| 1. |
- Wändell, Per, et al.
(author)
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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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In: Journal of Neurology. - : Springer Science and Business Media LLC. - 0340-5354 .- 1432-1459. ; 269:4, s. 1989-1995
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Journal article (peer-reviewed)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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| 2. |
- Wändell, Per, et al.
(author)
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Cardiomyopathy among first- and second-generation immigrants in Sweden : a nationwide total population study
- 2022
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In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 22:1
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Journal article (peer-reviewed)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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| 3. |
- Wändell, Per, et al.
(author)
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Distal forearm fractures in immigrant groups : A national Swedish study
- 2020
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In: Bone. - : Elsevier BV. - 8756-3282 .- 1873-2763. ; 138
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Journal article (peer-reviewed)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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| 4. |
- Wändell, Per, et al.
(author)
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Epilepsy in immigrants and Swedish-born : A cohort study of all adults 18 years of age and older in Sweden
- 2020
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In: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 76, s. 116-122
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Journal article (peer-reviewed)abstract
- Purpose: We aimed to study the association between country of birth and incident epilepsy in several immigrant groups using Swedish-born individuals as referents. Method: The study population included all adults aged 18 years and older in Sweden, living and deceased, 6,690,598 in the first-generation and 6,683,125 in the second-generation sub-study. Epilepsy was defined as having at least one registered diagnosis of epilepsy in the National Patient Register. The incidence of epilepsy in different immigrant groups, using Swedish-born as referents, was assessed by Cox regression, expressed as hazard ratios (HRs) and 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: In the first-generation sub-study, totally 76,541 individuals had at least one registered diagnosis of epilepsy (1.14 % in total; men 1.22 % and women 1.07 %), and in the second-generation study 72,545 (1.09 %; men 1.18 % and women 0.99 %). After adjusting for confounders, in first-generation immigrants compared to their Swedish-born counterparts the incidence was somewhat lower among both men (HR 0.92, 0.90-0.96) and women (HR 0.93, 0.90-0.96), and in the second-generation immigrants among women (HR 0.95, 0.92-0.99) but not men (HR 0.99; 0.96–1.02). Among immigrant groups, a higher incidence of epilepsy was observed among first-generation women from Africa and Iraq, and second-generation men and women from Bosnia, and women from Finland. Conclusions: Risk of epilepsy was lower in immigrants in general compared to the Swedish-born population; but with higher incidence in some specific groups.
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| 5. |
- Wändell, Per, et al.
(author)
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Hearing impairment among children in Sweden with foreign-born parents and natives : A national Swedish study
- 2021
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In: Acta Paediatrica, International Journal of Paediatrics. - : Wiley. - 0803-5253 .- 1651-2227. ; 110:10, s. 2817-2824
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Journal article (peer-reviewed)abstract
- Aim: We aimed to estimate the risk of hearing impairment in children and adolescents with foreign-born parents, compared to natives. Methods: A nationwide study of 1,923,590 (51.4% boys) individuals aged 0–17 years of age in Sweden. Hearing impairment was defined as at least one registered diagnosis in the National Patient Register between 1 January 1998 and 31 December 2015. We used Cox regression analysis to estimate relative risk (hazard ratios with 99% confidence intervals) of incident hearing impairment in children with foreign-born parents compared to Swedish-born natives. Cox regression models were stratified by sex and adjusted for age, co-morbidities and socioeconomic status. Results: A total of 20,514 cases (53.7% boys) with extended sensorineural hearing impairment were registered, also including noise-induced hearing impairment and that from other causes, and 6172 cases (50.0% boys) with conductive hearing impairment. The risk of extended sensorineural hearing impairment was higher in boys with parents from Asia, especially from Iraq, fully adjusted HR (99% CI) 1.30 (1.17–1.4), and lower in boys with parents from Nordic countries, South Europe, and North America. Conclusion: The risk of extended sensorineural hearing impairment was higher in boys with parents from Asia, in particular Iraq.
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| 6. |
- Wändell, Per, et al.
(author)
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Huntington’s disease among immigrant groups and Swedish-born individuals : a cohort study of all adults 18 years of age and older in Sweden
- 2021
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In: Neurological Sciences. - : Springer Science and Business Media LLC. - 1590-1874 .- 1590-3478. ; 42:9, s. 3851-3856
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Journal article (peer-reviewed)abstract
- Background: There is a lack of studies of Huntington’s disease (HD) in immigrants. Objective: To study the association between country of birth and incident HD in first-generation immigrants versus Swedish-born individuals and in second-generation immigrants versus Swedish-born individuals with Swedish-born parents. Methods: Study populations included all adults aged 18 years and older in Sweden, i.e., in the first-generation study 6,042,891 individuals with 1034 HD cases and in the second-generation study 4,860,469 individuals with 1001 cases. HD was defined as having at least one registered diagnosis of HD in the National Patient Register. The incidence of HD in different first-generation immigrant groups versus Swedish-born individuals was assessed by Cox regression, expressed as hazard ratios (HRs) and 95% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighborhood socioeconomic status. Results: Mean age-standardized incidence rates per 100,000 person-years were for all Swedish-born 0.82 and for all foreign born 0.53 and for all men 0.73 and for all women 0.81, with the highest incidence rates for the group 80–84 years of age. After adjusting for potential confounders, the HRs were lower in women in the first- and second-generation, i.e., 0.49 (95% CI 0.36–0.67) and 0.63 (95% 0.45–0.87), respectively, and also among women from Finland or with parents from Finland. Significance: In general, the risk of HD was lower in first-generation and second-generation immigrant women but not among male immigrants.
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| 7. |
- Wändell, Per, et al.
(author)
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Hypertension in Pregnancy Among Immigrant and Swedish Women : A Cohort Study of All Pregnant Women in Sweden
- 2024
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In: Journal of the American Heart Association. - 2047-9980. ; 13:5
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Journal article (peer-reviewed)abstract
- BACKGROUND: Little is known about risks of hypertensive disorders of pregnancy in both first-and second-generation immigrant women in Europe and other Western countries; such knowledge may help elucidate the influence of genetic versus social factors on such risks. We aimed to study both first-and second-generation immigrant women for the presence of all types of hypertension (preexisting hypertension, gestational hypertension, preeclampsia, and eclampsia) during pregnancy. METHODS AND RESULTS: A cohort study was conducted using data derived from the Swedish National Birth Register, the National Patient Register, and the Total Population Register. We used Cox regression analysis to compute hazard ratios (HRs) and 99% CIs while adjusting for sociodemographic factors and comorbidities. The first-generation study included a total of 1 084 212 deliveries and 68 311 hypertension cases, and the second-generation study included 989 986 deliveries and 67 505 hypertension cases. The fully adjusted HR (with 99% CI) for hypertension in pregnancy among first-generation immigrant women was 0.69 (0.66–0.72), and among second-generation immigrant women, it was 0.88 (0.86–0.91), compared with Swedish-born women with 2 Swedish-born parents. Women born in Finland or with parent(s) from Finland had higher risks, with fully adjusted HRs (99% CIs) of 1.30 (1.18–1.43) and 1.12 (1.07–1.17), respectively. CONCLUSIONS: Both first-and second-generation immigrant women had overall lower risks of hypertension in pregnancy compared with other Swedish women. However, the risk reduction was less pronounced in second-generation compared with first-generation immigrant women, suggesting that environmental factors in Sweden may have an important influence on risk of hypertension during pregnancy.
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| 8. |
- Wändell, Per, et al.
(author)
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Incident cases of vision impairment and blindness among adult foreign-born and Swedish-born individuals : A national Swedish study
- 2022
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In: European Journal of Ophthalmology. - : SAGE Publications. - 1120-6721 .- 1724-6016. ; 32:4, s. 1915-1923
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Journal article (peer-reviewed)abstract
- Purpose: To analyse risk of vision impairment (VI) and blindness in adult foreign-born individuals and Swedish-born individuals. Methods: A nationwide study of individuals 18 years of age and older (N = 6,042,891; 2,902,918 men and 3,139,973 women) in Sweden. VI (in general) and blindness was defined as at least one registered diagnosis in the National Patient Register between January 1, 1998 and December 31, 2015. Cox regression analysis was used to estimate the relative risk (hazard ratios (HR) with 95% confidence intervals (CI)) of incident VI in foreign-born compared to Swedish-born individuals. The Cox regression models were stratified by sex and adjusted for age, co-morbidities, and for sociodemographic status. Results: A total of 14,597 cases (6433 men and 8164 women) of VI were registered, with an age-standardized incidence per 100,000 person-years of 10.37 in men and 11.03 in women. VI (in general) was more common in immigrants, fully adjusted HRs (95% CI) were for immigrant men 1.38 (95% CI, 1.29–1.48) and women 1.24 (95% CI, 1.16–1.32), with significantly higher HRs among men and women from Eastern Europe, Africa, Latin America and Asia. Higher risks of blindness were also seen for immigrant men, HR 1.75 (95% CI 1.36–2.25), as well as for the other degrees of VI among immigrant men, HR 1.36 (95% CI 1.26–1.47), and immigrant women, HR 1.26 (95% CI 1.18–1.35). Conclusions: We observed a generally higher risk of VI among foreign-born men and women, especially from some regions.
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| 9. |
- Wändell, Per, et al.
(author)
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Levothyroxine treatment and incident dementia in adults with atrial fibrillation
- 2020
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In: Aging clinical and experimental research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 32:3, s. 433-439
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Journal article (peer-reviewed)abstract
- Objective: Levothyroxine treatment is common among older adults as is atrial fibrillation (AF), yet less is known about its potential effects on the development of dementia. Methods: The study population included all adults with diagnosed AF (n = 156,104) aged ≥ 45 years in Sweden without an earlier recorded diagnosis of dementia. Individuals with a dispensed prescription of levothyroxine on two or more occasions between July 1 2005 and December 31 2006 in Sweden were considered exposed (n = 12,978; 8.3%), and were compared to all other patients with AF without this treatment. Cox regression with hazard ratios (HRs) and 95% confidence interval (95% CI), with outcome defined as dementia of all causes between January 1, 2007 and December 31, 2015, was used in the analysis. Adjustments were made for socio-demographic factors (age, immigration status, marital status, educational level, neighborhood socioeconomic status), co-morbidity (cardiovascular disease, obesity, diabetes, COPD, depression, anxiety and alcohol related diagnoses), and cardiovascular medications. Results: During follow-up, a total of 9054 patients with AF were diagnosed with dementia (5.8%). We found no significant association of levothyroxine treatment and incident dementia, fully adjusted HR 1.03 (95% CI 0.96–1.11), neither among men and women, nor in different age-groups or subgroups of dementia. Conclusion: We found no significant association of levothyroxine treatment and incident dementia among patients with AF, which contrasts some earlier findings.
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| 10. |
- Wändell, Per, et al.
(author)
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Levothyroxine treatment is associated with an increased relative risk of overall and organ specific incident cancers – a cohort study of the Swedish population
- 2020
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In: Cancer Epidemiology. - : Elsevier BV. - 1877-7821 .- 1877-783X. ; 66
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Journal article (peer-reviewed)abstract
- High thyroid hormone values have been associated with an increased risk of incident cancers, especially breast cancer but also lung cancer and any solid cancers. We explored whether there is an increased risk of overall and cause-specific cancers in those receiving levothyroxine treatment. We included all individuals ≥ 18 years in Sweden (N = 8,573,313) on January 1 2009, and identified patients with two or more dispensed prescriptions of levothyroxine 2005–2006 (n = 253,193, 3.0 %). A cancer diagnosis in the Swedish Cancer Register 2009–2015 was used as outcome. We excluded patients with a cancer diagnosis before 2005. Cox regression was used (hazard ratios, HRs, and 95 % confidence intervals, CI) with adjustments for age, socioeconomic/neighborhood factors and co-morbidities. Totally 399,751 cases of incident cancer were identified, with a slight increased overall risk associated with levothyroxine treatment for both men, adjusted HR 1.06 (95 % CI 1.03–1.10), and women, adjusted HR 1.08 (95 % CI 1.07–1.10). For men, increased risks were found for cancers of the thyroid gland and other endocrine glands. For women, increased risks were found for cancers of the breast, endometrium, other female genitals (ovaries not included), stomach, colon, liver, pancreas, urinary bladder, skin, leukemia, and unspecified primary tumor. Unlike men, for women, no increased risk was found for cancer of the thyroid gland. In conclusions, levothyroxine treatment was associated with an excess cancer risk, including many different types of cancer, especially among women. Our results need confirmation by other studies, but levothyroxine is recommended to be prescribed only on approved indications.
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