| 1. |
- Chen, Lingjing, et al.
(författare)
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Labour market integration among young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) at working age
- 2024
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 54:1, s. 148-158
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Tidskriftsartikel (refereegranskat)abstract
- METHODS: Multiple Swedish nationwide registers were used to identify 8045 individuals, aged 20-29, with an incident diagnosis of ADHD 2006-2011. Labour market integration was conceptualized according to the core-peripheral model as a continuum from a strong (core) to a weak (peripheral) connection to the labour market. Sequence analyses categorized clusters of labour market integration, from 1 year before to 5 years after their ADHD diagnosis for individuals diagnosed with ADHD and a matched control group without ADHD. Multinomial logistic regression computed odds ratios (ORs) with 95% confidence intervals (CIs) between sociodemographic factors and comorbid disorders and the identified clusters.RESULTS: About one-fourth of the young adults diagnosed with ADHD belonged to clusters characterized by a transition to a mainly peripheral labour market position, which was approximately four-times higher compared to controls without ADHD. Foremost, those living in small cities/villages (OR 1.9; CI 1.5-2.2), those having comorbid autism-spectrum disorder (OR 13.7; CI 6.8-27.5) or schizophrenia/psychoses (OR 7.8; CI 3.8-15.9) were associated with a transition towards a peripheral labour market position throughout the study period. Those with a high educational level (OR 0.1; CI 0.1-0.1), and men (OR 0.7; CI 0.6-0.8) were less likely to have a peripheral labour market position.CONCLUSIONS: Young adults diagnosed with ADHD are four-times more likely to be in the peripheral labour market position compared to those without ADHD. To increase labour market participation, special attention is warranted to those with low educational level, those living outside big cities and those with comorbid mental disorders.
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| 2. |
- Chen, Lingjing
(författare)
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Rectal cancer survivorship : work loss and long-term morbidity
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the last few decades, due to early detection and advances in treatments, rectal cancer survival has been improved significantly. Meanwhile, rectal cancer survivors and health practitioners are facing more challenges arising from the disease, in terms of survivors’ longterm morbidity and work ability. The general aims of the register-based doctoral projects therefore include: 1). to evaluate the short- and long-term work loss in incident relapse-free rectal cancer survivors, together with the underlying association between work loss and survivors’ clinical characteristics; 2). to investigate the long-term cardiotoxicity in irradiated relapse-free rectal cancer survivors; 3). to systematically estimate the long-term drug use as a proxy for morbidity in relapse-free rectal cancer survivors. In Study I, we included 2815 curatively treated working-age rectal cancer patients without previous disability pension and their matched general comparators. After a median follow-up of 6 years (range 0-10 years), we found nearly one fourth relapse-free survivors and one tenth of their comparators were on disability pension listing, making the disability pension risk significantly doubled in the relapse-free survivors. Abdominoperineal resection was associated with higher disability pension risk than anterior resection. Surgical complications and reoperation also yielded more risk in survivors’ disability pension. In Study II, using the same study design as the previous study, we found the median work loss days during the 1st after treatment was 147 days and 336 days among relapse-free rectal cancer survivors without (n=2,529) and with (n=909) prediagnostic work loss history, respectively. Among those who had prediagnostic work loss, the post-treatment work loss varied very little by clinical characteristics; whereas among those without any prediagnostic work loss, advanced stage at diagnosis, operated with Abdominoperineal resection, neoadjuvant (chemo)radiotherapy treatment and surgical complications were all associated with higher work loss risk in survivors. In Study III, we included 14901 register-based (9227 received preoperative radiotherapy (RT) and surgery and 5674 were treated only with surgery) and 2675 trial-based (randomized into preoperative RT or not followed by surgery) relapse-free rectal cancer patients during a maximum follow-up of 18 and 33 years, respectively. We found no significant overall or subtypes of cardiovascular risk associated with preoperative RT. Although a slightly elevated risk of venous thromboembolism was noted in both cohorts during the first 6 months following treatment, the absolute number of patients affected was rather low, hence the safety of RT was further assured. In Study IV, we evaluated the detailed prescribed drug dispensing using defined daily doses (DDDs) by the Anatomical Therapeutic Chemical (ATC) classification among relapse-free rectal cancer patients across a maximum follow-up of 10 years. In comparison to the general population, rectal cancer survivors had a slight increase in overall drug use. While the survivors did acquire more drugs in digestive system, this could be due to both the long-term disease complications and potential prophylactic treatment.
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| 3. |
- Chen, Lingjing, et al.
(författare)
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Risk Factors for Disability Pension among Young Adults Diagnosed with Attention-deficit Hyperactivity Disorder (ADHD) in Adulthood.
- 2022
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Ingår i: Journal of Attention Disorders. - : SAGE Publications. - 1087-0547 .- 1557-1246. ; 26:5, s. 723-734
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate risk factors of disability pension (DP) in young adults diagnosed with ADHD in Sweden.METHOD: In total, 9718 individuals diagnosed with incident ADHD in young adult age (19-29 years) 2006 to 2011, were identified through national registers. They were followed for 5 years and Cox regression models were applied to analyze the DP risk (overall and by sex), associated with socio-demographics, work-related factors, and comorbid disorders.RESULTS: Twenty-one percent of all received DP. Being younger at diagnosis (hazard ratio [HR] = 1.54; 95%confidence interval [CI] 1.39-1.71); low educational level (HR = 1.97; 95%CI 1.60-2.43 for <10 years); work-related factors at baseline (no income from work [HR = 2.64; 95%CI 2.35-2.98] and sickness absence >90 days [HR = 2.48; 95%CI2.17-2.83]); and schizophrenia/psychoses (HR = 2.16; 95%CI 1.66-2.80), autism (HR = 1.87; 95%CI 1.42-2.46), anxiety (HR = 1.34; 95%CI 1.22-1.49) were significantly associated with an increased risk of DP. Similar risk patterns were found in men and women.CONCLUSION: Work-related factors and comorbid mental disorders need to be highlighted in early vocational rehabilitation for individuals with ADHD.
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| 4. |
- Chen, Lingjing, et al.
(författare)
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Short- and long-term risks of cardiovascular disease following radiotherapy in rectal cancer in four randomized controlled trials and a population-based register
- 2018
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Ingår i: Radiotherapy and Oncology. - : ELSEVIER IRELAND LTD. - 0167-8140 .- 1879-0887. ; 126:3, s. 424-430
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Tidskriftsartikel (refereegranskat)abstract
- Aim: A population-based cohort and four randomized trials enriched with long-term register data were used to clarify if radiotherapy in combination with rectal cancer surgery is associated with increased risks of cardiovascular disease (CVD). Methods: We identified 14,901 rectal cancer patients diagnosed 1995-2009 in Swedish nationwide registers, of whom 9227 were treated with preoperative radiotherapy. Also, we investigated 2675 patients with rectal cancer previously randomized to preoperative radiotherapy or not followed by surgery in trials conducted 1980-1999. Risks of CVD overall and subtypes were estimated based on prospectively recorded hospital visits during relapse-free follow-up using multivariable Cox regression. Maximum follow-up was 18 and 33 years in the register and trials, respectively. Results: We found no association between preoperative radiotherapy and overall CVD risk in the register (Incidence Rate Ratio, IRR = 0.99, 95% confidence interval (CI) 0.92-1.06) or in the pooled trials (IRR = 1.07, 95% CI 0.93-1.24). We noted an increased risk of venous thromboembolism among irradiated patients in both cohorts (lRR(register) = 1.41, 95% CI 1.15-2.72; IRRtrials = 1.41, 95% CI 0.97-2.04), that remained during the first 6 months following surgery among patients treated 2006-2009, after the introduction of antithrombotic treatment (IRR6 (months) = 2.30, 95% CI 1.01-5.21). However, the absolute rate difference of venous thromboembolism attributed to RT was low (10 cases per 1000 patients and year). Discussion: Preoperative radiotherapy did not affect rectal cancer patients' risk of CVD overall. Although an excess risk of short-term venous thromboembolism was noted, the small increase in absolute numbers does not call for general changes in routine prophylactic treatment, but might do so for patients already at high risk of venous thromboembolism. (C) 2017 Elsevier B.V. All rights reserved.
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| 5. |
- Chen, Lingjing, et al.
(författare)
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Work Loss Duration and Predictors Following Rectal Cancer Treatment among Patients with and without Prediagnostic Work Loss
- 2016
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - 1055-9965 .- 1538-7755. ; 25:6, s. 987-994
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Tidskriftsartikel (refereegranskat)abstract
- Background: The number of working-age rectal cancer survivors is increasing due to early detection and improved treatment. However, work loss duration and predictors among them have not been studied thoroughly. Methods: We identified 3,438 patients with stage I-III rectal cancer, 18 to 61 years of age in the Swedish Colorectal Cancer Register 1996-2009. Information on work loss due to sick leave or disability pension was collected from 2 years before diagnosis to 5 years after (until December 31st, 2013). Incidence rate ratios (IRR) of work loss were estimated in a negative binominal model by clinical characteristics for the 1st and 2nd-5th years after diagnosis. Patients were stratified by prediagnostic work loss. Results: Patients without prediagnostic work loss (74%) experienced median 147 days (25th and 75th percentile: 55 and 281) of work loss during the 1st year after diagnosis. Work loss rates (2nd-5th years) were significantly increased among relapse-free patients diagnosed in stage III [IRR = 1.92; 95% confidence interval (CI), 1.52-2.43], operated with abdominoperineal resection (IRR = 1.26; 95% CI, 1.03-1.56), and treated with neoadjuvant (chemo) radiotherapy (IRR = 1.46; 95% CI, 1.06-2.02). Patients with prediagnostic work loss (26%) experienced median 336 days (25th and 75th percentile: 183 and 365) of work loss during the 1st year, and rates did not vary clinically till 5 years. Conclusion: Without prediagnostic work loss, disease-and treatment-related factors could help identify rectal cancer patients in need of early interventions to facilitate return to work. Impact: Clinical awareness around prediagnostic and postdiagnostic work loss and individualized cancer rehabilitation programs should be emphasized among cancer survivors.
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| 6. |
- Stratmann, Marlene, et al.
(författare)
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Differences in all-cause and cause-specific mortality due to external causes and suicide between young adult refugees, non-refugee immigrants and Swedish-born young adults : The role of education and migration-related factors
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 17:12 December
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Tidskriftsartikel (refereegranskat)abstract
- Background International migration has increased during the past years and little is known about the mortality of young adult immigrants and refugees that came to Sweden as children. This study aimed to investigate 1) the risk of all-cause and cause-specific mortality in young accompanied and unaccompanied refugees and non-refugee immigrants compared to Swedish born individuals; and 2) to determine the role of educational level and migrations-related factors in these associations. Methods This register linkage study is based on 682,358 individuals (633,167 Swedish-born, 2,163 unaccompanied and 25,658 accompanied refugees and 21,370 non-refugee immigrants) 19-25 years old, who resided in Sweden 31.12.2004. Outcomes were all-cause mortality and mortality due to suicide and external causes. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox regression models with a maximum follow-up to 2016. Results After adjusting for covariates, all-cause mortality was significantly lower in non-refugee immigrants (aHR 0.70, 95% CI 0.59-0.84) and refugees (aHR 0.76, 95% CI 0.65-0.88) compared to Swedish-born individuals. The same direction of association was observed for mortality due to suicide and external causes. No differences between accompanied and unaccompanied refugees were found. Risk estimates for all migrant groups varied with educational level, duration of residency, age at arrival and country of birth. Further, the mortality risk of migrants arriving in Sweden before the age of 6 years did not significantly differ from the risk of their Swedish-born peers. Low education was a considerable risk factor. Conclusion In general, young adult refugees and non-refugee immigrants have a lower risk of all-cause and cause-specific mortality than Swedish-born individuals. The identified migrant groups with higher mortality risk need specific attention.
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