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- Döring, Nora, et al.
(författare)
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Labour market position of young people and premature mortality in adult life : A 26-year follow-up of 569 528 Swedish 18 year-olds
- 2021
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Ingår i: The Lancet Regional Health. - : Elsevier BV. - 2666-7762. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Throughout the industrialized world, demand for low skilled labour is falling. The length of schooling is increasing in response, but so is the proportion of individuals not finishing upper secondary school. The objective of this study was to evaluate the associations between labour market positions at age 18 and all-cause and suicide- and accident-specific mortality in later adulthood.Methods: Labour market positions at age 18 were categorized for all Swedes born 1972-77 (n=630 959) into four main groups: employed, successful students, students not about to qualify (SNAQs), and individuals not in employment, education or training (NEETs). Cox proportional hazard models were fitted to assess allcause, suicide and accident mortality up to 2016 (ages 39-44), adjusting for high school grades, parental and own prior psychiatric diagnoses, and childhood socioeconomic status.Findings: SNAQs had substantially increased all-cause (men: HR=2.10; 95% CI 1.92-2.28, women: HR=1.64; 95% CI: 1.44-1.86), suicide (men: HR=2.16; CI: 1.86-2.51, women: HR=2.10; 95% CI 1.64-2.69), and accident specific (men: HR=2.08; 95% CI 1.77-2.44, women: 1.87; 95% CI 1.33;2.62) mortality risks compared to successful students. The risks were similar for NEETs. There was no increased risk among full-time employed compared to successful students.Interpretation: Expanding the educational system may be a natural response to falling demand for low skilled labour but not by far one that corrects the major societal challenge of it. Unless educational systems adequately respond to this challenge, only more inequality is to be expected ahead.
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- Gong, Tong, et al.
(författare)
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Perinatal exposure to traffic-related air pollution and autism spectrum disorders
- 2016
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Ingår i: Environmental Health Perspectives. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 0091-6765. ; 125:1, s. 119-126
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies from the United States indicate that exposure to air pollution in early life is associated with autism spectrum disorders (ASD) in children, but the evidence is not consistent with European data. Objective: We aimed to investigate the association between exposure to air pollution from road traffic and the risk of ASD in children, with careful adjustment for socioeconomic and other confounders. Method: Children born and residing in Stockholm, Sweden, during 1993–2007 with an ASD diagnosis were identified through multiple health registers and classified as cases (n = 5,136). A randomly selected sample of 18,237 children from the same study base constituted controls. Levels of nitrogen oxides (NOx) and particulate matter with diameter ≤ 10 μm (PM10) from road traffic were estimated at residential addresses during mother’s pregnancy and the child’s first year of life by dispersion models. Odds ratios (OR) and 95% confidence intervals (CI) for ASD with or without intellectual disability (ID) were estimated using logistic regression models after conditioning on municipality and calendar year of birth as well as adjustment for potential confounders. Result: Air pollution exposure during the prenatal period was not associated with ASD overall (OR = 1.00; 95% CI: 0.86, 1.15 per 10-μg/m3 increase in PM10 and OR = 1.02; 95% CI: 0.94, 1.10 per 20-μg/m3 increase in NOx during mother’s pregnancy). Similar results were seen for exposure during the first year of life, and for ASD in combination with ID. An inverse association between air pollution exposure and ASD risk was observed among children of mothers who moved to a new residence during pregnancy. Conclusion: Early-life exposure to low levels of NOx and PM10 from road traffic does not appear to increase the risk of ASD.
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- Hollander, Anna-Clara, et al.
(författare)
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Validation study of randomly selected cases of PTSD diagnoses identified in a Swedish regional database compared with medical records : is the validity sufficient for epidemiological research?
- 2019
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In Sweden, the patients' diagnoses are recorded in administrative registers. The research value of these registers is determined by their diagnostic validity, that is, if the diagnosis recorded meets the relevant diagnostic criteria. The aim of the study was to assess the validity of post-traumatic stress disorder (PTSD)-diagnoses as compared with case notes in medical records (MRs) and to test if there was a difference in validity by gender, migration status and those with and without psychotic symptoms. We hypothesised that the validity would be sufficient, using both Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and DSM-5 but higher according to DSM-IV than DSM-5, and that the validity would be the same for men and women, but different for Swedish-born and migrants, and for those with and without psychotic symptoms.DESIGN AND SETTING: A validation of the register-diagnoses using MRs from treatment centres within the Region of Stockholm to examine whether patients with a register-diagnosis of PTSD fulfilled DSM criteria of PTSD according to the case notes in their MRs.PARTICIPANTS: A random sample of 187 patients aged 18-64, who had been diagnosed with PTSD (F43.1 in the ICD-10) were drawn from the Region of Stockholm's MR database 2013-2015.PRIMARY OUTCOME MEASURE: Validity of the PTSD diagnoses according to DSM-IV and DSM-5 as proportions of true positives with 95% CI.RESULTS: The hypothesised sufficient validity of the PTSD diagnoses was confirmed. Although the point-estimates for DSM-IV were higher than for DSM-5, the hypothesis that there would be significant differences in validity between DSM-IV and DSM-5 was not confirmed. There were no significant validity differences by gender, migration status and for those with and without psychotic symptoms.CONCLUSIONS: This study has found that validity of the PTSD diagnoses in the register of the Region of Stockholm to be sufficient for epidemiological research.
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- Seblova, Dominika, et al.
(författare)
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Thirty-year trends in dementia : a nationwide population study of Swedish inpatient records
- 2018
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Ingår i: Clinical Epidemiology. - 1179-1349. ; 10, s. 1679-1693
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Tidskriftsartikel (refereegranskat)abstract
- Background: The continuous growth of the current dementia epidemic is contingent on the stability of age- and sex-specific trends over time. However, recent evidence suggests declining or stable trends. The aim of this study was to evaluate the real-world changes in the burden of dementia in older adults in Sweden from 1987 to 2016 by estimating age- and sex-specific incidence of dementia diagnosis in hospital inpatient records (dementia incidence). Differences in trends by sex, age, and educational levels were also examined. Methods: The entire Swedish population aged 65 years and older was followed up from 1987 to 2016. Age-, sex-, and education-stratified dementia incidence rates for every follow-up year were estimated using the National Patient Register. Hazard ratio of receiving a dementia diagnosis in the inpatient records per 1 calendar year increase was estimated with discrete time logistic models with a complementary log-log link. Results: After increase, especially in those >85 years of age, dementia incidence started to decrease in the last 5 years of the study period. After 2011, 1 calendar year increase was associated with lower hazard ratio of receiving a hospital diagnosis of dementia. The decrease had the highest magnitude in 70-74-year-olds (5.5%), followed by 75-79-year-olds (-4.5%) and 80-84-year-olds (-4.0%). The decrease was present in both sexes and at all educational levels up to 90 years of age. Age was associated with the level of dementia incidence, and the trends differed by age group. Educational gradient was observed. University-educated older adults had the lowest rates of dementia. However, the trend over time did not substantially differ by sex or educational level. Conclusion: Our results provide more evidence that dementia incidence may be declining. They also suggest that at least in hospitals, the number of new patients with dementia may decrease in the future.
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- Wicks, Susanne
(författare)
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Socioeconomic disadvantage in childhood and later risk of schizophrenia and other psychoses : national register-based studies
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim of this thesis was to analyse the association between various types of indicators of socioeconomic disadvantage in childhood and the risk of later developing schizophrenia and other psychoses. Furthermore, the importance of socioeconomic disadvantage was explored in relation to immigration, school performance, and an indicator of genetic liability for psychosis. Methods: The study populations were based on register linkages of several Swedish registers. They were identified in the Multi-Generation Register and were followed in the National Patient Register regarding admissions for schizophrenia and other psychoses. Exposure of up to seven different indicators of childhood socioeconomic disadvantage (housing, single-parent household, parental socioeconomic classification, parental employment, households receiving social welfare benefits, parental early retirement, and parental education) was obtained via linkage to the national Population and Housing Censuses performed every 5 years between 1960 and 1990, and the Income and Taxation Registers. School performance data was obtained via the School Register. Hazard Ratios were estimated by multivariate Cox proportional hazard models. Results: Five of seven indicators of childhood socioeconomic disadvantage were associated with later risk of schizophrenia and other psychoses (fully adjusted HRs from 1.2 to 1.7) (study I-IV). The risks increased with increasing number of exposures to the different indicators of socioeconomic disadvantage (study I, IV). First and second generation immigrants had increased risks for schizophrenia and other psychoses (HRs 1.4-3.1 and 1.0-2.0 respectively), compared with the Swedish majority population. These risks decreased considerably after adjusting for indicators of socioeconomic disadvantage (study II). In an adoption design (study III) both indicators of genetic liability (HR=4.7) and disadvantaged socioeconomic position (HRs 1.2-2.0) were independently associated with an increased risk for non-affective psychosis. The risk was considerably higher among adoptees exposed to both types of indicators (HRs from 5.7 to 15.0). Synergy indexes were larger than 1 (3.2, 2.6, 1.2). In study IV, risks were increased for schizophrenia (HR=1.9), other non-affective psychoses (HR=3.0), and affective psychoses (HR=2.3) in association with poor average grade, compared with those with a midrange average grade at graduation from compulsory school. Adjustments for socioeconomic position of the family reduced these estimates marginally (schizophrenia: HR=1.7, other non-affective psychoses: HR=2.8, affective psychoses: HR=2.1). Conclusion: The results indicate that socioeconomic disadvantage during childhood or foetal life contributes to the risk of developing schizophrenia and other psychoses. Furthermore, this risk may even be relatively higher in individuals with a genetic liability for psychosis. Thus, influencing the social situation in childhood may have beneficial effects on the occurrence of psychosis. Socioeconomic disadvantage may also contribute to the increased risk of psychoses in immigrants. However, childhood socioeconomic disadvantage did not substantially affect the risk of psychoses associated with low school performance. In summary, there is support for social disadvantage in the aetiology of psychosis. This knowledge may open up for preventive methods on a societal level, perhaps targeting vulnerable groups as immigrants and individuals with genetic liability.
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