of this study was to examine the mediating effect of the psychosocial work environment on the association between precarious employment (PE) and increased risk of common mental disorders (CMD), substance use disorders and suicide attempts.

Methods

This longitudinal register-study was based on the working population of Sweden, aged 25-60 years in 2005 (N=2 552 589). Mediation analyses based on a decomposition of counterfactual effects were used to estimate the indirect effect of psychosocial risk factors (PRF) (mediators, measured in 2005) on the association between PE (exposure, measured in 2005) and the first diagnosis of CMD, substance use disorders, and suicide attempts occurring over 2006-2017.

Results

The decomposition of effects showed that the indirect effect of the PRF is practically null for the three outcomes considered, among both sexes. PE increased the odds of being diagnosed with CMD, substance use disorders, and suicide attempts, among both men and women. After adjusting for PE, low job control increased the odds of all three outcomes among both sexes, while high job demands decreased the odds of CMD among women. High job strain increased the odds of CMD and suicide attempts among men, while passive job increased the odds of all three outcomes among women.

Conclusion

The results of this study did not provide evidence for the hypothesis that psychosocial risks could be the pathways linking precarious employment with workers' mental health. Future studies in different social contexts and labour markets are needed.

This study aims to investigate the relationship between education and alcohol-related morbidity and the role that low job control and heavy physical workload play in explaining these associations among men and women in Sweden. This register-based cohort study (SWIP cohort) includes over three million individuals registered in Sweden in 2005. Job control and physical workload were measured using a job exposure matrix linked to the index person based on their registered occupation at baseline. Alcohol-related morbidity was measured through diagnoses in the national patient registers between 2006 and 2020. Cox proportional hazards regression models were built to estimate associations between education and alcohol-related morbidity. Reductions in hazard ratios (HRs) were calculated after adjusting for job control, physical workload, and other covariates. Models were also stratified by sex. Lower levels of education predicted a higher risk of alcohol-related morbidity (HR: 2.55 95% confidence interval: 2.49-2.62 for the lowest educated compared to the highest). Low job control and heavy physical workload both played roles in explaining educational differences in alcohol-related morbidity even after accounting for sociodemographic and health factors (15.1% attenuation for job control and 18.3% for physical workload among the lowest educated). Physical workload explained a larger proportion of the associations among men compared to women. Lower levels of education were associated with an increased risk of alcohol-related morbidity and working conditions partly explained these associations beyond what was explained by sociodemographic and health factors. Improving working conditions could therefore prevent some cases of alcohol-related morbidity.