| 1. |
- Carlsson, Axel C, et al.
(författare)
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Neighborhood socioeconomic status at the age of 40 years and ischemic stroke before the age of 50 years : A nationwide cohort study from Sweden
- 2017
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Ingår i: International Journal of Stroke. - : SAGE PUBLICATIONS LTD. - 1747-4930 .- 1747-4949. ; 12:8, s. 815-826
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years.Methods: All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated.Results: A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status, education level, immigrant status, region of residence, and neighborhood services, there was a lower risk of stroke in residents from high-socioeconomic status neighborhoods (hazard ratio 0.87, 95% confidence interval 0.78-0.96), and an increased risk of stroke in adults from low-socioeconomic status neighborhoods (hazard ratio 1.16, 95% confidence interval 1.06-1.27), compared to their counterparts living in middle-socioeconomic status neighborhoods. After further adjustment for hospital diagnoses of hypertension, diabetes, heart failure, and atrial fibrillation prior to the age of 40, the higher risk in neighborhoods with low socioeconomic status was attenuated, but remained significant (hazard ratio 1.12, 95% confidence interval 1.02-1.23).Conclusions: In a nationwide study of individuals between 40 and 50 years, we found that the risk of ischemic stroke differed depending on neighborhood socioeconomic status, which calls for increased efforts to prevent cardiovascular diseases in low socioeconomic status neighborhoods.
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| 2. |
- Carlsson, Axel C., et al.
(författare)
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Neighbourhood socioeconomic status and coronary heart disease in individuals between 40 and 50 years.
- 2016
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Ingår i: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 102:10
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The incidence of myocardial infarction (MI) has decreased in general but not among younger middle-aged adults. We performed a cohort study of the association between neighbourhood socioeconomic status (SES) at the age of 40 and risk of MI before the age of 50 years. METHODS: All individuals in Sweden were included in the year of their 40th birthday, if it occurred between 1998 and 2010. National registers were used to categorise neighbourhood SES into high, middle and low, and to retrieve information on incident MI and coronary heart disease (CHD). Cox regression models, adjusted for marital status, education level, immigrant status and region of residence, provided an estimate of the HRs and 95% CIs for MI or CHD. RESULTS: Out of 587 933 men and 563 719 women, incident MI occurred in 2877 (0.48%) men and 932 (0.17%) women; and CHD occurred in 4400 (0.74%) men and 1756 (0.31%) women during a mean follow-up of 5.5 years. Using individuals living in middle-SES neighbourhoods as referents, living in high-SES neighbourhoods was associated with lower risk of MI in both sexes (HR (95% CI): men: 0.72 (0.64 to 0.82), women: 0.66 (0.53 to 0.81)); living in low-SES neighbourhoods was associated with a higher risk of MI (HR (95% CI): men: 1.31 (1.20 to 1.44), women: 1.28 (1.08 to 1.50)). Similar risk estimates for CHD were found. CONCLUSIONS: The results of our study suggest an increased risk of MI and CHD among residents from low-SES neighbourhoods and a lower risk in those from high-SES neighbourhoods compared with residents in middle-SES neighbourhoods.
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| 3. |
- Wändell, Per, et al.
(författare)
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Amyotrophic lateral sclerosis (ALS) among immigrant groups and Swedish-born individuals : a cohort study of all adults 18 years of age and older in Sweden
- 2022
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Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 0340-5354 .- 1432-1459. ; 269:4, s. 1989-1995
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a lack of studies of amyotrophic lateral sclerosis (ALS) in immigrants. Objective: The objective is to study the association between country of birth and incident ALS in first-generation immigrants versus Swedish-born individuals, and in second-generation immigrants versus native Swedes. Methods: Study populations included all adults aged 18 years and older in Sweden, in the first-generation study 6,128,698 individuals (2,975,141 men, 3,153,557 women) with 5,344 ALS cases (3017 men, 2327 women), and in the second-generation study 4,588,845 individuals (2,346,855 men and 2,241,990 women) with 3,420 cases (2027 men and 1393 women). ALS was defined as having at least one registered diagnosis of ALS in the National Patient Register 1998–2017. The incidence of ALS in different first-generation immigrant groups versus Swedish-born individuals was assessed by Cox regression, expressed as hazard ratios (HRs) with 95% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighbourhood socioeconomic status. Results: After adjusting for potential confounders, the HRs were lower in foreign-born men, 0.71 (95% CI 0.63–0.81), and women, 0.80 (95% CI 0.70–0.92). The ALS risk was lower among men and women from most Western countries (Europe outside Nordic countries, and North America), and from other regions of the world (Africa, Asia, and Latin America). Among men and women with foreign-born parents, the risk of ALS did not differ significantly from native Swedes. Significance: In general, the risk of ALS was lower in first-generation men and women but did not differ in second-generation individuals.
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| 4. |
- Wändell, Per, et al.
(författare)
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Association Between Relevant Co-Morbidities and Dementia in Patients With Atrial Fibrillation–A National Swedish Study
- 2019
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Ingår i: Archives of Medical Research. - : Elsevier BV. - 0188-4409. ; 50:2, s. 29-35
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Tidskriftsartikel (refereegranskat)abstract
- Background: The risk of dementia is increased in patients with atrial fibrillation (AF). Objective: To study relevant co-morbidities and incident dementia (vascular dementia, Alzheimers disease, other dementia and all dementia) in AF patients. Methods: All adults (n = 537,513) ≥45 years diagnosed with AF in hospitals in Sweden 1998–2012 were included. Cox regression was used to estimate hazard ratios (HR) with 95% CIs for association between co-morbidities, and incident dementia, after adjustment for age, residence place in Sweden, and socio-economic factors. Results: Totally 30,332 patients (5.6%) were diagnosed with dementia during the follow-up, with 14,097 men (4.9%) and 16,235 women (6.5%). After adjustments (HRs; 95% CI), hypertension was associated with lower risk of incident dementia (all types) in men (0.79; 0.76–0.82) and women (0.77; 0.74–0.79). Higher risk of dementia was seen in patients with stroke, diabetes, depression and anxiety. Lower risks of dementia were also seen in AF patients with concomitant coronary heart disease and congestive heart failure. Conclusions: The findings regarding incident dementia need to be interpreted with great caution, owing to possible “survival bias” or reversed causation. However, the lower associated risks of dementia associated with hypertension could possibly be explained by protective effects of certain antihypertensive drugs.
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| 5. |
- Wändell, Per, et al.
(författare)
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Atrial fibrillation in immigrant groups : a cohort study of all adults 45 years of age and older in Sweden
- 2017
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Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 32:9, s. 785-796
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Tidskriftsartikel (refereegranskat)abstract
- To study the association between country of birth and incident atrial fibrillation (AF) in several immigrant groups in Sweden. The study population included all adults (n = 3,226,752) aged 45 years and older in Sweden. AF was defined as having at least one registered diagnosis of AF in the National Patient Register. The incidence of AF in different immigrant groups, using Swedish-born as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence intervals (CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighbourhood socioeconomic status. Compared to their Swedish-born counterparts, higher incidence of AF [HR (95% CI)] was observed among men from Bosnia 1.74 (1.56-1.94) and Latvia 1.29 (1.09-1.54), and among women from Iraq 1.96 (1.67-2.31), Bosnia 1.88 (1.61-1.94), Finland 1.14 (1.11-1.17), Estonia 1.14 (1.05-1.24) and Germany 1.08 (1.03-1.14). Lower incidence of AF was noted among men (HRs ≤ 0.60) from Iceland, Southern Europe (especially Greece, Italy and Spain), Latin America (especially Chile), Africa, Asia (including Iraq, Turkey, Lebanon and Iran), and among women from Nordic countries (except Finland), Southern Europe, Western Europe (except Germany), Africa, North America, Latin America, Iran, Lebanon and other Asian countries (except Turkey and Iraq). In conclusion, we observed substantial differences in incidence of AF between immigrant groups and the Swedish-born population. A greater awareness of the increased risk of AF development in some immigrant groups may enable for a timely diagnosis, treatment and prevention of its debilitating complications, such as stroke.
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| 6. |
- Wändell, Per, et al.
(författare)
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Atrial fibrillation in immigrants under the age of 45 y in Sweden
- 2019
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Ingår i: International Health. - : Oxford University Press (OUP). - 1876-3413 .- 1876-3405. ; 11:3, s. 193-202
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To study association between country of birth and risk of first-onset atrial fibrillation (AF) in first- and second-generation immigrants to Sweden under 45 y of age.Methods: The study population included all individuals (n = 3 248 457) under the age of 45 y in Sweden, including immigrants (n = 722 249). AF was defined as first registered diagnosis in the National Patient Register. Association between country of birth and risk of AF was assessed by Cox regression, calculating HRs and 95% CIs, using Swedish-born individuals as referents. All models were stratified by sex, and in different models were adjusted for age, area of residence in Sweden, educational level, marital status, neighbourhood socioeconomic status and co-morbidity(ies).Results: A higher fully adjusted HR of incident AF was found in the total sample of first-generation immigrants, 1.44 (95% CI 1.35 to 1.54), in males born in Denmark, Lebanon and Iraq, and in females born in Turkey and Iraq. Lower HRs were found in male and female immigrants from Latin America and Iran, and female immigrants from Finland. Among second-generation immigrants, the fully adjusted HR was significantly lower, 0.70 (95% CI 0.58 to 0.83).Conclusions: Clinicians may show a greater awareness of AF in some groups of younger immigrants to enable early diagnosis.
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| 7. |
- Wändell, Per, et al.
(författare)
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Cardiomyopathy among first- and second-generation immigrants in Sweden : a nationwide total population study
- 2022
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Ingår i: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: We aimed to analyze the risk of cardiomyopathies (CMPs) among first-generation and second-generation immigrants. Methods: All individuals aged 18 years of age and older, n = 6,123,661 in the first-generation study, and n = 4,587,764 in the second-generation study were analyzed. CMP was defined as at least one registered diagnosis in the National Patient Register between January 1, 1998 and December 31, 2018. Cox regression analysis was used to estimate the relative risk (hazard ratios (HR) with 99% confidence intervals (CI)) of incident CMP with adjustments made for age, cancer, other comorbidities, and sociodemographic factors. Results: In the first-generation study, a total of 33,321 CMP cases were registered, 20,780 men and 12,541 women, where the fully adjusted models showed HRs (99% CI) for all foreign-born men of 0.92 (0.86–0.98) and for women of 0.90 (0.83–0.98). For dilated CMP, the risk was higher for men from Nordic countries, more specifically men from Finland, and lower for men and women from Asia. For hypertrophic CMP, the risk was higher for men from Africa and Asia. For other types of CMPs, the risk was lower in men and women from Asia. In the second-generation study, a total of 26,559 cases were registered (17,620 men and 8939 women), with no significant differences overall or among specific groups, when Swedish-born with foreign-born parents were compared to Swedish-born with Swedish-born parents. Conclusions: We observed a generally lower risk of CMPs among foreign-born individuals, but with a higher risk especially for hypertrophic CMPs for men from Africa and Asia, and a higher risk of dilated CMP for men from Nordic countries.
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| 8. |
- Wändell, Per, et al.
(författare)
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Dementia in immigrant groups : A cohort study of all adults 45 years of age and older in Sweden
- 2019
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Ingår i: Archives of Gerontology and Geriatrics. - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 82, s. 251-258
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study the association between country of birth and incident dementia in several immigrant groups in Sweden. Methods: The study population included all adults (n = 3,286,624) aged 45 years and older in Sweden. Dementia was defined as having at least one registered diagnosis of dementia in the National Patient Register. The incidence of dementia in different immigrant groups, using Swedish-born as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence intervals (CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighbourhood socioeconomic status. Results: A total of 136,713 individuals had a registered dementia event, i.e. 4.2%; 3.6% among men and 4.9% among women. After adjusting for confounders, in general, there was a lower incidence of dementia among both male immigrants (HR 0.85, 0.83–0.88) and female immigrants (HR 0.93, 0.91–0.95) compared to their Swedish-born counterparts. Among immigrant groups, a higher incidence (HR, 95%CI) of dementia was observed among men from Finland (1.14, 1.08–1.20), Bosnia (1.61, 1.18–2.20), Estonia (1.25, 1.10–1.43) and Russia (1.37, 1.12–1.69), and women from Finland (1.20 1.15–1.24) and Norway (1.14, 1.07–1.22). Conclusions: Risk of dementia was lower in immigrants in general compared to the Swedish-born population; however there were substantial differences among immigrant groups in risk of dementia. Developing dementia in a new country with a different language could cause problems for both patients and the health care staff.
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| 9. |
- Wändell, Per, et al.
(författare)
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Distal forearm fractures in immigrant groups : A national Swedish study
- 2020
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Ingår i: Bone. - : Elsevier BV. - 8756-3282 .- 1873-2763. ; 138
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim was to analyse risk of forearm fractures in first- and second-generation immigrants to Sweden. Methods: A nationwide study of individuals 20 years of age and older was conducted. Forearm fractures were defined as at least one registered diagnosis in the National Patient Register between January 1, 1998 and December 31, 2012. Cox regression analysis was used to estimate the relative risk (hazard ratios (HR) with 95% confidence intervals (CI)) of incident forearm fractures compared to Swedish-born individuals, or in second-generation immigrant groups relative to individuals with Swedish-born parents. Cox regression models were stratified by sex and adjusted for age, sociodemographic status, and co-morbidities. Results: A total of 5,953,764 individuals were included in the first-generation study (2,861,256 men, and 3,092,508 women), and a forearm fracture was registered in 166,955 individuals (2.8%). The second-generation study included 4,656,023 individuals (2,368,585 men, and 2,287,438 women) with a registered forearm fracture in 111,576 individuals (2.4%). Fully adjusted HRs showed marginally lower risks when all immigrants were studied, for first-generation men 0.95 (95% CI 0.92–0.98) and women 0.95 (95% CI 95 0.92–0.97), and for second-generation men 0.93 (95% CI 0.90–0.97) and women 0.90 (95% CI 0.88–0.93). An increased risk was found among some first-generation immigrant men, especially in men from the Middle East. Conclusions: We observed a marginally lower overall risk of fractures among immigrants, but with differences among the immigrant groups.
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| 10. |
- Wändell, Per, et al.
(författare)
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Effects of cardiovascular pharmacotherapies on incident dementia in patients with atrial fibrillation : A cohort study of all patients above 45 years diagnosed with AF in hospitals in Sweden
- 2019
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 297, s. 55-60
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with atrial fibrillation (AF) have an increased dementia risk dementia. We aimed to study the effect of antihypertensive drugs on dementia in AF patients. Methods: Included patients were ≥45 years diagnosed with AF in Swedish National Patient Register (n = 160,251; 89,723 men and 70,528 women) and alive on January 1, 2007. We excluded patients with dementia before onset of AF. Cox regression was used (hazard ratios, HRs, and 99% confidence interval, CI) with adjustments for sex, age, socioeconomic factors and co-morbidities, using incident dementia diagnosis until December 31, 2015 as outcome. Cardiovascular pharmacotherapies were obtained from the Swedish Prescribed Drug Register. Results: Incident dementia occurred in 9532 patients (5.9%), 4669 men (5.2%) and 4863 women (6.9%). ARBs were associated with lower risk for all patients (HR 0.87, 99% CI 0.78–0.98), especially in the ages 65–84 years of age (HR 0.87, 99% CI 0.76–0.99). Loop-diuretics were associated with higher risk for all dementia among patients 65–84 years of age (HR 1.16, 99% CI 1.00–1.35), and in the sub-group of other causes of dementia than Alzheimer Disease (AD) and vascular dementia (VaD) (HR 1.14, 99% CI 1.00–1.30), but with a lower risk in the sub-group of AD and VaD (HR 0.81, 99% CI 0.68–0.95). Conclusion: ARBs were associated with a decreased incidence of dementia, and loop diuretics with a higher risk in general but lower risk in the AD and VaD sub-group. ARBs could have specific advantages in prevention of dementia, but the results need confirmation in further studies.
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