Aims: This article examines how the Diderichsen model has been used and adapted in research on health inequalities during COVID-19, and explores how the pandemic has prompted further theoretical development. This review therefore addresses the question of how a well-established theoretical framework has helped researchers understand pandemic-related health inequalities and what opportunities exist for its continued refinement. Methods: A narrative literature review was conducted using Google Scholar, Web of Science, PubMed and Scopus. Included studies cited a key publication presenting the Diderichsen model and addressed COVID-19 as a central topic. After screening 298 articles, 24 were included for full analysis. The studies were categorised by how they engaged with the model - conceptually, empirically or through further development. Results: The Diderichsen model was commonly used to frame discussions of health inequality or to interpret pandemic-related disparities in exposure, vulnerability and outcomes. Several studies emphasised occupational and housing-related exposure, class-based comorbidities and the unequal social consequences of COVID-19. A smaller number of studies proposed expanded frameworks, incorporating multilevel and temporal dimensions and introducing new mechanisms related to pandemic responses. These adaptations often focused on migrants, ethnic minorities and other particularly affected groups. Conclusions: The review confirms the ongoing relevance of the Diderichsen model in pandemic health inequality research. It argues that the model can be further strengthened by explicitly incorporating concepts of political decision-making, symbolic recognition and social justice. This would improve its capacity to capture the full complexity of health inequalities in times of crisis.

Background  Childhood adversity places individuals in a vulnerable position, resulting in potentially enduring disadvantage across life domains like health and work. Studying the manifestation of this disadvantage is crucial for understanding which resources society can provide to mitigate or prevent it, which makes this subject a fundamental public health concern. This study investigated whether disadvantage patterns after childhood adversity differ by gender and educational level, using out-of-home care as proxy for early adversity.

Methods  We used register data from a 1953 Swedish birth cohort. Distinct profiles of socioeconomic and health disadvantage in individuals with out-of-home care experience were identified using group-based multi-trajectory modelling. Multinomial logistic regression was then used to determine whether gender and education, individually or in interaction with each other, predict group membership.

Results  In the population without history of out-of-home care, adulthood disadvantage was highly gendered, with women being more likely to experience disadvantage related to unemployment and poor health, while criminality and substance misuse was more common among men. History of out-of-home care was associated with a general increase in adulthood disadvantage, but the gender differences were largely absent. Women in this group were however less likely than men to experience disadvantage across multiple life domains (complex disadvantage OR = 0.56, p = 0.046; unemployment-related disadvantage OR = 0.51, p = 0.005). Higher level of education was associated with reduced likelihood of membership in the group marked by disabling health disadvantage (OR = 0.55, p = 0.002) and complex disadvantage (OR = 0.37, p = 0.001). An interaction term between gender and education was not significant.

Conclusions  Adulthood disadvantage was more common in the group with history of out-of-home care. The gender differences in disadvantage present in the full cohort were largely attenuated among individuals with out-of-home care history. We showed that using administrative data on outcomes across multiple life domains can provide rich descriptions of adult experiences after childhood adversity. Future research could examine gender differences in mechanisms translating into resilient or vulnerable trajectories, including the protective potential of education in relation to specific disadvantage patterns.

Ways of exiting the labour market both reflect previous health and socioeconomic disadvantage, and shape opportunities for healthy ageing. We apply sequence analysis on data from a 1953 Stockholm birth cohort to describe typical labour market exit routes between ages 55 and 68, both in the full sample and among the subgroup of individuals with childhood experience of out-of-home care for family reasons — a population with a high prevalence of childhood adversity. Information on income is used to further characterize these routes. Based on multinomial logistic regression analysis, we examine educational attainment and gender as predictors of exit routes, and as effect modifiers in the association between out-of-home care and exit routes. The normative transition from employment to pension was the most common type of exit in both samples. Individuals clustered into two non-normative routes in the full sample (health-related benefits; early mortality) and four non-normative routes in the care-experienced sample (health-related benefits with income from work; health-related benefits without income from work; unemployment; early mortality), largely reflecting a higher degree of financial disadvantage. We furthermore show that out-of-home care is associated with higher odds of following non-normative exit routes and that higher educational attainment might have the potential to mitigate this association. No consistent differences between men and women emerged in the analyses. Altogether, this study is the first to take a person-centred and prospective approach to describe the heterogeneity in early labour market exits in a high-risk population. Future research should further explore resilience factors in this context.

In the early stages of the COVID-19 pandemic, PCR testing served different purposes for individuals and for policy makers. Policy makers relied on testing for representative case numbers to track and mitigate the spread of the disease whereas individuals needed tests to protect themselves and others, or to travel or go work. Systematic differences in testing across population groups can bias case numbers, making it more difficult for policy makers to implement effective non-pharmaceutical interventions. We link records of 494 699 PCR-tests taken between 2020-07-01 and 2020-12-31 to individual records in several administrative registers for 1 480 126 working age individuals in the counties of Stockholm and Scania in Sweden. We estimate the likelihood of getting tested, test positivity rate and hospitalization risk by sex, household size, migration background, education, income and medical risk factors in the individual or in the household using regression models with age, occupation and neighbourhood as fixed effects. We find that testing behaviour vary independently by several demographic, socioeconomic and medical factors. Several groups that were at an elevated risk of being hospitalized for COVID-19, including men, individuals born outside Europe and those with low education, had low testing rates and high positivity rates. Numbers of confirmed SARS-CoV-2 infections reflect both infection rates and the testing behaviour of the population. To improve the utility of testing in future pandemics, policy makers may collect data on negative tests and dedicate part of the testing capacity for representative screening.

Background Childhood adversity is associated with a host of negative health and socioeconomic outcomes far into adulthood. The process of avoiding such outcomes is often referred to as resilience. Mapping resilience comprehensively and across contexts is highly relevant to public health, as it is a step towards understanding environments and interventions that contribute to preventing or reversing negative outcomes after early adverse experiences. Objectives This review scoped out the literature on resilience factors in relation to adulthood outcomes as diverse as mental health and educational attainment. Our aim was to understand where there is untapped research potential, by examining the current evidence base on resilience factors in terms of (a) resources that can buffer the impact of childhood adversity and (b) the pathways linking adversity to long-term outcomes. Furthermore, we aimed to identify gender patterns in these resources and pathways, which has not been a primary interest of reviews on resilience to date, and which can add to our understanding of the different ways in which resilience may unfold. Eligibility criteria Studies had to include an adversity experienced in childhood, an outcome considered indicative of resilience in adulthood, and at least one putative resilience factor, which had to be approached via mediation or moderation analysis. We considered cohort, case-control and cross-sectional studies. Sources of evidence We searched PubMed, Scopus and PsycINFO and included original, peer-reviewed articles published before 20 July 2023 in English, German, French, Spanish, Dutch and Swedish. Charting methods All three authors collaborated on the extraction of information relevant to answering the research questions. The results were visually and narratively summarised. Results We included 102 studies. Traditionally anchored in the field of psychology, the resilience literature focuses heavily on individual-level resilience factors. Gender was considered in approximately 22% of included studies and was always limited to comparisons between men and women. There is no evidence that childhood adversity impacts men and women differently in the long term, but there is some evidence for gender differences in resilience factors. Conclusions There is untapped potential in resilience research. By considering structural-level factors simultaneously with individual-level factors, and including gender as one of the elements that shape resilience, we can map resilience as a heterogeneous, multilevel process from a public health perspective. This would complement the extensive existing literature on individual-level factors and help reframe resilience as a concept that can be intervened on at a structural level, and that is subject to societal norms and forces, such as gender. There is a lack of quantitative studies including transgender and gender-non-conforming persons.

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.

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.

Aims: Nordic register material is often considered to be a gold standard for studies of social epidemiology and population health, but it comes with certain limitations. This short communication aims to draw attention to lacking coverage as a potentially growing problem of Nordic register material. Methods: The article is based on a short review of previous studies and commentaries on the strengths and limitations of Nordic register data with a particular focus on studies of employment and migration. Results: In times of institutional and demographic change in the Nordic countries, the assumption of universal register coverage can be challenged. Precarious and informal employment arrangements, important social determinants of health, provide a good illustration of the problem. Work that is carried out in the semi-legal margins of the labour market, sometimes by a 'hidden population' of non-resident, short-term labour immigrants, will not be covered by the registers. Researchers may therefore run the risk of misrepresenting reality if they maintain the belief that population registers cover the entire population. Conclusions: The Nordic registers are an extraordinary resource for public health researchers, but continuous quality control and assessment of validity and completeness will be crucial to maintain relevance in a transitioning society.

There is growing evidence on the observed and expected consequences of climate change on population health worldwide. There is limited understanding of its consequences for child health inequalities, between and within countries. To examine these consequences and categorize the state of knowledge in this area, we conducted a review of reviews indexed in five databases (Medline, Embase, Web of Science, PsycInfo, Sociological Abstracts). Reviews that reported the effect of climate change on child health inequalities between low- and high-income children, within or between countries (high- vs low–middle-income countries; HICs and LMICs), were included. Twenty-three reviews, published between 2007 and January 2021, were included for full-text analyses. Using thematic synthesis, we identified strong descriptive, but limited quantitative, evidence that climate change exacerbates child health inequalities. Explanatory mechanisms relating climate change to child health inequalities were proposed in some reviews; for example, children in LMICs are more susceptible to the consequences of climate change than children in HICs due to limited structural and economic resources. Geographic and intergenerational inequalities emerged as additional themes from the review. Further research with an equity focus should address the effects of climate change on adolescents/youth, mental health and inequalities within countries.