| 1. |
- Alexandersson, Kristina
(författare)
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Sickness absence in a Swedish county : with reference to gender, occupation, pregnancy and parenthood
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The occurrence of sickness absence in relation to gender, occupation, age, pregnancy and parenthood was analysed in a Swedish county. Data on all new sick-leave spells exceeding 7 days in the county of Östergötland (400,000 inhabitants) were recorded in 1985-1987. Information on diagnoses, occupation, age, gender, number of children etc. for each of the 45,000 persons sicklisted/year were included in the database. Incidence measures were obtained using census data as denominator.The largest and most consistent variation in occurrence of sickness absence concerned occupation and gender, When categorising the occupations according to degree of gender-segregation, women in the extremely maledominated group (>90% men) had exceptionally high sick-leave rates, while both men and women in the group of gender-integrated occupations had significantly lower sick-leave rates. These variations with male-and female domination of occupational groups were found for sickness absence in general as well as for sick-leave due to pregnancy-related diagnoses. Men with custody of young children had the lowest sickness absence, young women in the same situation the highest, while there were no gender differences in persons without young children. Sickness absence due to pregnancy-related diagnoses varied to a large degree with occupation, but was still high in occupations with a generally low sickness absence, and increased much more than in any otherdiagnostic group over the three years. About half of the gender differences in sickness absence could be explained by sickness absence among pregnant women.In conclusion, the occurrence of sickness absence was associated with gender, age, occupation, gender segregation of occupation, pregnancy and parenthood. Further research should focus on etiological studies and intervention trials.
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| 2. |
- Burström, Kristina, et al.
(författare)
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A comparison of individual and social time trade-off values for health states in the general population
- 2006
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 76:3, s. 359-370
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to compare directly elicited individual time trade-off (TTO) values in a general population sample with the social values derived using the UK EQ-5D index tariff. In the Stockholm County 1998 postal Public Health Survey (n =4950, 20–88 years), the EQ-5D self-classifier, a TTO and a rating scale (RS) question were included (n = 2549 for all three questions). The mean TTO (EQ-5D) value was 0.943 (0.890) in the youngest age-group and 0.699 (0.733) in the oldest age-group. The difference between TTO and EQ-5D values was greater in more severe health status groups was. The same equation as for the UK EQ-5D index tariff was estimated for TTO and RS and resulted in significant and consistent coefficients for nearly all dimensions. The coefficients for moderate problems were closer to the EQ-5D index tariff than the coefficients for severe problems. Age was also significant after controlling for the EQ-5D dimensions (p < 0.05). The results suggest that individual and social TTO values differ systematically and that the difference is greater the more severe the health status is. The social EQ-5D index tariff may also underestimate the severity in health status at older ages; age appears to correlate with additional health problems not captured by the EQ-5D classification.
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| 3. |
- Burström, Kristina, et al.
(författare)
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Health-related quality of life by disease and socio-economic group in the general population in Sweden
- 2001
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 55:1, s. 51-69
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Tidskriftsartikel (refereegranskat)abstract
- Measuring health-related quality of life (HRQoL) on population level, is becoming increasingly important for priority setting in health policy. In the health economics field, it is common to measure HRQoL in terms of health-state utilities or QoL weights. This study investigates the feasibility of obtaining mean QoL weights by mapping survey data to the generic HRQoL measure EQ-5D and to describe the HRQoL in terms of mean QoL weights in certain disease and socio-economic groups. Data from the 1996–1997 Survey of Living Conditions, interviews with a representative sample (16–84 years) of the Swedish population (n=11 698) were used. The mean QoL weight decreased from 0.91 among the youngest to 0.61 among the oldest, and was lower for women than for men. The QoL weight was 0.88 in the highest socio-economic group and 0.78 in the lowest socio-economic group. The QoL weight was lowest (0.38) among persons with depression and highest among persons with hypertension (0.71). The QoL weight decreased from 0.95 for persons with very good global self-rated health to 0.20 for persons with very poor global self-rated health. The results support the feasibility and validity of the mapping approach. HRQoL varies greatly between socio-economic groups and different disease groups.
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| 4. |
- Burström, Kristina, et al.
(författare)
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Increasing socio-economic inequalities in life expectancy and QALYs in Sweden 1980-1997
- 2005
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Ingår i: Health Economics. - : Wiley-Blackwell. - 1099-1050 .- 1057-9230. ; 14:8, s. 831-850
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to estimate the change in socio-economic differences in life expectancy and in quality-adjusted life years (QALYs), for men and women at different ages, in Sweden 1980 to 1997. We used data from the Swedish Survey of Living Conditions (the ULF survey), which is linked to mortality data, to estimate the life expectancy in different socio-economic groups in 1980 and 1997 (n=100 868). Health state scores were obtained by mapping responses to selected ULF survey interview questions into the generic health-related quality of life measure EQ-5D, using the UK EQ-5D index tariff (n=34 447). For 20-year-old men the difference in life expectancy between the highest (higher non-manual) and the lowest socio-economic group (unskilled manual) was 2.11 years in 1980 and 3.79 years in 1997. The corresponding figures for 20-year-old women were 1.56 in 1980 and 2.15 in 1997. The difference in QALYs between the highest and the lowest socio-economic group increased from 5.76 QALYs in 1980 to 7.06 QALYs in 1997 for 20-year-old men, and from 4.14 QALYs in 1980 to 5.66 QALYs in 1997 for 20-year-old women. The widening socio-economic inequalities over time were more stable for men than for women. We conclude that our results suggest that the socio-economic inequality in health has increased between 1980 and 1997 in Sweden.
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| 5. |
- Burström, Kristina, et al.
(författare)
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Swedish population health-related quality of life results using the EQ-5D
- 2001
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Ingår i: Quality of life research. - : Springer Nature B.V. - 1573-2649 .- 0962-9343. ; 10:7, s. 621-635
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Tidskriftsartikel (refereegranskat)abstract
- Health-related quality of life (HRQoL) measured on population level may be useful to guide policies for health. This study aims to describe the HRQoL; in EQ-5D dimensions, mean rating scale (RS) scores and mean EQ-5D index values, in the general population, by certain disease and socio-economic groups, in Stockholm County 1998. The EQ-5D self-classifier and a RS were included in the 1998 cross-sectional postal Stockholm County public health survey to a representative sample (n = 4950, 20-88 years), 63% response rate. Mean RS score ranged from 0.90 (20-29 years) to 0.69 (80-88 years), mean EQ-5D index value ranged from 0.89 (20-29 years) to 0.74 (80-88 years). For different diseases mean RS scores ranged from 0.80 (asthma) to 0.69 (angina pectoris), mean EQ-5D index values ranged from 0.79 (asthma) to 0.66 (low back pain). The mean health state scores (RS and EQ-5D index) were 0.06 lower in the unskilled manual group than in the higher non-manual group after controlling for age and sex (p < 0.0001). This difference was 0.03 after controlling also for different diseases (p < 0.0001). In conclusion, our results show that the HRQoL varies greatly between socio-economic and disease groups. Furthermore, after controlling for age, sex and disease, HRQoL is lower in manual than in non-manual groups.[PUBLICATION ABSTRACT]
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| 6. |
- Burström, Kristina, et al.
(författare)
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The value of the change in health in Sweden 1980/81 to 1996/97
- 2003
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Ingår i: Health economics. - : Wiley. - 1099-1050 .- 1057-9230. ; 12:8, s. 637-654
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Tidskriftsartikel (refereegranskat)abstract
- The study aimed to estimate the value of the change in health in Sweden 1980/81 to 1996/97. Quality-adjusted life years (QALYs) for men and women at specific ages were estimated for 1980/81, 1988/89 and 1996/97, by combining survival rates and health state scores. Data from the Swedish Survey of Living Conditions (n = 39,966) were used to estimate age-specific health state scores. Responses to selected survey questions were mapped into the EQ-5D measure, using the UK EQ-5D index tariff to derive health state scores. The monetary value of a QALY was assumed to be 100,000 dollars. Life expectancy for infants increased by 3.68 years for males and 2.70 years for females between 1980/81 and 1996/97. Average health status decreased in younger age groups whereas it increased in older age groups. Expected QALYs for infants increased by 2.64 for males and 0.54 for females. With 3% discounting the gain was 0.11 QALYs (11,000 dollars) among males and a loss by 0.58 QALYs (58,000 dollars) among females. The corresponding gain in discounted QALYs for a 75-year-old was 1.15 (115,000 dollars) and 0.80 (80,000 dollars), respectively. It is concluded that older persons have experienced considerable health gains whereas the health gains have been small or non-existent for younger women.
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| 7. |
- Diderichsen, Finn, et al.
(författare)
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Differential vulnerability and susceptibility : how to make use of recent development in our understanding of mediation and interaction to tackle health inequalities
- 2019
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 48:1, s. 268-274
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Tidskriftsartikel (refereegranskat)abstract
- This paper discusses the concepts of vulnerability and susceptibility and their relevance for understanding and tackling health inequalities. Tackling socioeconomic inequalities in health is based on an understanding of how an individual's social position influences disease risk. Conceptually, there are two possible mechanisms (not mutually exclusive): there is either some cause(s) of disease that are unevenly distributed across socioeconomic groups (differential exposure) or the effect of some cause(s) of disease differs across groups (differential effect). Since differential vulnerability and susceptibility are often used to denote the latter, we discuss these concepts and their current use and suggest an epidemiologically relevant distinction. The effect of social position can thus be mediated by causes that are unevenly distributed across social groups and/or interact with social position. Recent improvements in the methodology to estimate mediation and interaction have made it possible to calculate measures of relevance for setting targets and priorities in policy for health equity which include both mechanisms, i.e. equalize exposure or equalize effects. We finally discuss the importance of differential susceptibility and vulnerability for the choice of preventive strategies, including approaches that target high-risk individuals, whole populations and vulnerable groups.
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| 8. |
- Diderichsen, Finn, et al.
(författare)
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Gunnar Inghe: A founding father of Scandinavian social medicine and still highly relevant
- 2023
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 51:4, s. 513-516
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Tidskriftsartikel (refereegranskat)abstract
- Gunnar Inghe (1910–1977) was a founding father of Scandinavian social medicine and the first editor of the Scandinavian Journal of Social Medicine. He worked as a physician for social care clients in Stockholm from 1944 to 1961 and was professor in social medicine from 1961 to 1975. We (F.D. and U.J.) were his last two PhD students. As we were recollecting the 50-year history of the Scandinavian Journal of Public Health in 2022, it became evident to us how relevant Gunnar Inghe’s work, 45 years after his death, still is for today’s social medicine, population health research and policy in Scandinavia. We shall explain why with five examples of Inghe’s work: reproductive health, health of paupers, foundation of the discipline, international solidarity and collaboration between medical and social care.
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| 9. |
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| 10. |
- Eek, Frida, et al.
(författare)
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Differences in socioeconomic and gender inequalities in tobacco smoking in Denmark and Sweden; a cross sectional comparison of the equity effect of different public health policies
- 2010
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Denmark and Sweden are considered to be countries of rather similar socio-political type, but public health policies and smoking habits differ considerably between the two neighbours. A study comparing mechanisms behind socioeconomic inequalities in tobacco smoking, could yield information regarding the impact of health policy and -promotion in the two countries. Methods: Cross-sectional comparisons of socioeconomic and gender differences in smoking behaviour among 6 995 Danish and 13 604 Swedish persons aged 18-80 years. Results: The prevalence of smoking was higher in Denmark compared to Sweden. The total attributable fraction (TAF) of low education regarding daily smoking was 36% for Danish men and 35% for Danish women, and 32% and 46%, respectively, for Swedish men and women. TAF of low education regarding continued smoking were 16.2% and 15.8% for Danish men and women, and 11.0% and 18.8% for Swedish men and women, respectively The main finding of the study was that the socioeconomic patterning of smoking, based on level of education and expressed as the relative contribution to the total burden of smoking exposure, was rather different in Sweden and Denmark. Moreover, these differences were modified by gender and age. As a general pattern, socioeconomic differences in Sweden tended to contribute more to the total burden of this habit among women, especially in the younger age groups. In men, the patterns were much more similar between the two countries. Regarding continued smoking/unsuccessful quitting, the patterns were similar for women, but somewhat different for men. Here we found that socioeconomic differences contributed more to overall continued smoking in Danish men, especially in the middle-age and older age strata. Conclusion: The results imply that Swedish anti-smoking policy and/or implemented measures have been less effective in a health equity perspective among the younger generation of women, but more effective among men, compared to Danish policy implementation. The results also raises the more general issue regarding the possible need for a trade-off principle between overall population efficacy versus equity efficacy of anti-tobacco, as well as general public health policies and intervention strategies.
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