| 1. |
- Björkenstam, C., et al.
(author)
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School grades, parental education and suicide : a national register-based cohort study
- 2010
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In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738.
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Journal article (peer-reviewed)abstract
- Background To investigate whether school performance is a risk factor for suicide death later in life and, if so, to what extent this is explained by intergenerational effects of parental education. Methods This population-based cohort study comprises national birth cohorts between 1972 and 1981 in Sweden. We followed 898 342 students, graduating between 1988 and 1997 from the 9 years of compulsory school, equivalent to junior high school, until 31 December 2006, generating 11 148 758 person-years and 1490 suicides. Final school grades, in six categories, and risk of suicide were analysed with Poisson regression. Results The incidence rate ratio (RR) for suicide death for students with the lowest grades was 4.57 (95% CI 2.82 to 7.40) for men and 2.67 (1.42 to 5.01) for women compared to those with highest grades after adjustment for a number of sociodemographic and parental morbidity variables, such as year of graduation, parental education, lone parenthood, household receiving social welfare or disability pension, place of schooling, adoption, maternal age and parent's mental illness. Students with grades in the middle categories had RRs in between. These relationships were not modified by parental education. Conclusions The strong association between low school grades and suicide in youth and young adulthood emphasises the importance of both primary and secondary prevention in schools.
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| 2. |
- Haider, S I, et al.
(author)
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The influence of educational level on polypharmacy and inappropriate drug use : a register-based study of over 600,000 older people
- 2009
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In: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 57:1, s. 62-69
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Journal article (peer-reviewed)abstract
- To investigate whether low educational attainment is associated with polypharmacy and potential inappropriate drug use (IDU) in older people. Cross-sectional register-based study. Sweden. Older people aged 75 to 89 who, filled at least one drug prescription between August and October 2005 and, consequently, were listed in the Swedish Prescribed Drug Register (SPDR) (N=626,258). Data were obtained from the SPDR, the inpatient register, and the education register. The main outcome measures were polypharmacy (concurrent use of >= 5 drugs), excessive polypharmacy (concurrent use of >= 10 drugs), and potential IDU. Four quality indicators developed by the Swedish National Board of Health and Welfare were used for the assessment of potential IDU: concurrent use of three or more psychotropic drugs, prescription of long-acting benzodiazepines, prescription of anticholinergics, and at least one clinically relevant potential drug-drug interaction (DDI). Comorbidity was measured using the Charlson Comorbidity Index. Subjects with low education had a higher probability of polypharmacy (odds ratio (OR)=1.11, 95% confidence interval (CI)=1.10-1.12), excessive polypharmacy (OR=1.15, 95% CI=1.13-1.17), and potential IDU (OR=1.09, 95% CI=1.07-1.17), after adjustment for age, sex, comorbidity, and type of residential area (urban or rural). Decreasing educational attainment was associated with a higher probability of using three or more psychotropic drugs and potential DDIs, whereas the opposite association was observed for anticholinergic drugs. Long-acting benzodiazepines showed no association. Elderly women with low education were slightly more likely to have polypharmacy, excessive polypharmacy, and potential IDU than men with low education. Overall, the ORs were modest and statistically significant because of the large sample size. Low educational attainment was associated with a greater likelihood of poypharmacy, excessive polypharmacy, and potential IDU in elderly Swedish persons, even after controlling for age, sex, place of residence, and comorbidity. Women with low education had slightly higher likelihood of receiving polypharmacy and potential IDU than men with low education. The recently established SPDR may be useful for continuous monitoring and for designing interventions to improve drug quality in low-educated elderly people.
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| 3. |
- Henriksson, Göran, et al.
(author)
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Are manual workers at higher risk of death than non-manual employees when living in Swedish municipalities with higher income inequality?
- 2007
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In: Eur J Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 17:2, s. 139-44
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To test the hypothesis that manual workers are at higher risk of death than are non-manual employees when living in municipalities with higher income inequality. DESIGN: Hierarchical regression was used for the analysis were individuals were nested within municipalities according to the 1990 Swedish census. The outcome was all-cause mortality 1992-1998. The income measure at the individual level was disposable family income weighted against composition of family; the income inequality measure used at the municipality level was the Gini coefficient. PARTICIPANTS: The study population consisted of 1 578 186 people aged 40-64 years in the 1990 Swedish census, who were being reported as unskilled or skilled manual workers, lower-, intermediate-, or high-level non-manual employees. RESULTS: There was no significant association between income inequality at the municipality level and risk of death, but an expected gradient with unskilled manual workers having the highest risk and high-level non-manual employees having the lowest. However, in the interaction models the relative risk (RR) of death for high-level non-manual employees was decreasing with increasing income inequality (RR = 0.77; 95% CI, 0.63-0.93), whereas the corresponding risk for unskilled manual workers increased with increasing income inequality (RR = 1.24; 95% CI, 1.06-1.46). The RRs for skilled manual, low- and medium- level non-manual employees were not significant. Controlling for income at the individual level did not substantially alter these findings, neither did potential confounders at the municipality level. CONCLUSIONS: The findings suggest that there could be a differential impact from income inequality on risk of death, dependent on individuals' social position.
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| 4. |
- Henriksson, Göran, et al.
(author)
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Income distribution and mortality: implications from a comparison of individual-level analysis and multilevel analysis with Swedish data
- 2006
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In: Scand J Public Health. - : SAGE Publications. - 1403-4948. ; 34:3, s. 287-94
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Journal article (peer-reviewed)abstract
- BACKGROUND: This follow-up study analyses whether there is an association between income distribution in Swedish municipalities and risk of death from all causes in the total Swedish population aged 40-64 years and compares the results obtained with analyses performed on individual-level analysis and multilevel analysis. METHODS: Individual-level data on social and economic circumstances were obtained from various official records and were linked to the national cause-of-death register. Analyses were made with two methods, an individual-level regression and a multilevel regression. The study population comprised all people 40-64 years of age in the 1990 Swedish census, altogether 2.57 million people in 284 municipalities. RESULTS: The main results showed that in the individual-level regression the income distribution showed a positive and significant association (risk ratio = 1.29; 95% CI = 1.24-1.34) with higher mortality for those living in municipalities with higher income inequality. This association was not found in the multilevel regression analysis (RR = 1.03; 95%CI = 0.94-1.13). CONCLUSION: There seems to be no association between income distribution and mortality in Sweden when considering the possibility of clustering in municipalities. Further studies on the relationship between income inequality and health should aim at elucidate processes within area-level units.
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| 5. |
- Hjern, Anders, et al.
(author)
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Social adversity predicts ADHD-medication in school children – a national cohort study
- 2010
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:6, s. 920-924
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Journal article (peer-reviewed)abstract
- Aims: To test the hypothesis that psychosocial adversity in the family predicts medicated ADHD in school children. Method: ADHD-medication during 2006 was identified in the Swedish Prescribed Drug Register in national birth cohorts of 1.1 million 6–19 year olds. Logistic regression models adjusted for parental psychiatric disorders were used to test our hypothesis. Results: There was a clear gradient for ADHD medication with level of maternal education, with an adjusted odds ratio of 2.20 (2.04–2.38) for the lowest compared with the highest level. Lone parenthood and reception of social welfare also implied higher risks of ADHD-medication with adjusted ORs of 1.45 (1.38–1.52) and 2.06 (1.92–2.21) respectively. Low maternal education predicted 33% of cases with medicated ADHD and single parenthood 14%. Conclusions: Social adversity in the family predicts a considerable proportion of ADHD-medication in school children in Sweden.
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