| 1. |
- Chaix, Basile, et al.
(författare)
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Income change at retirement, neighbourhood-based social support, and ischaemic heart disease: Results from the prospective cohort study "Men born in 1914"
- 2007
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 1873-5347 .- 0277-9536. ; 64:4, s. 818-829
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Tidskriftsartikel (refereegranskat)abstract
- Retirement from active life often leads to decreased finances and reduced social contact, which may increase ischaemic heart disease (IHD) risk in individuals. We examined whether income evolution during the decade before retirement has an impact on subsequent IHD, and explored the mediating effect of common risk factors and social support from different sources (marriage/cohabitation, support from friends/relatives, and neighbourhood-based social support). We analyzed data from the 1982-1983 prospective cohort study, "Men born in 1914" (n = 498, follow-up period = 10 years) conducted in Malmo, Sweden, merged with yearly income data for 14 years preceding baseline. Low income 10 years before retirement predicted both higher prevalence of IHD risk factors at retirement, and weaker neighbourhood-based social support. Income 10 years before retirement was a strong predictor of IHD incidence and mortality after retirement, but a significant downward income mobility at retirement did not increase IHD risk. After adjustment, low neighbourhood-based social support increased the risk of IHD incidence and mortality, and mediated 7-8% of the income effect. In conclusion, income 10 years before retirement, but not the subsequent income evolution, was a strong predictor of IHD post-retirement. This socioeconomic gradient was partly mediated by the protective effect of neighbourhood-based social support, which may be particularly important among the elderly in compensating for social disruptions related to retirement.
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| 2. |
- Merlo, Juan, et al.
(författare)
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Diastolic blood pressure and area of residence: multilevel versus ecological analysis of social inequity
- 2001
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 55:11, s. 791-798
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVES---To study geographical differences in diastolic blood pressure and the influence of the social environment (census percentage of people with low educational achievement) on individual diastolic blood pressure level, after controlling for individual age and educational achievement. To compare the results of multilevel and ecological analyses. DESIGN---Cross sectional analysis performed by multilevel linear regression modelling, with women at the first level and urban areas at the second level, and by single level ecological regression using areas as the unit of analysis. SETTING---Malmö, Sweden (population 250 000). PARTICIPANTS---15 569 women aged 45 to 73, residing in 17 urban areas, who took part in the Malmö Diet and Cancer Study (1991-1996). MAIN RESULTS---In the "fixed effects" multilevel analysis, low educational achievement at both individual (beta =1.093, SE=0.167) and area levels (beta =2.966, SE=1.250) were independently associated with blood pressure, although in the "random effects" multilevel analysis almost none of the total variability in blood pressure across persons was attributable to areas (intraclass correlation=0.3%). The ecological analysis also found an association between the area educational variable and mean diastolic blood pressure (beta =4.058, SE=1.345). CONCLUSIONS---The small intraclass correlation found indicated very marginal geographical differences and almost no influence of the urban area on individual blood pressure. However, these slight differences were enough to detect an effect of the social environment on blood pressure. The ecological study overestimated the associations found in the "fixed" effects multilevel analysis, and neither distinguished individual from area levels nor provided information on the intraclass correlation. Ecological analyses are inadequate to evaluate geographical differences in health.
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| 3. |
- Merlo, Juan, et al.
(författare)
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Effect of neighborhood social participation on individual use of hormone replacement therapy and antihypertensive medication: a multilevel analysis.
- 2003
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Ingår i: American Journal of Epidemiology. - : Oxford University Press (OUP). - 0002-9262. ; 157:9, s. 774-783
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Tidskriftsartikel (refereegranskat)abstract
- The authors investigated a possible contextual effect of neighborhood on individual use of hormone replacement therapy (HRT) and antihypertensive medication (AHM) and the impact of neighborhood social participation on individual use of these medications. They attempted to disentangle contextual from individual influences. Multilevel logistic regression modeling was used to analyze data on 15,456 women aged 45–73 years (first level) residing in 95 neighborhoods (second level) of the city of Malmö, Sweden (250,000 inhabitants) who participated in the Malmö Diet and Cancer Study (1991–1996). AHM use was studied among 7,558 participants with defined hypertension. Of the total variability in medication use in this population, only 1.7% (HRT) and 0.5% (AHM) was between neighborhoods. After adjustment for age, individual socioeconomic factors, individual low levels of social participation, and health and behavioral variables, no neighborhood effect on AHM use was found. However, women living in neighborhoods with low social participation were much less likely to use HRT (odds ratio = 0.36, 95% confidence interval: 0.21, 0.63), especially if they themselves experienced low social participation (synergy index, 1.53) or were immigrants (synergy index, 1.68). The Malmö neighborhoods were homogeneous with regard to HRT and especially AHM use. However, differences in neighborhood social participation affected HRT use independently of individual characteristics.
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| 4. |
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| 5. |
- Merlo, Juan, et al.
(författare)
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God vård på lika villkor vid hjärtinfarkt i dagens Sverige. Geografiska skillnader i dödlighet utan betyd
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:1-2, s. 20-23
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Tidskriftsartikel (refereegranskat)abstract
- It is a known fact that the 1990s brought a decrease in mortality after myocardial infarction in Sweden but that differences in mortality rates following myocardial infarction still remain between the Swedish counties. Unresolved, however, are questions as to what these inter-county differences mean for the individual patient and what role hospital care plays in this context. We analysed all patients aged 64-85 years who were hospitalised following diagnosis of myocardial infarction in Sweden during the period 1993-1996. To gain an understanding of the relevance of geographical differences in mortality after myocardial infarction for the individual patient we applied multi-level regression analysis and calculated county and hospital median odds ratios (MORs) in relation to 28-day mortality. For hospitalised patients with myocardial infarction, being cared for in another hospital with higher mortality would increase the risk of dying by 9% (MOR=1.09) in men and 12% in women. If these patients moved to another county with higher mortality the risk would increase by 7% and 3%, respectively. The small geographical differences in 28-day mortality after myocardial infarction found in Sweden suggest a high degree of equality across the country; however, further improvement could be achieved in hospital care, especially for women - an issue that deserves further analysis.
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