| 1. |
- Agardh, Emilie E., et al.
(författare)
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Alcohol and type 2 diabetes : The role of socioeconomic, lifestyle and psychosocial factors
- 2019
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 47:4, s. 408-416
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: We investigate (a) alcohol consumption in association with type 2 diabetes, taking heavy episodic drinking (HED), socioeconomic, health and lifestyle, and psychosocial factors into account, and (b) whether a seemingly protective effect of moderate alcohol consumption on type 2 diabetes persists when stratified by occupational position.METHODS: This population-based longitudinal cohort study comprises 16,223 Swedes aged 18-84 years who answered questionnaires about lifestyle, including alcohol consumption in 2002, and who were followed-up for self-reported or register-based diabetes in 2003-2011. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated in a multivariable-adjusted logistic regression model for all participants and stratified by high and low occupational position. We adjusted for HED, socioeconomic (occupational position, cohabiting status and unemployment), health and lifestyle (body mass index (BMI), blood pressure, smoking, physical inactivity, poor general health, anxiety/depression and psychosocial (low job control and poor social support) characteristics one by one, and the sets of these factors.RESULTS: Moderate consumption was inversely associated with type 2 diabetes after controlling for health and lifestyle (OR=0.47; 95% CI: 0.29-0.79) and psychosocial factors (OR=0.40; 95% CI: 0.22-0.79) when compared to non-drinkers. When adjusting for socioeconomic factors, there was still an inverse but non-significant association (OR=0.59; 95% CI: 0.35-1.00). In those with high occupational position, there was no significant association between moderate consumption and type 2 diabetes after adjusting for socioeconomic (OR=0.67; 95% CI: 0.3-1.52), health and lifestyle (OR=0.70; 95% CI: 0.32-1.5), and psychosocial factors (OR=0.75; 95% CI: 0.23-2.46). On the contrary, in those with low occupational position, ORs decreased from 0.55 (95% CI: 0.28-1.1) to 0.35 (95% CI: 0.15-0.82) when adjusting for psychosocial factors, a decrease that was solely due to low job control. HED did not influence any of these associations.CONCLUSIONS: Moderate alcohol consumption is associated with a lower risk of type 2 diabetes, after adjusting for HED, health and lifestyle, and psychosocial characteristics. The association was inverse but non-significant after adjusting for socioeconomic factors. When stratified by occupational position, there was an inverse association only in those with low occupational position and after adjusting for low job control.
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| 2. |
- Ahmed, Arif, et al.
(författare)
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Consumption of fruit and vegetables and the risk of type 2 diabetes : a 4-year longitudinal study among Swedish adults
- 2020
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Ingår i: Journal of Nutritional Science. - : Cambridge University Press (CUP). - 2048-6790. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- A low intake of fruit and vegetables is a significant contributor to the global burden of disease. The aim of this study was to estimate the size of the risk of type 2 diabetes (T2D) of a low intake and to investigate possible sex differences. In this regard, this study used a longitudinal data from the Stockholm Public Health Cohort located in Sweden, collected in 2010 and 2014. The analysis included 14 718 men and 20 589 women aged 25 to 84 years. Fruit and vegetable intake, separately <2 servings/d or combined <4 servings/d (one serving corresponding to 100 g) was set as a cut-point for low intake. The sex difference at baseline was examined. Sex-stratified logistic regression was performed with onset of T2D as the outcome and fruit and vegetable intake at baseline as the exposure with adjustment for other known risk factors. Results indicate that men consumed significantly (P < 0.001) less fruit and vegetables compared with women. A 62 % higher risk to develop T2D over the 4-year period was observed in men who had low vegetable intake compared with high intake after adjusting for age, education, BMI, smoking, alcohol and physical activity (OR 1.62; 95 % CI 1.00, 2.63). In women, a significantly higher risk of T2D was also observed with a low intake of vegetables, but not after adjustment. The present study suggests that higher consumption of vegetables seems to be protective for the onset of T2D in men. Thus, increasing the intake of vegetables in men should be a public health priority.
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| 3. |
- Ahrén, Jennie, et al.
(författare)
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Ungdomars psykosociala hälsa
- 2012
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Ingår i: Den orättvisa hälsan. - Stockholm : Liber. - 9789147099757
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Araghi, Marzieh, et al.
(författare)
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No association between moist oral snuff (snus) use and oral cancer : pooled analysis of nine prospective observational studies
- 2021
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 49:8, s. 833-840
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Worldwide, smokeless-tobacco use is a major risk factor for oral cancer. Evidence regarding the particular association between Swedish snus use and oral cancer is, however, less clear. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between snus use and oral cancer.Methods: A total of 418,369 male participants from nine cohort studies were followed up for oral cancer incidence through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors.Results: During 9,201,647 person-years of observation, 628 men developed oral cancer. Compared to never-snus use, ever-snus use was not associated with oral cancer (adjusted HR 0.90, 95% CI: 0.74, 1.09). There were no clear trends in risk with duration or intensity of snus use, although lower intensity use (<= 4 cans/week) was associated with a reduced risk (HR 0.65, 95% CI: 0.45, 0.94). Snus use was not associated with oral cancer among never smokers (HR 0.87, 95% CI: 0.57, 1.32).Conclusions: Swedish snus use does not appear to be implicated in the development of oral cancer in men.
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| 5. |
- Araghi, Marzieh, et al.
(författare)
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Smokeless tobacco (snus) use and colorectal cancer incidence and survival : Results from nine pooled cohorts
- 2017
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 45:8, s. 741-748
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association.METHODS: A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).RESULTS: During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis.CONCLUSIONS: Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention.
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| 6. |
- Araghi, Marzieh, et al.
(författare)
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Use of moist oral snuff (snus) and pancreatic cancer : Pooled analysis of nine prospective observational studies
- 2017
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 141:4, s. 687-693
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Tidskriftsartikel (refereegranskat)abstract
- While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between Swedish snus use and the risk of pancreatic cancer. A total of 424,152 male participants from nine cohort studies were followed up for risk of pancreatic cancer through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. During 9,276,054 person-years of observation, 1,447 men developed pancreatic cancer. Compared to never-snus use, current snus use was not associated with risk of pancreatic cancer (HR 0.96, 95% CI 0.83-1.11) after adjustment for smoking. Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer. What's new? While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. Smokeless tobacco like snus yields lower exposure to tobacco carcinogens compared with smoking, because it does not undergo combustion, but delivers an equivalent dose of nicotine. Using pooled individual data from the Swedish Collaboration on Health Effects of Snus Use, here the authors show that Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer.
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| 7. |
- Arefalk, Gabriel, et al.
(författare)
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Smokeless Tobacco (Snus) and Risk of Heart Failure of Ischemic and Non-Ischemic Origin: a Pooled Analysis of Eight Prospective Cohort Studies
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundSnus, a Swedish type of smokeless tobacco, has potent acute hemodynamic effects, which could provoke stress on the cardiovascular system, including the myocardium. Snus has, however, not been linked to risk of ischemic heart disease. Therefore, we hypothesized that snus use increases the risk for heart failure of non-ischemic origin.MethodsWe conducted a pooled analysis of eight Swedish prospective cohort studies involving individual participant data from 350,711 men. Shared frailty models with random effects at the cohort level, were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs) of heart failure in relation to snus use. We investigated dose-response associations, and association with ischemic and non-ischemic heart failure in separate. For positive control purposes, we also investigated associations between smoking and risk of heart failure.ResultsDuring a median follow-up time of 16 years, 5,404 men were hospitalized for heart failure. In models adjusting for age, smoking, previous myocardial infarction and educational level, current snus use was associated with a higher risk of heart failure (HR 1.27, 95 % CI 1.07-1.50), relative to non-current snus use. A dose-response pattern was observed, with higher risk with more snus cans used per week. We observed an association of snus use with non-ischemic heart failure, HR 1.34 (95 % CI 1.11-1.63), but not with ischemic heart failure, HR 1.01 (95 % CI 0.72-1.42). Smoking was more strongly associated with heart failure, particularly of ischemic origin, than snus use.ConclusionsSnus use was associated with a modestly increased risk for heart failure of non-ischemic origin in a dose-response manner. This finding has public health implications for the risk assessment of snus use, and potentially other modes of smokeless use of nicotine.
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| 8. |
- Bell, Max, et al.
(författare)
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Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic : a population-based cohort study
- 2023
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Ingår i: BMC Medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The coronavirus disease 2019 (COVID-19) disproportionately affects minority populations in the USA. Sweden — like other Nordic countries — have less income and wealth inequality but lacks data on the socioeconomic impact on the risk of adverse outcomes due to COVID-19.Methods: This population-wide study from March 2020 to March 2022 included all adults in Stockholm, except those in nursing homes or receiving in-home care. Data sources include hospitals, primary care (individual diagnoses), the Swedish National Tax Agency (death dates), the Total Population Register “RTB” (sex, age, birth country), the Household Register (size of household), the Integrated Database For Labor Market Research “LISA” (educational level, income, and occupation), and SmiNet (COVID data). Individual exposures include education, income, type of work and ability to work from home, living area and living conditions as well as the individual country of origin and co-morbidities. Additionally, we have data on the risks associated with living areas. We used a Cox proportional hazards model and logistic regression to estimate associations. Area-level covariates were used in a principal component analysis to generate a measurement of neighborhood deprivation. As outcomes, we used hospitalization and death due to COVID-19.Results: Among the 1,782,125 persons, male sex, comorbidities, higher age, and not being born in Sweden increase the risk of hospitalization and death. So does lower education and lower income, the lowest incomes doubled the risk of death from COVID-19. Area estimates, where the model includes individual risks, show that high population density and a high percentage of foreign-born inhabitants increased the risk of hospitalization.Conclusions: Segregation and deprivation are public health issues elucidated by COVID-19. Neighborhood deprivation, prevalent in Stockholm, adds to individual risks and is associated with hospitalization and death. This finding is paramount for governments, agencies, and healthcare institutions interested in targeted interventions.
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| 9. |
- Berglind, Daniel, et al.
(författare)
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The influence of the COVID-19 pandemic on physical activity in Stockholm County : Evidence from time series models of smartphone measured daily steps data spanning over 3 years
- 2024
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Ingår i: Preventive Medicine. - : Elsevier Inc. - 1096-0260 .- 0091-7435. ; 183
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Tidskriftsartikel (refereegranskat)abstract
- It has been reported that physical activity levels decreased during the COVID-19 pandemic. Previous studies often relied on self-reported physical activity, which has low accuracy. Studies based on objectively measured physical activity have had short data collection periods, thereby not allowing the consideration of pre-pandemic levels of physical activity or the influence over the different waves of the pandemic. In this study, we utilize smartphone-measured step data from a nonprobability sample in Stockholm County, Sweden, where measures to limit the spread of COVID-19 differed from those in many other countries. The results are based on 522 individuals and 532,739 person-days with step data spanning from 2019 to 2021. Generalized additive models were fitted for each individual, and meta-regression was used to combine the results from individual models. Daily steps decreased during the first wave but increased during the third wave compared to individual pre-pandemic levels. The decrease in daily steps occurred primarily in young individuals and those with occupations allowing remote work. Individuals of retirement age on the contrary increased their daily steps during the same period. This study reveal that the influence of the COVID-19 pandemic was temporary and that younger age and the possibility of working from home were associated with a decreasing trend in physical activity. •Using mobile phone derived daily steps data over three years.•Negative influence of Covid-19-pandemic on walking steps only exists during the early stage of the pandemic.•Being younger and having the possibility of working from home are associated with fewer steps per day.•Individual modeling with meta-analysis is an ideal method for large scale physical activity studies.
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| 10. |
- Bremberg, Sven, et al.
(författare)
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Övergång från skola till arbete
- 2010
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Ingår i: Investera i barns hälsa. - Stockholm : Gothia. ; , s. 162-170
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 11. |
- Byhamre, Marja Lisa, et al.
(författare)
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Swedish snus use is associated with mortality : a pooled analysis of eight prospective studies
- 2020
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Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 49:6, s. 2041-2050
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The health consequences of the use of Swedish snus, including its relationship with mortality, have not been fully established. We investigated the relationship between snus use and all-cause and cause-specific mortality (death due to cardiovascular diseases, cancer diseases and all other reasons, respectively) in a nationwide collaborative pooling project.METHODS: We followed 169 103 never-smoking men from eight Swedish cohort studies, recruited in 1978-2010. Shared frailty models with random effects at the study level were used in order to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of mortality associated with snus use.RESULTS: Exclusive current snus users had an increased risk of all-cause mortality (aHR 1.28, 95% CI 1.20-1.35), cardiovascular mortality (aHR 1.27, 95% CI 1.15-1.41) and other cause mortality (aHR 1.37, 95% CI 1.24-1.52) compared with never-users of tobacco. The risk of cancer mortality was also increased (aHR 1.12, 95% CI 1.00-1.26). These mortality risks increased with duration of snus use, but not with weekly amount.CONCLUSIONS: Snus use among men is associated with increased all-cause mortality, cardiovascular mortality, with death from other causes and possibly with increased cancer mortality.
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| 12. |
- Chen, Jie, et al.
(författare)
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Long-term exposure to ambient air pollution and bladder cancer incidence in a pooled European cohort : the ELAPSE project
- 2022
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 126:10, s. 1499-1507
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Tidskriftsartikel (refereegranskat)abstract
- Background: The evidence linking ambient air pollution to bladder cancer is limited and mixed.Methods: We assessed the associations of bladder cancer incidence with residential exposure to fine particles (PM2.5), nitrogen dioxide (NO2), black carbon (BC), warm season ozone (O3) and eight PM2.5 elemental components (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc) in a pooled cohort (N = 302,493). Exposures were primarily assessed based on 2010 measurements and back-extrapolated to the baseline years. We applied Cox proportional hazard models adjusting for individual- and area-level potential confounders.Results: During an average of 18.2 years follow-up, 967 bladder cancer cases occurred. We observed a positive though statistically non-significant association between PM2.5 and bladder cancer incidence. Hazard Ratios (HR) were 1.09 (95% confidence interval (CI): 0.93–1.27) per 5 µg/m3 for 2010 exposure and 1.06 (95% CI: 0.99–1.14) for baseline exposure. Effect estimates for NO2, BC and O3 were close to unity. A positive association was observed with PM2.5 zinc (HR 1.08; 95% CI: 1.00–1.16 per 10 ng/m3).Conclusions: We found suggestive evidence of an association between long-term PM2.5 mass exposure and bladder cancer, strengthening the evidence from the few previous studies. The association with zinc in PM2.5 suggests the importance of industrial emissions.
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| 13. |
- 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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| 14. |
- Gebreslassie, Mihretab, et al.
(författare)
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Should Nicotine Replacement Therapy be Provided Free of Charge? : A Cost-Utility Analysis in Sweden
- 2023
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Ingår i: Nicotine & tobacco research. - : Oxford University Press. - 1462-2203 .- 1469-994X. ; 25:11, s. 1762-1769
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Treatment with nicotine replacement therapy (NRT) during an attempt to quit smoking increases the likelihood of success by about 55%. However, out-of-pocket payment for NRT can hinder its use. Aims and Methods This study aims therefore to assess the cost-effectiveness of subsidizing NRT in Sweden. A homogeneous cohort-based Markov model was used to assess the lifetime costs and effects of subsidized NRT from a payer and societal perspective. Data to populate the model were retrieved from the literature, and selected parameters were varied in deterministic and probabilistic sensitivity analyses to assess robustness of model outputs. Costs are presented in USD, year 2021. Results A 12-week treatment with NRT was estimated to cost USD 632 (474-790) per person. From a societal perspective, subsidized NRT was a cost-saving alternative in 98.5% of the simulations. NRT is cost-saving across all ages, but the health and economic gains are somewhat larger among younger smokers from a societal perspective. When a payer perspective was used, the incremental cost-effectiveness ratio was estimated at 14 480 (11 721-18 515) USD per QALY which was cost-effective at a willingness to pay of 50 000 USD per QALY in 100 % of the simulations. Results were robust with realistic changes in the inputs during scenario and sensitivity analyses. Conclusions Subsidizing NRT is potentially a cost-saving smoking cessation strategy from a societal perspective and cost-effective from a payer perspective. Implications This study found that subsidizing NRT is potentially a cost-saving smoking cessation policy alternative compared to current practice from a societal perspective. From a healthcare payer perspective, subsidizing NRT is estimated to cost USD 14 480 to gain an extra QALY. NRT is cost-saving across all ages, but the health and economic gains are somewhat larger among younger smokers from a societal perspective. Moreover, subsidizing NRT removes the financial barriers that are mostly faced by socioeconomically disadvantaged smokers which might reduce health inequalities. Thus, future economic evaluations should further investigate the health inequality impacts with methods that are more suitable for this.
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| 15. |
- Gudjonsdottir, Hrafnhildur, et al.
(författare)
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Cohort Profile : The Stockholm Diabetes Prevention Programme (SDPP)
- 2022
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 51:6, s. e401-e413
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Tidskriftsartikel (refereegranskat)abstract
- The Stockholm Diabetes Prevention Programme (SDPP) was established in the mid-1990s as a baseline for a community-based intervention aimed at primary prevention of type 2 diabetes (T2D). The intervention was found to be ineffective, but the cohort continues to contribute to our understanding of the pathogenesis of T2D and cardiometabolic risk factors.The cohort comprises 15 070 men and 19 416 women, born between 1938 and 1961, resident in five municipalities in Stockholm County, Sweden, at baseline. A sub-cohort answered a screening survey (10 236 men and 16 481 women), and a sub-cohort of those participated in a clinical examination (3128 men and 4821 women) at baseline (clinical cohort).The clinical cohort has been followed up after 10 years, when 2383 men and 3329 women participated, and after 20 years, when 1752 men and 2545 women participated.Socioeconomic, demographic and health-related register information was collected for all. The screening survey contains self-reported information on own and familial T2D. For the clinical cohort, we conducted oral glucose tolerance tests, drew blood and took blood pressures and anthropometric measurements. The participants also filled in questionnaires on lifestyle and psychosocial conditions.Data are available on request after ethical approval; information is available on the study webpage [Stockholm-Diabetes-Prevention-Programme-(SDPP)(regionstockholm.se)].
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| 16. |
- Hvidtfeldt, Ulla Arthur, et al.
(författare)
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Long term exposure to air pollution and kidney parenchyma cancer – Effects of low-level air pollution : a Study in Europe (ELAPSE)
- 2022
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Ingår i: Environmental Research. - : Academic Press Inc.. - 0013-9351 .- 1096-0953. ; 215
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Particulate matter (PM) is classified as a group 1 human carcinogen. Previous experimental studies suggest that particles in diesel exhaust induce oxidative stress, inflammation and DNA damage in kidney cells, but the evidence from population studies linking air pollution to kidney cancer is limited.METHODS: We pooled six European cohorts (N = 302,493) to assess the association of residential exposure to fine particles (PM2.5), nitrogen dioxide (NO2), black carbon (BC), warm season ozone (O3) and eight elemental components of PM2.5 (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc) with cancer of the kidney parenchyma. The main exposure model was developed for year 2010. We defined kidney parenchyma cancer according to the International Classification of Diseases 9th and 10th Revision codes 189.0 and C64. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level.RESULTS: The participants were followed from baseline (1985–2005) to 2011–2015. A total of 847 cases occurred during 5,497,514 person-years of follow-up (average 18.2 years). Median (5–95%) exposure levels of NO2, PM2.5, BC and O3 were 24.1 μg/m3 (12.8–39.2), 15.3 μg/m3 (8.6–19.2), 1.6 10−5 m−1 (0.7–2.1), and 87.0 μg/m3 (70.3–97.4), respectively. The results of the fully adjusted linear analyses showed a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 0.92, 1.15) per 10 μg/m³ NO2, 1.04 (95% CI: 0.88, 1.21) per 5 μg/m³ PM2.5, 0.99 (95% CI: 0.89, 1.11) per 0.5 10−5 m−1 BCE, and 0.88 (95% CI: 0.76, 1.02) per 10 μg/m³ O3. We did not find associations between any of the elemental components of PM2.5 and cancer of the kidney parenchyma.CONCLUSION: We did not observe an association between long-term ambient air pollution exposure and incidence of kidney parenchyma cancer.
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| 17. |
- Lager, Anton, et al.
(författare)
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A Pragmatic Approach to Evidence-Based Public Health Policy
- 2012
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Ingår i: Open Public Health Journal. - : Bentham Science Publishers Ltd.. - 1874-9445. ; 5, s. 70-73
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Tidskriftsartikel (refereegranskat)abstract
- The evidence-based approach is a means to improve the quality, safety and cost-effectiveness of the public sec-tor as a whole, not only the health service. But to be successful, the evidence-based approach needs to be restricted to the stage of the policy process where it really can make a contribution; namely in the choice of intervention. In the policy pro-cess phase that precedes the choice of intervention, i.e. the problem formulation phase, there can by definition be no "evi-dence" available, since no controlled trials can ever prove that one problem is bigger than another. Further, the policy pro-cess phase following the choice of intervention, i.e. the implementation phase, is to date still restricted to research of weaker design and the policy makers need to consider input from many different sources also here. A pragmatic approach, focusing the choice of intervention phase of the policy process, has proved successful in the dissemination of an evidence-based policy for parenting support in Sweden.
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| 18. |
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| 19. |
- Lager, Anton Carl Jonas, et al.
(författare)
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Causal effect of education on mortality in a quasi-experiment on 1.2 million Swedes
- 2012
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Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : Proceedings of the National Academy of Sciences. - 0027-8424 .- 1091-6490. ; 109:22, s. 8461-8466
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Tidskriftsartikel (refereegranskat)abstract
- In 1949-1962, Sweden implemented a 1-y increase in compulsory schooling as a quasi-experiment. Each year, children in a number of municipalities were exposed to the reform and others were kept as controls, allowing us to test the hypothesis that education is causally related to mortality. We studied all children born between 1943 and 1955, in 900 Swedish municipalities, with control for birth-cohort and area differences. Primary outcome measures are all-cause and cause-specific mortality until the end of 2007. The analyses include 1,247,867 individuals, of whom 92,351 died. We found lower all-cause mortality risk in the experimental group after age 40 [hazard ratio (HR) = 0.96, 95% confidence interval (CI) 0.93-0.99] but not before (HR = 1.03, 95% CI 0.98-1.07) or during the whole follow-up (HR = 0.98, 95% CI 0.95-1.01). After age 40, the experimental group had lower mortality from overall cancer, lung cancer, and accidents. In addition, exposed women had lower mortality from ischemic heart disease, and exposed men lower mortality from overall external causes. In analyses stratified for final educational level, we found lower mortality in the experimental group within the strata that settled for compulsory schooling only (HR = 0.94, 95% CI 0.89-0.99) and compulsory schooling plus vocational training (HR = 0.92, 95% CI 0.88-0.97). Thus, the experimental group had lower mortality from causes known to be related to education. Lower mortality in the experimental group was also found among the least educated, a group that clearly benefited from the reform in terms of educational length. However, all estimates are small and there was no evident impact of the reform on all-cause mortality in all ages.
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| 20. |
- Lager, Anton C. J., et al.
(författare)
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Cognitive and emotional outcomes after prolonged education : a quasi-experiment on 320 182 Swedish boys
- 2017
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 46:1, s. 303-311
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cognitive and socio-emotional abilities are powerful predictors of death and disease as well as of social and economic outcomes. Education is societies' main way of promoting these abilities, ideally so that inequalities by socioeconomic background are reduced. However, the extent to which education serves these cognitive, social-emotional and equality objectives is relatively unknown and intensively debated. Drawing on a Swedish school reform that was explicitly designed as a massive quasiexperiment, we assessed differential impact of education on intelligence and emotional control across childhood socioeconomic position. We also assessed initial differences in abilities by childhood socioeconomic position and how well childhood socioeconomic position and abilities predict all-cause mortality. Methods: The Swedish comprehensive school reform, rolled out during the 1950s, extended compulsory education from 8 to 9 years in some municipalities whereas others were kept as controls for the sake of evaluation. We followed eight full cohorts of Swedish boys born between 1951 and 1958, who lived in 1017 municipalities with known experimental status (344 336 boys) and whose childhood socioeconomic position was known (320 182 boys). At conscription, intelligence was measured by four subtests and emotional control (calm and efficient responses in various situations) was rated by a military psychologist. Both measures were standardized to have a mean of 100 and standard deviation of 15. All-cause mortality was recorded until 49-56 years of age. Results: The reform had an average positive impact on intelligence of 0.75 IQ units (95% confidence interval (CI): 0.54, 0.97; P < 0.0005). The impact on emotional control was negative; -0.50 units (95% CI: -0.72, -0.28; P < 0.0005). Both effects differed by socioeconomic background so that the average IQ difference between sons of high nonmanual and unqualified manual workers was reduced from 16.32 to 15.57 units and the difference in emotional control was reduced from 6.50 to 5.63 units. All-cause mortality was predicted by low childhood socioeconomic position [hazard ratio (HR) = 1.15 [95% CI: 1.11, 1.20], P < 0.0005], low intelligence [HR = 1.39 (95% CI: 1.34, 1.44), P < 0.0005] as well as low emotional control [HR = 1.61 (95% CI: 1.55, 1.67), P < 0.0005] in mutually adjusted models. Conclusions: Extending compulsory education promoted intelligence but lowered emotional control, and reduced disparities over social background in both. Emotional control was the strongest predictor of all-cause mortality. Our results are in line with the idea that education is important in our efforts to achieve healthy, competent and fair societies, but much more work is needed to understand the links between education and non-cognitive skills.
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- Lager, Anton, et al.
(författare)
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Children's overweight and obesity : Local and national monitoring using electronic health records
- 2009
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 37:2, s. 201-205
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To test the feasibility of a system for monitoring children's obesity and overweight based on data from electronic health records in the school health services. Methods: Data on weight and height from electronic health records at school health services were collected for 10-year-olds in 2003—2004, 2004—2005 and 2005—2006. School health personnel extracted group-level data with a simple program installed on the computer containing the health records. Four Swedish municipalities were included in the study: Karlstad, Umeå, Västerås, and Ystad. Results: The system achieved coverage of 92—96% of all children in 2005—2006. The overall prevalence rates were 4.2% (3.8—4.7%) obese and 22.0% (21.1—23.0%) overweight, including obesity. Conclusions: A system based on electronic health records from the school health services can successfully provide data. The system has practical, economical and ethical strengths.
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