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1.	Agahi, Neda, et al. (författare) Heavy alcohol consumption before and after negative life events in late mid-life : longitudinal latent trajectory analyses 2022 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 76:4, s. 360-366 Tidskriftsartikel (refereegranskat)abstract Background People who experience negative life events report more heavy alcohol consumption compared with people without these experiences, but little is known about patterns of change within this group. This study aims to identify trajectories of heavy alcohol consumption before and after experiencing either divorce, or severe illness or death in the family. Furthermore, the aim is to examine characteristics of individuals belonging to each trajectory.Methods Longitudinal study of public sector employees from the Finnish Retirement and Aging Study with up to 5 years of annual follow-ups (n=6783; eligible sample n=1393). Divorce and severe illness or death in the family represented negative life events. Heavy alcohol consumption was categorised as >14 units/week.Results Based on latent trajectory analysis, three trajectories of heavy drinking were identified both for divorce and for severe illness or death in the family: ‘No heavy drinking’ (82% illness/death, 75% divorce), ‘Constant heavy drinking’ (10% illness/death, 13% divorce) and ‘Decreasing heavy drinking’ (7% illness/death, 12% divorce). Constant heavy drinkers surrounding illness or death in the family were more likely to be men, report depression and anxiety and to smoke than those with no heavy drinking. Constant heavy drinkers surrounding divorce were also more likely to be men and to report depression compared with those with no heavy drinking.Conclusions Most older workers who experience divorce or severe illness or death in the family have stable drinking patterns regarding heavy alcohol consumption, that is, most do not initiate or stop heavy drinking.
2.	Agahi, Neda, et al. (författare) Social and economic conditions in childhood and the progression of functional health problems from midlife into old age 2014 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 68:8, s. 734-740 Tidskriftsartikel (refereegranskat)abstract Background Childhood living conditions have been found to predict health and mortality in midlife and in old age. This study examines the associations between social and economic childhood conditions and the onset and progression of functional health problems from midlife into old age, and the extent to which potential associations are mediated by educational attainment and smoking. Methods Data from the Level of Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old were merged to create a longitudinal data set with five repeated measures from 1968 to 2004 (n=1765, aged 30-50 years and free from functional health problems at baseline). Multilevel regression models were used to analyse retrospective reports of social and economic conditions in childhood (eg, conflicts or economic problems in the family) in relation to the progression of functional health problems over the 36-year period. Results Results showed that social and economic disadvantages in childhood were associated with an earlier onset and a faster progression of functional health problems from midlife into old age. Subsequent models showed that differences in educational attainment, but not smoking, explained much of the association between childhood disadvantages and trajectories of functional health problems. Conclusions According to these results, adverse social and economic conditions in childhood affect the development of functional health problems from midlife into old age indirectly through less favourable life careers, including lower education. Creating equal opportunities for educational attainment may help reduce the long-term effects of disadvantaged childhood conditions and postpone functional health problems.
3.	Ahmad Kiadaliri, Aliasghar, et al. (författare) Educational inequalities in falls mortality among older adults : population-based multiple cause of death data from Sweden 2018 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 72:1, s. 68-70 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Falls are the leading cause of fatal injuries among elderly adults. While socioeconomic status including education is a well-documented predictor of many individual health outcomes including mortality, little is known about socioeconomic inequalities in falls mortality among adults. This study aimed to assess educational inequalities in falls mortality among older adults in Sweden using multiple cause of death data.METHODS: All residents aged 50‒75 years in the Skåne region, Sweden, during 1998‒2013 (n=566 478) were followed until death, relocation outside Skåne or end of 2014. We identified any mention of falls on death certificates (n=1047). We defined three levels of education. We used an additive hazards model and Cox regression with age as time scale adjusted for marital status and country of birth to calculate slope and relative indices of inequality (SII/RII). We also computed the population attributable fraction of lower educational attainment. Analyses were performed separately for men and women.RESULTS: Both SII and RII revealed statistically significant educational inequalities in falls mortality among men in favour of high educated (SII (95% CI): 15.5 (9.8 to 21.3) per 100 000 person-years; RII: 2.19 (1.60 to 3.00)) but not among women. Among men, 34% (95% CI 19 to 46) of falls deaths were attributable to lower education.CONCLUSIONS: There was an inverse association between education and deaths from falls among men but not women. The results suggest that individual's education should be considered in falls reduction interventions.
4.	Ahnquist, Johanna, et al. (författare) Is cumulative exposure to economic hardships more hazardous to women's health than men's? : A 16-year follow-up study of the Swedish Survey of Living Conditions 2007 Ingår i: Journal of Epidemiology and Community Health. - Swedish Natl Inst Publ Hlth, SE-10352 Stockholm, Sweden. Karolinska Inst, Stockholm, Sweden. Swedish Natl Board Hlth & Welf, Stockholm, Sweden. : BMJ PUBLISHING GROUP. - 0143-005X .- 1470-2738. ; 61:4, s. 331-336 Tidskriftsartikel (refereegranskat)abstract Background: Previous research has shown an association between cumulative economic hardships and various health outcomes. However, the cumulative effects of economic hardships in regard to gender differences have not been given enough attention. Methods: 1981 women and 1799 men were followed up over a period of 16 years (1981-1997), using data from the Swedish Survey of Living Conditions panel study. The temporal association between economic hardships and self-rated health, psychological distress and musculoskeletal disorders was analysed. Results: A dose-response effect on women's health was observed with increasing scores of cumulative exposure to financial stress but not with low income. Women exposed to financial stress at both T-1 and T-2 had an increased risk of 1.4-1.6 for all health measures compared with those who were not exposed. A similar consistent dose-response effect was not observed among men. Conclusions: There is a temporal relationship between cumulative economic hardships and health outcomes, and health effects differ by gender. Financial stress seems to be a stronger predictor of poor health outcomes than low income, particularly among women. Policies geared towards reducing health inequalities should recognise that long-term exposure to economic hardships damages health, and actions need to be taken with a gender perspective.
5.	Akre, O, et al. (författare) Differences in citation rates by country of origin for papers published in top-ranked medical journals: do they reflect inequalities in access to publication? 2011 Ingår i: Journal of epidemiology and community health. - : BMJ. - 1470-2738 .- 0143-005X. ; 65:2, s. 119-123 Tidskriftsartikel (refereegranskat)
6.	Alexanderson, K., et al. (författare) Diagnosis-specific sick leave as a long-term predictor of disability pension : a 13-year follow-up of the GAZEL cohort study 2012 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 66:2, s. 155-159 Tidskriftsartikel (refereegranskat)abstract Background Factors that increase the risk of labour market exclusion are poorly understood. In this study, we examined the extent to which all-cause and diagnosis-specific sick leave predict subsequent disability pension (DP).Methods Prospective cohort study of 20 434 persons employed by the French national gas and electric company (the GAZEL study). New sick-leave spells >7 days in 1990–1992 were obtained from company records. Follow-up for DP was from 1994 to 2007.Results The HR, adjusted for age and occupational position, for DP was 3.5 (95% CI 2.7 to 4.5) in men and 2.6 (95% CI 1.9 to 3.5) in women with one or more sick-leave spells >7 days compared with those with no sick leave. The strongest predictor of DP was sick leave with a psychiatric diagnosis, HR 7.6 (95% CI 5.2 to 10.9) for men and 4.1 (95% CI 2.9 to 5.9) for women. Corresponding HRs for sick leave due to circulatory diagnoses in men and women were 5.6 (95% CI 3.7 to 8.6) and 3.1 (95% CI 1.8 to 5.3), for respiratory diagnoses 3.9 (95% CI 2.6 to 5.8) and 2.6 (95% CI 1.7 to 4.0), and musculoskeletal diagnoses 4.6 (95% CI 3.4 to 6.4) and 3.3 (95% CI 2.2 to 4.8), respectively.Conclusions Sick leave with a psychiatric diagnosis is a major risk factor for subsequent DP, especially among men. Sick leave due to musculoskeletal or circulatory disorders was also a strong predictor of DP. Diagnosis-specific sick leave should be recognised as an early risk marker for future exclusion from the labour market.
7.	Allaouat, S, et al. (författare) Long-term exposure to ambient fine particulate matter originating from traffic and residential wood combustion and the prevalence of depression 2021 Ingår i: Journal of epidemiology and community health. - : BMJ. - 1470-2738 .- 0143-005X. ; 75:11, s. 1111-1116 Tidskriftsartikel (refereegranskat)abstract Air pollution has been suggested to be associated with depression. However, current evidence is conflicting, and no study has considered different sources of ambient particulate matter with an aerodynamic diameter below 2.5 µm (PM2.5). We evaluated the associations of long-term exposure to PM2.5 from road traffic and residential wood combustion with the prevalence of depression in the Helsinki region, Finland.MethodsWe conducted a cross-sectional analysis based on the Helsinki Capital Region Environmental Health Survey 2015–2016 (N=5895). Modelled long-term outdoor concentrations of PM2.5 were evaluated using high-resolution emission and dispersion modelling on an urban scale and linked to the home addresses of study participants. The outcome was self-reported doctor-diagnosed or treated depression. We applied logistic regression and calculated the OR for 1 μg/m3 increase in PM2.5, with 95% CI. Models were adjusted for potential confounders, including traffic noise and urban green space.ResultsOf the participants, 377 reported to have been diagnosed or treated for depression by a doctor. Long-term exposure to PM2.5 from road traffic (OR=1.23, 95% CI 0.86 to 1.73; n=5895) or residential wood combustion (OR=0.78, 95% CI 0.43 to 1.41; n=5895) was not associated with the prevalence of depression. The estimates for PM2.5 from road traffic were elevated, but statistically non-significant, for non-smokers (OR=1.38, 95% CI 0.94 to 2.01; n=4716).ConclusionsWe found no convincing evidence of an effect of long-term exposure to PM2.5 from road traffic or residential wood combustion on depression.
8.	Almquist, Ylva B., et al. (författare) A decade lost : does educational success mitigate the increased risks of premature death among children with experience of out-of-home care? 2018 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 72:11, s. 997-1002 Tidskriftsartikel (refereegranskat)abstract Background: Past research has consistently identified children with experience of out-of-home care (OHC) as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, the empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success for the association between OHC experience and premature mortality.Methods: Drawing on a Stockholm cohort born in 1953 (n=15,117), we analysed the associations between placement in OHC (ages 0-12), school performance (ages 13, 16, and 19), and premature all-cause mortality (ages 20-56) by means of Cox and Laplace regression analysis.Results: The Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that these children died more than a decade, based on median survival time, before their majority population peers. However, among individuals who performed well at school, i.e. scored above-average marks at age 16 (grade 9) and age 19 (grade 12), respectively, the risks of premature mortality did not significantly differ between the two groups.Conclusion: Educational success seems to mitigate the increased risks of premature death among children with experience of OHC.
9.	Almquist, Ylva (författare) Peer status in school and adult disease risk : A 30-year follow-up study of disease-specific morbidity in a Stockholm cohort 2009 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 63:12, s. 1028-1034 Tidskriftsartikel (refereegranskat)abstract Background: Children have a social status position of their own, apart from that of the family, that may have an impact on short-term and long-term health. The aim of the present study was to analyse the associations between childhood social status in school (ie, peer status) and disease-specific morbidity in adulthood. Methods: Data were derived from a longitudinal study using a 1953 cohort born in Stockholm, Sweden: The Stockholm Birth Cohort Study (1953–2003). Peer status was sociometrically assessed in sixth grade (1966). Hazard ratios for adult disease-specific morbidity based on information on inpatient care (1973–2003) were calculated by peer status category for men and women separately, using Cox regression. Results: The results indicate that the lower the childhood peer status, the higher the overall adult disease risk. There were, however, differences in the degree and magnitude to which disease-specific inpatient care varied with peer status. Some of the steepest gradients were found for mental and behavioural disorders (eg, alcohol abuse and drug dependence), external causes (eg, suicide) and various lifestyle-related diseases (eg, ischaemic heart disease and diabetes). The results were not explained by childhood social class. Conclusion: The present study underlines the importance of recognising children’s social position, apart from that of their family, for later health. Not only psychologically related diseases but also those related to behavioural risk factors demonstrate some of the largest relative differences by peer status, suggesting that health-related behaviour may be one important mechanism in the association between peer status and morbidity.
10.	Andersson, H. Ingemar, 1950-, et al. (författare) Impact of chronic pain on health care seeking, self care, and medication : results from a population-based Swedish study 1999 Ingår i: Journal of Epidemiology and Community Health. - 0143-005X .- 1470-2738. ; 53:8, s. 503-509 Tidskriftsartikel (refereegranskat)abstract STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms.
11.	Andersson, H. Ingemar, et al. (författare) Impact of chronic pain on health care seeking, self care, and medication : results from a population-based Swedish study 1999 Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group. - 0143-005X .- 1470-2738. ; 53:8, s. 503-509 Tidskriftsartikel (refereegranskat)abstract STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms.
12.	Astell-Burt, Thomas, et al. (författare) The association between green space and mental health varies across the lifecourse. A longitudinal study 2014 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 68:6, s. 578-583 Tidskriftsartikel (refereegranskat)abstract Background Epidemiological studies on green space and health have relied almost exclusively on cross-sectional designs, restricting understanding on how this relationship could vary across the lifecourse. Methods We used multilevel linear regression to analyse variation in minor psychiatric morbidity over nine annual waves of the British Household Panel Survey (1996-2004). The sample was restricted to residents of urban areas who remained within their neighbourhoods for at least 12 months. The 12-item General Health Questionnaire and confounders were reported for 29 626 male and 35 781 female observations (person-years). This individual-level dataset was linked to a measure of green space availability within each ward of residence. Regression models included age, gender, employment status, household tenure, marital status, education, smoking status and household income. Results When not considering age, green space was associated with better mental health among men, but not women. Interaction terms fitted between age and green space revealed variation in the association between green space and mental health across the lifecourse and by gender. For men, the benefit of more green space emerged in early to mid-adulthood. Among older women, a curvilinear association materialised wherein those with a moderate availability of green space had better mental health. Conclusions These findings illustrate how the relationship between urban green space and health can vary across the lifecourse, and they highlight the need for longitudinal studies to answer why green space may be better for health at some points in the lifecourse than others.
13.	Aurpibul, Linda, et al. (författare) Birth order is associated with an increased risk of obesity in young adults in Thailand 2021 Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group Ltd. - 0143-005X .- 1470-2738. ; 75:3, s. 305-308 Tidskriftsartikel (refereegranskat)abstract Background There is a growing body of evidence showing that early life events are associated with increased risk of cardiovascular and metabolic diseases later in adult life. However, there is a paucity of data in this field from Asian populations. In this study, we examined the association of birth order with obesity risk and cardiometabolic outcomes in young adults in Thailand. Methods Participants were the offspring from a birth cohort study in Chiang Mai (northern Thailand), who were followed up at similar to 20.5 years of age. Clinical assessments included anthropometry, blood pressure, fasting blood samples and carotid intima-media thickness. Insulin sensitivity was estimated using homeostatic model assessment of insulin resistance (HOMA-IR). Participants were stratified into two groups: first-borns and later-borns. Health outcomes between groups were compared using multivariable models adjusting for important confounders, in particular maternal body mass index (BMI). Results A total of 559 participants were studied: 316 first-borns (46% males) and 243 later-borns (47% males). Adjusted models showed anthropometric differences, with first-borns being 2.3 kg heavier (p=0.023) with a BMI 0.86 kg/m(2) greater (p=0.019) than later-borns. Thus, rates of obesity were higher in first-borns than in later-borns (6.6% vs 2.9%), so that first-borns had an adjusted relative risk of obesity 3.3 times greater than later-borns [95% CI 1.42 to 7.88; p=0.006]. There were no observed differences in cardiovascular or metabolic parameters assessed, including HOMA-IR. Conclusion As observed in other populations, first-borns in Thailand had greater BMI and an increased risk of obesity in young adulthood. However, we observed no other cardiometabolic differences between first- and later-borns.
14.	B. Almquist, Ylva, et al. (författare) Intergenerational transmission of alcohol misuse : mediation and interaction by school performance in a Swedish birth cohort 2020 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 74:7, s. 598-604 Tidskriftsartikel (refereegranskat)abstract Background Children whose parents misuse alcohol have increased risks of own alcohol misuse in adulthood. Though most attain lower school marks, some still perform well in school, which could be an indicator of resilience with protective potential against negative health outcomes. Accordingly, the aim of this study was to examine the processes of mediation and interaction by school performance regarding the intergenerational transmission of alcohol misuse.Methods Data were drawn from a prospective Swedish cohort study of children born in 1953 (n=14 608). Associations between parental alcohol misuse (ages 0–19) and participants' own alcohol misuse in adulthood (ages 20–63) were examined by means of Cox regression analysis. Four-way decomposition was used to explore mediation and interaction by school performance in grade 6 (age 13), grade 9 (age 16) and grade 12 (age 19).Results Mediation and/or interaction by school performance accounted for a substantial proportion of the association between parental alcohol misuse and own alcohol misuse in adulthood (58% for performance in grade 6, 27% for grade 9 and 30% for grade 12). Moreover, interaction effects appeared to be more important for the outcome than mediation.Conclusion Above-average school performance among children whose parents misused alcohol seems to reflect processes of resilience with the potential to break the intergenerational transmission of alcohol misuse. Four-way decomposition offers a viable approach to disentangle processes of interaction from mediation, representing a promising avenue for future longitudinal research.
15.	Baccini, M., et al. (författare) Impact of heat on mortality in 15 european cities : attributable deaths under different weather scenarios 2011 Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group Ltd. - 0143-005X .- 1470-2738. ; 65:1, s. 64-70 Tidskriftsartikel (refereegranskat)abstract Background: High ambient summer temperatures have been shown to influence daily mortality in cities across Europe. Quantification of the population mortality burden attributable to heat is crucial to the development of adaptive approaches. The impact of summer heat on mortality for 15 European cities during the 1990s was evaluated, under hypothetical temperature scenarios warmer and cooler than the mean and under future scenarios derived from the Intergovernmental Panel on Climate Change Special Report on Emission Scenarios (SRES).Methods: A Monte Carlo approach was used to estimate the number of deaths attributable to heat for each city. These estimates rely on the results of a Bayesian random-effects meta-analysis that combines city-specific heat-mortality functions.Results: The number of heat-attributable deaths per summer ranged from 0 in Dublin to 423 in Paris. The mean attributable fraction of deaths was around 2%. The highest impact was in three Mediterranean cities (Barcelona, Rome and Valencia) and in two continental cities (Paris and Budapest). The largest impact was on persons over 75 years; however, in some cities, important proportions of heat-attributable deaths were also found for younger adults. Heat-attributable deaths markedly increased under warming scenarios. The impact under SRES scenarios was slightly lower or comparable to the impact during the observed hottest year.Conclusions: Current high summer ambient temperatures have an important impact on European population health. This impact is expected to increase in the future, according to the projected increase of mean ambient temperatures and frequency, intensity and duration of heat waves.
16.	Bahmanyar, S., et al. (författare) Risk of suicide among operated and non-operated patients hospitalised for peptic ulcers 2009 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 63:12, s. 1016-1021 Tidskriftsartikel (refereegranskat)abstract Background: Some small studies have reported high risk of suicide after surgical treatment for peptic ulcer. The aim of the present study was to explore the risk of suicide in hospitalised gastric ulcer and duodenal ulcer patients separately among operated and non-operated cohorts. Methods: Retrospective cohorts of 163 579 non-operated patients with gastric ulcer or duodenal ulcer and 28 112 patients with surgical treatment for ulcer, recorded in the Swedish Inpatient Register since 1965, were followed from the first hospitalisation, or operation for the surgery cohort, until death, any cancer, emigration, or 31 December 2003. Standardised mortality ratios (SMRs) were calculated, and Poisson regression produced adjusted relative risk estimates among operated and non-operated patients. Results: Non-operated patients hospitalised for peptic ulcer showed a 70% excess risk of suicide (SMR 1.7, 95% CI 1.6 to 1.9) and those who underwent operation had a 60% increased risk (SMR 1.6, 95% CI 1.4 to 1.8). The risk of suicide was very high during the first year after hospitalisation (SMR 4.0, 95% CI 3.4 to 4.7) and more marked among women, patients under 70 and patients hospitalised without complications of ulcer. Both gastric ulcer and duodenal ulcer patients had high risk of suicide completion. Conclusion: Hospitalised patients with gastric ulcer or duodenal ulcer have an increased risk of suicide regardless of surgical treatment. These patients, especially women, are at very high risk during the first year after first hospitalisation/operation. The evaluation and management of suicidal thoughts in patients in medical settings should be further considered.
17.	Barr, B, et al. (författare) To what extent have relaxed eligibility requirements and increased generosity of disability benefits acted as disincentives for employment? A systematic review of evidence from countries with well-developed welfare systems 2010 Ingår i: Journal of epidemiology and community health. - : BMJ. - 1470-2738 .- 0143-005X. ; 64:12, s. 1106-1114 Tidskriftsartikel (refereegranskat)
18.	Beckman, Anders, et al. (författare) Country of birth, socioeconomic position, and health care expenditure― a multilevel analysis of the city of Malmö, Sweden 2004 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 58:2, s. 145-149 Tidskriftsartikel (refereegranskat)abstract Study objective: The principle of equity aims to guarantee allocation of healthcare resources on the basis of need. Therefore, people with a low income and persons living alone are expected to have higher healthcare expenditures. Besides these individual characteristics healthcare expenditure may be influenced by country of birth. This study therefore aimed to investigate the role of country of birth in explaining individual healthcare expenditure.Design: Multilevel regression model based on individuals (first level) and their country of birth (second level).Setting: The city of Malmö, Sweden.Participants: All the 52 419 men aged 40–80 years from 130 different countries of birth, who were living in Malmö, Sweden, during 1999.Main results: At the individual level, persons with a low income and persons living alone showed a higher healthcare expenditure, with regression coefficients (and 95% confidence intervals) being 0.358 (0.325 to 0.392) and 0.197 (0.165 to 0.230), respectively. Country of birth explained a considerable part (18% and 13%) of the individual differences in the probability of having a low income and living alone, respectively. However, this figure was only 3% for having some health expenditure, and barely 0.7% with regard to costs in the 74% of the population with some health expenditure.Conclusions: Malmö is a socioeconomically segregated city, in which the country of birth seems to play only a minor part in explaining individual differences in total healthcare expenditure. These differences seem instead to be determined by individual low income and living alone.
19.	Benyi, Emelie, et al. (författare) Adult height is associated with risk of cancer and mortality in 5.5 million Swedish women and men 2019 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 73:8, s. 730-736 Tidskriftsartikel (refereegranskat)abstract Background Previous studies have indicated that taller individuals are at greater risk of developing cancer. Death from cancer and other specific causes have also been linked to height, but the results have been inconclusive. We aimed to shed further light on the associations between height, cancer incidence and mortality.Methods We conducted a nationwide, population-based prospective cohort study, including 5.5 million Swedish women and men (aged 20-74). They were followed over a period of up to 54 years. Heights were retrieved from national registers (mainly the Passport Register where heights are most often self-reported). The risks of overall and specific cancers, as well as overall and cause-specific mortality, were presented as HR with 95% CIs per 10 cm increase in height.Results A total of 278 299 cases of cancer and 139 393 cases of death were identified. For overall cancer, HR was 1.19 (1.18-1.20) in women and 1.11 (1.10-1.12) in men for every 10 cm increase in height. All 15 specific cancer types were positively associated with height-most strongly for malignant melanoma in both genders, with HRs of 1.39 (1.35-1.43) in women and 1.34 (1.30-1.38) in men. For overall mortality, HR was 0.98 (0.97-0.99) in women and 0.91 (0.90-0.92) in men for every 10 cm increase in height. Cancer mortality was increased in taller individuals, with HR 1.15 (1.13-1.17) in women and 1.05 (1.03-1.07) in men for every 10 cm increase in height, whereas shorter individuals had increased overall mortality due to a number of other causes, such as cardiovascular disease.Conclusion Overall and specific cancer risks, particularly malignant melanoma, were positively associated with height. Cancer mortality also increased with height. In contrast, overall mortality was decreased with height, particularly in men due to inverse associations with height for other causes of death.
20.	Berglund, A (författare) What's in a Word? Concept mapping: a graphical tool to reinforce learning of epidemiological concepts 2015 Ingår i: Journal of epidemiology and community health. - : BMJ. - 1470-2738 .- 0143-005X. ; 69:12, s. 1232-1236 Tidskriftsartikel (refereegranskat)
21.	Bergström, Martin, et al. (författare) Do different scales measure the same construct? Three Sense of Coherence scales. 2009 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 63:2, s. 166-167 Tidskriftsartikel (refereegranskat)abstract Background: Different scales claim to measure the construct ‘‘Sense of Coherence’’. Results from these scales have been compared without knowing whether they measure the same construct. This article compares two versions of Antonovsky’s original scale (SOC-13 and SOC-29), translated into Swedish, and a three-item scale (SOC-3) that claims to measure Sense of Coherence. Methods: The data were analysed in a cross-sectional setting. The study consisted of university students studying social work (n=395. Results: The original scales had no distribution problems in differentiating Sense of Coherence. The SOC-3 had severe distribution problems. The two versions of the original Sense of Coherence scale had an acceptable reliability (Cronbach’s a; SOC-29=0.93, SOC-13=0.89). The SOC-3 scale did not have an acceptable reliability (Cronbach’s a=0.39). SOC-29 and SOC-13 had a high intercorrelation (r=0.96, p,0.001). The SOC-3 significantly correlated with SOC-29 (r=20.72, p,0.001) and SOC-13 (r=20.67, p,0.001), but the magnitude was significantly lower than the intercorrelation between SOC- 29 and SOC-13 (Fisher’s z-transformation, p,0.001. Conclusions: Because scales that claim to measure the same construct are not always interchangeable, researchers should make sure they compare results from studies that use the same scales.
22.	Bergström, Malin, et al. (författare) Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children? 2015 Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group. - 0143-005X .- 1470-2738. ; 69:8, s. 769-774 Tidskriftsartikel (refereegranskat)abstract Background In many Western countries, an increasing number of children with separated parents have joint physical custody, that is, live equally much in their parents respective homes. In Sweden, joint physical custody is particularly common and concerns between 30% and 40% of the children with separated parents. It has been hypothesised that the frequent moves and lack of stability in parenting may be stressful for these children. Methods We used data from a national classroom survey of all sixth and ninth grade students in Sweden (N=147839) to investigate the association between childrens psychosomatic problems and living arrangements. Children in joint physical custody were compared with those living only or mostly with one parent and in nuclear families. We conducted sex-specific linear regression analyses for z-transformed sum scores of psychosomatic problems and adjusted for age, country of origin as well as childrens satisfaction with material resources and relationships to parents. Clustering by school was accounted for by using a two-level random intercept model. Results Children in joint physical custody suffered from less psychosomatic problems than those living mostly or only with one parent but reported more symptoms than those in nuclear families. Satisfaction with their material resources and parent-child relationships was associated with childrens psychosomatic health but could not explain the differences between children in the different living arrangements. Conclusions Children with non-cohabitant parents experience more psychosomatic problems than those in nuclear families. Those in joint physical custody do however report better psychosomatic health than children living mostly or only with one parent. Longitudinal studies with information on family factors before and after the separation are needed to inform policy of childrens postseparation living arrangements.
23.	Bishop, Lauren, et al. (författare) Role of hospitalisation for substance misuse in marital status transitions : a 47-year follow-up of a Swedish birth cohort 2024 Ingår i: Journal of Epidemiology and Community Health. - 0143-005X .- 1470-2738. ; 78:3, s. 153-159 Tidskriftsartikel (refereegranskat)abstract Background Substantial research suggests that the risk of substance misuse is higher among individuals who remain unmarried or experience marital dissolution, whereas marriage tends to be protective. However, few studies have considered the role of substance misuse for transitions between discrete marital status categories. The current study aims to estimate associations between substance misuse and marital status transitions from ages 20–66.Methods Our study population was a national Swedish cohort born in 1953 (n=71 901), followed from 1973 to 2019. Annual marital status and hospitalisation records for substance misuse were derived from the Total Population and National Patient registers, respectively. We used a five-state multistate model to estimate associations between substance misuse and marital status transitions—the state space included never married, married, divorced and widowed with death as the absorbing state. We further used fixed-effect models to estimate the effects of substance misuse on transitions out of marriage.Results Findings suggested that individuals’ substance misuse was associated with an increased risk of transitioning from married to divorced (HR=3.54, 95% CI 3.40 to 3.69) or widowed (HR=1.71, 95% CI 1.46 to 2.01), and transitioning to death from all states. Substance misuse was also negatively associated with transitioning from never married to married (HR=0.59, 95% CI 0.57 to 0.61), and into remarriage after divorce (HR=0.86, 95% CI 0.80 to 0.92). The fixed-effect results suggested that substance misuse increased the risk of transitioning to divorce and widowhood, net of sociodemographic characteristics.Conclusion Substance misuse is associated with an increased risk of marital dissolution and death when accounting for nearly 50 years of marital biographies.
24.	Björk, Jonas, et al. (författare) Recreational values of the natural environment in relation to neighbourhood satisfaction, physical activity, obesity and wellbeing. 2008 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 62:4, s. 2-2 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: The aim of this population-based study was to investigate associations between recreational values of the close natural environment and neighbourhood satisfaction, physical activity, obesity and wellbeing. METHODS: Data from a large public health survey distributed as a mailed questionnaire in suburban and rural areas of southern Sweden were used (N = 24,819; 59% participation rate). Geocoded residential addresses and the geographical information system technique were used to assess objectively five recreational values of the close natural environment: serene, wild, lush, spacious and culture. RESULTS: On average, a citizen of the Scania region, inner city areas excluded, only had access to 0.67 recreational values within 300 metres distance from their residence. The number of recreational values near the residence was strongly associated with neighbourhood satisfaction and physical activity. The effect on satisfaction was especially marked among tenants and the presence of recreational values was associated with low or normal body mass index in this group. A less marked positive association with vitality among women was observed. No evident effect on self-rated health was detectable. CONCLUSIONS: Immediate access to natural environments with high recreational values was rare in the study population and was distributed in an inequitable manner. Moreover, such access was associated with a positive assessment of neighbourhood satisfaction and time spent on physical activity, which can be expected to reduce obesity and increase vitality by having a buffering effect on stress.
25.	Björkenstam, C., et al. (författare) School grades, parental education and suicide : a national register-based cohort study 2010 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. Tidskriftsartikel (refereegranskat)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.
26.	Björkenstam, Charlotte, et al. (författare) Self-reported suicide ideation and attempts, and medical care for intentional self-harm in lesbians, gays and bisexuals in Sweden 2016 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 70:9, s. 895-901 Tidskriftsartikel (refereegranskat)abstract Background Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for intentional self-harm between 1969 and 2010, including age at initial treatment and recurrence. Methods We used data from the Stockholm Public Health Cohort, a population-based sample of 874 lesbians/gays, 841 bisexuals and 67980 heterosexuals, whose self-administered surveys have been linked to nationwide registers. Estimates of risk for medical care were calculated as incidence rate ratios (IRR) with 95% CIs. Results Both suicidal ideation and attempts were more commonly reported by lesbian/gay and bisexual (LGB) individuals. Adjusting for risk-time and confounding, lesbians (IRR 3.8, 95% CI 2.7 to 5.4) and bisexual women (IRR 5.4, 95% CI 4.4 to 6.6) experienced elevated risk for medical care for intentional self-harm, as compared to heterosexual women. Gay men evidenced higher risk (IRR 2.1, 95% CI 1.3 to 3.4) as compared to heterosexual men. Recurrent medical care was more frequent in LGB individuals, especially in bisexual women and gay men. Lesbian and bisexual women were also younger than heterosexual women when they first received medical care for intentional self-harm. Conclusions Positive histories of suicidal ideation, attempts and medical care for intentional self-harm, including higher levels of recurrence, are more prevalent among LGB individuals in contrast to heterosexuals. Lesbian/bisexual women evidence an earlier age of onset of treatment. Tailored prevention efforts are urgently needed.
27.	Björkenstam, Emma, et al. (författare) Association between income trajectories in childhood and psychiatric disorder : a Swedish population-based study 2017 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 71:7, s. 648-654 Tidskriftsartikel (refereegranskat)abstract Background Childhood family income variation is an understudied aspect of households' economic context that may have distinct consequences for children. We identified trajectories of childhood family income over a 12-year period, and examined associations between these trajectories and later psychiatric disorders, among individuals born in Sweden between 1987 and 1991 (n=534 294).Methods We used annual income data between the ages of 3-14 years and identified 5 trajectories (2 high-income upward, 1 downward and 2 low-income upward trajectories). Psychiatric disorders in the follow-up period after age 15 were defined from International Classification of Disease (ICD)-codes in a nationwide patient register. Multiadjusted risks for all psychiatric disorders, as well as for specific psychiatric diagnoses, were calculated as HRs with 95% CIs.Results Of the 5 identified income trajectories, the constant low and the downward trajectories were particularly associated with later psychiatric disorder. Children with these trajectories had increased risks for psychiatric disorder, including mood, anxiety, psychotic disorders and attention deficit/hyperactivity disorder. The association remained, even after adjusting for important variables including parental psychiatric disorder. In contrast, the relationship was reversed for eating disorders, for which children in higher income trajectories had elevated risks.Conclusions Findings show that children growing up in a household characterised by low or decreasing family income have an increased risk for psychiatric disorder. Continued work is needed to reduce socioeconomic inequalities in psychiatric disorders. Policies and interventions for psychiatric disorders should consider the socioeconomic background of the family as an important risk or protective factor.
28.	Björkenstam, Emma, et al. (författare) Childhood household dysfunction, school performance and psychiatric care utilisation in young adults : a register study of 96 399 individuals in Stockholm County 2016 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 70:5, s. 473-480 Tidskriftsartikel (refereegranskat)abstract Background Exposure to childhood household dysfunction increases the risk of psychiatric morbidity. Although school performance also has been linked with psychiatric morbidity, limited research has considered school performance as a mediating factor. To address this gap in the literature, the current register study examined whether school performance mediates the association between childhood household dysfunction (experienced between birth and age 14 years) and psychiatric care utilisation in young adulthood.Methods We used a Swedish cohort of 96 399 individuals born during 1987–1991. Indicators of childhood household dysfunction were familial death, parental substance abuse and psychiatric morbidity, parental somatic disease, parental criminality, parental separation/single-parent household, public assistance recipiency and residential instability. Final school grades from the 9th year of compulsory school were used to create five categories. Estimates of risk of psychiatric care utilisation (measured as inpatient, outpatient and primary care) after the age of 18 years were calculated as HRs with 95% CIs. Mediation was tested with the bootstrap approach.Results Cumulative exposure to childhood household dysfunction was positively associated with psychiatric care utilisation. Specifically, individuals exposed to three or more indicators with incomplete school grades had the highest risk (HR=3.7 (95% CI 3.3 to 4.1) after adjusting for demographics), compared to individuals exposed to no indicators with highest grades. School performance was found to mediate the relationship.Conclusions Our findings suggest that future efforts to prevent or mitigate the negative effects of childhood household dysfunction on psychiatric morbidity may benefit from integration of strategies that improve school performance among vulnerable youth.
29.	Brännström, Lars, et al. (författare) Spatial spillover effects of a community action programme targeting on-licensed premises on violent assaults : evidence from a natural experiment 2016 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 70:3, s. 226-230 Tidskriftsartikel (refereegranskat)abstract Background Spatial dependencies may influence the success of community action strategies to prevent and reduce harmful alcohol use. This study examined the effectiveness of a multicomponent Responsible Beverage Service (RBS) programme targeting on-licensed premises on police-recorded assaults in Swedish municipalities. It was expected that the implementation of the programme within any given municipality had an indirect effect by reducing violent assaults in adjacent municipalities.Methods This study was a natural experiment exploiting the temporal and spatial variation in the implementation of the RBS programme to predict change in the rate of violent assaults in all Swedish municipalities during 1996–2009 (n=288; T=14; N=4 032). Yearly police-recorded violent assaults per 100 000 inhabitants aged 15 and above committed on weekend nights were used as a dependent variable. Programme fidelity was identified by means of survey data. A semilogarithmic fixed-effects spatial panel regression model was used to estimate the direct, indirect and total effects of the programme.Results The direct, indirect and total effects were −1.8% (95% CI −4.4% to 0.8%), −5.8% (95% CI −11.5% to −0.1%) and −7.6% (95% CI −13.2% to −2.2%), respectively. Averaged over time and across all municipalities, implementing one additional programme component in all municipalities will thus reduce violent assaults in one typical municipality by nearly 8%.Conclusions The indirect effect of the programme was three times larger than its direct effect. Failing to account for such local spillover effects can result in a considerable underestimation of the programme's total impact and may lead to erroneous policy recommendations.
30.	Bränstrom, Richard (författare) Minority stress factors as mediators of sexual orientation disparities in mental health treatment : a longitudinal population-based study 2017 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 71:5, s. 446-452 Tidskriftsartikel (refereegranskat)abstract Background Substantial mental health disparities between lesbian, gay and bisexual (LGB) individuals compared with heterosexuals have been identified. The aim was to examine potential sexual orientation-based disparities in mental health treatment in a prospectively analysed population-based sample in Sweden and to explore potential moderators and mediators. Method 30 730 individuals from the Stockholm Public Health Cohort were followed up with questionnaires and registry-based health record data on psychiatric healthcare visits and prescription drug use between 1 January 2011 and 31 December 2011. Results In adjusted analyses, gay and lesbian individuals were more likely to receive treatment for anxiety disorders (adjusted ORs (AOR) = 3.80; 95% CI 2.54 to 5.69) and to use antidepressant medication (AOR= 2.13; 95% CI 1.62 to 2.79); and bisexuals were more likely to receive treatment for mood disorders (AOR = 1.58; 95% CI 1.00 to 2.48), anxiety disorders (AOR = 3.23; 95% CI 2.22 to 4.72) and substance use disorders (AOR = 1.91; 95% CI 1.12 to 3.25), and to use antidepressant medication (AOR = 1.91; 95% CI 1.12 to 3.25) when compared with heterosexuals. The largest mental health treatment disparities based on sexual orientation were found among bisexual women, gay men and younger lesbian women. More frequent experiences of victimisation/threat of violence and lack of social support could partially explain these disparities. Conclusions This study shows a substantially elevated risk of poor mental health among LGB individuals as compared with heterosexuals. Findings support several factors outlined in the minority stress theory in explaining the mechanisms behind these disparities.
31.	Canvin, Krysia, et al. (författare) Can I risk using public services? Perceived consequences of seeking help and health care among households living in poverty: qualitative study 2007 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 61:11, s. 984-989 Tidskriftsartikel (refereegranskat)abstract Objectives: To improve understanding of how families living in adverse conditions perceive their encounters with public services and how past experiences influence current and future attempts to seek help.Design: Qualitative interviews with adult members of households living in poverty in deprived areas, plus observations conducted in the surrounding neighbourhoods and service settings.Participants: Purposive sample of 25 adults living in a deprived area, on welfare benefits.Setting: Eight sites in disadvantaged areas in Merseyside, North Wales, London and Greater Manchester in 2004/05.Results: Participants generally perceived public services as a source of distrust and a potential risk to well-being. Encounters with a range of services were perceived as risky in terms of losing resources, being misunderstood or harshly judged, and carrying the ultimate threat of losing custody of their children. Participants perceived that they were subjected to increasing levels of surveillance, with fear of “being told on” by neighbours, in addition to service providers, adding to anxiety. Adverse consequences included avoiding child health and social services, anxiety and self-imposed isolation.Conclusions: Approaching services was perceived as akin to taking a gamble that might or might not result in their needs being met. Faced with this “choice”, participants employed strategies to minimise the risks that on the surface may appear risky to health. If public services are to succeed in providing support to disadvantaged families, greater efforts are needed to build trust and demonstrate understanding for the strategies these families use to maintain their well-being against formidable odds.
32.	Carlson, Per (författare) Relatively poor, absolutely ill? : A study of regional income inequality in Russia and its possible health consequences 2005 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 59:5, s. 389-394 Tidskriftsartikel (refereegranskat)abstract Study objective: To investigate whether the income distribution in a Russian region has a "contextual" effect on individuals' self rated health, and whether the regional income distributions are related to regional health differences. Methods: The Russia longitudinal monitoring survey (RLMS) is a survey (n = 7696) that is representative of the Russian population. With multilevel regressions both individual as well as contextual effects on self rated health were estimated. Main results: The effect of income inequality is not negative on men's self rated health as long as the level of inequality is not very great. When inequality levels are high, however, there is a tendency for men's health to be negatively affected. Regional health differences among men are in part explained by regional income differences. On the other hand, women do not seem to be affected in the same way, and individual characteristics like age and educational level seem to be more important. Conclusions: It seems that a rise in income inequality has no negative effect on men's self rated health as long as the level of inequality is not very great. On the other hand, when inequality levels are higher a rise tends to affect men's health negatively. A curvilinear relation between self rated health and income distribution is an interesting hypothesis. It could help to explain the confusing results that arise when you look at countries with a high degree of income inequality (USA) and those with lower income inequality (for example, Japan and New Zealand).
33.	Carlson, Per, 1967- (författare) Risk behaviours and self-rated health in Russia 1998 2001 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 55:11, s. 806-817 Tidskriftsartikel (refereegranskat)
34.	Chaix, Basile, et al. (författare) Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort 2007 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 61:4, s. 349-355 Tidskriftsartikel (refereegranskat)abstract Background: In a public health perspective, it is of interest to assess the magnitude of geographical variations in ischaemic heart disease (IHD) mortality and quantify the strength of contextual effects on IHD. Objective: To investigate whether area effects vary according to the individual and contextual characteristics of the population, socioeconomic contextual influences were assessed in different age groups and within territories of differing population densities. Design: Multilevel survival analysis of a 28-year longitudinal database. Participants: 341 048 residents of the Scania region in Sweden, reaching age 50-79 years in 1996, followed up over 7 years. Results: After adjustment for several individual socioeconomic indicators over the adult age, Cox multilevel models indicated geographical variations in IHD mortality and socioeconomic contextual effects on the mortality risk. However, the magnitude of geographical variations and strength of contextual effects were modified by the age of individuals and the population density of their residential area: socioeconomic contextual effects were much stronger among non-elderly than among elderly adults, and much larger within urban territories than within rural ones. As a consequence, among non-elderly residents of urban territories, the socioeconomic contextual effect was almost as large as the effect of individual 20-year cumulated income. Conclusions: Non-elderly residents of deprived urban neighbourhoods constitute a major target for both contextual epidemiology of coronary disease and public health interventions aimed at reducing the detrimental effects of the social environment on IHD.
35.	Chaix, Basile, et al. (författare) Children's exposure to nitrogen dioxide in Sweden: investigating environmental injustice in an egalitarian country. 2006 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 60:3, s. 234-241 Tidskriftsartikel (refereegranskat)abstract Study objective: Prior studies have shown that children are particularly sensitive to air pollution. This study examined whether children of low socioeconomic status suffered greater exposure to outdoor nitrogen dioxide than more affluent ones, both at their place of residence and at school, in a country with widespread state intervention for social equity. Design: Local scale data on outdoor nitrogen dioxide obtained from a validated air pollution model were analysed, along with all school children accurately geocoded to their building of residence and school. Participants: All 29 133 children in grades one through nine (aged 7 to 15 years) residing and attending school in Malmo, Sweden, in 2001. Main results: Defining the socioeconomic status of children according to the mean income in their residential building, the spatial scan statistic technique allowed the authors to identify eight statistically significant clusters of low socioeconomic status children, all of which were located in the most polluted areas of Malmo. Four clusters of high socioeconomic status children were found, all of them located in the least polluted areas. The neighbourhood socioeconomic status better predicted the nitrogen dioxide exposure of children than the socioeconomic status of their building of residence. Exposure to nitrogen dioxide at the place of residence and school of attendance regularly increased as the socioeconomic status of a child's neighbourhood of residence decreased. Conclusions: Evidence of environmental injustice was found, even in a country noted for its egalitarian welfare state. Enforcement of environmental regulations may be necessary to achieve a higher level of environmental equity.
36.	Chaix, B, et al. (författare) Comparison of a spatial approach with the multilevel approach for investigating place effects on health: the example of healthcare utilisation in France 2005 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 59:6, s. 517-526 Tidskriftsartikel (refereegranskat)abstract Study objective: Most studies of place effects on health have followed the multilevel analytical approach that investigates geographical variations of health phenomena by fragmenting space into arbitrary areas. This study examined whether analysing geographical variations across continuous space with spatial modelling techniques and contextual indicators that capture space as a continuous dimension surrounding individual residences provided more relevant information on the spatial distribution of outcomes. Healthcare utilisation in France was taken as an illustrative example in comparing the spatial approach with the multilevel approach. Design: Multilevel and spatial analyses of cross sectional data. Participants: 10 955 beneficiaries of the three principal national health insurance funds, surveyed in 1998 and 2000 on continental France. Main results: Multilevel models showed significant geographical variations in healthcare utilisation. However, the Moran's I statistic showed spatial autocorrelation unaccounted for by multilevel models. Modelling the correlation between people as a decreasing function of the spatial distance between them, spatial mixed models gave information not only on the magnitude, but also on the scale of spatial variations, and provided more accurate standard errors for risk factors effects. The socioeconomic level of the residential context and the supply of physicians were independently associated with healthcare utilisation. Place indicators better explained spatial variations in healthcare utilisation when measured across continuous space, rather than within administrative areas. Conclusions: The kind of conceptualisation of space during analysis influences the understanding of place effects on health. In many contextual studies, viewing space as a continuum may yield more relevant information on the spatial distribution of outcomes.
37.	Chaix, Basile, et al. (författare) Neighbourhood social interactions and risk of acute myocardial infarction. 2008 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 62:1, s. 62-68 Tidskriftsartikel (refereegranskat)abstract STUDY OBJECTIVE: Previous studies of neighbourhood effects on ischaemic heart disease (IHD) have used census or administrative data to characterise the residential context, most commonly its socioeconomic level. Using the ecometric approach to define neighbourhood social interaction variables that may be relevant to IHD, neighbourhood social cohesion and safety were examined to see how they related to acute myocardial infarction (AMI) mortality, after adjustment for individual and neighbourhood confounders. DESIGN: To construct social interaction variables, multilevel models were used to aggregate individual perceptions of safety and cohesion at the neighbourhood level. Linking data from the Health Survey in Scania, Sweden, and the Population, Hospital, and Mortality Registers, multilevel survival models were used to investigate determinants of AMI mortality over a three year and nine month period. PARTICIPANTS: 7791 Individuals aged 45 years and over. MAIN RESULTS: The rate of AMI mortality increased with decreasing neighbourhood safety and cohesion. After adjustment for individual health and socioeconomic variables, low neighbourhood cohesion, and to a lesser extent low safety, were associated with higher AMI mortality. Neighbourhood cohesion effects persisted after adjustment for various neighbourhood confounding factors (income, population density, percentage of residents from low-income countries, residential stability) and distance to the hospital. There was some evidence that neighbourhood cohesion effects on AMI mortality were caused by effects on one-day case-fatality, rather than on incidence. CONCLUSIONS: Beyond commonly evoked effects of the physical environment, neighbourhood social interaction patterns may have a decisive influence on IHD, with a particularly strong effect on survival after AMI.
38.	Chaix, Basile, et al. (författare) Spatial clustering of mental disorders and associated characteristics of the neighbourhood context in Malmo, Sweden, in 2001. 2006 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 60:5, s. 427-435 Tidskriftsartikel (refereegranskat)abstract Study objective: Previous research provides preliminary evidence of spatial variations of mental disorders and associations between neighbourhood social context and mental health. This study expands past literature by (1) using spatial techniques, rather than multilevel models, to compare the spatial distributions of two groups of mental disorders (that is, disorders due to psychoactive substance use, and neurotic, stress related, and somatoform disorders); and (2) investigating the independent impact of contextual deprivation and neighbourhood social disorganisation on mental health, while assessing both the magnitude and the spatial scale of these effects. Design: Using different spatial techniques, the study investigated mental disorders due to psychoactive substance use, and neurotic disorders. Participants: All 89285 persons aged 40-69 years residing in Malmo, Sweden, in 2001, geolocated to their place of residence. Main results: The spatial scan statistic identified a large cluster of increased prevalence in a similar location for the two mental disorders in the northern part of Malmo. However, hierarchical geostatistical models showed that the two groups of disorders exhibited a different spatial distribution, in terms of both magnitude and spatial scale. Mental disorders due to substance consumption showed larger neighbourhood variations, and varied in space on a larger scale, than neurotic disorders. After adjustment for individual factors, the risk of substance related disorders increased with neighbourhood deprivation and neighbourhood social disorganisation. The risk of neurotic disorders only increased with contextual deprivation. Measuring contextual factors across continuous space, it was found that these associations operated on a local scale. Conclusions: Taking space into account in the analyses permitted deeper insight into the contextual determinants of mental disorders.
39.	Chaparro, M. Pia, et al. (författare) Influences of the neighbourhood food environment on adiposity of low-income preschool-aged children in Los Angeles County : a longitudinal study 2014 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 68:11, s. 1027-1033 Tidskriftsartikel (refereegranskat)abstract Background Few studies have examined the association between the food environment and adiposity in early childhood, a critical time for obesity prevention. The objective of this study was to examine the longitudinal association between neighbourhood food environment and adiposity among low-income preschool-aged children in a major metropolitan region in the USA. Methods The study sample was 32 172 low-income preschool-aged children in Los Angeles County who had repeated weight and height measurements collected between ages 2 and 5 years through a federal nutrition assistance programme. We conducted multilevel longitudinal analyses to examine how spatial densities of healthy and unhealthy retail food outlets in the children's neighbourhoods were related to adiposity, as measured by weight-for-height z-score (WHZ), while controlling for neighbourhood-level income and education, family income, maternal education, and child's gender and race/ethnicity. Results Density of healthy food outlets was associated with mean WHZ at age 3 in a non-linear fashion, with mean WHZ being lowest for those exposed to approximately 0.7 healthy food outlets per square mile and higher for lesser and greater densities. Density of unhealthy food outlets was not associated with child WHZ. Conclusions We found a non-linear relationship between WHZ and density of healthy food outlets. Research aiming to understand the sociobehavioural mechanisms by which the retail food environment influences early childhood obesity development is complex and must consider contextual settings.
40.	Chaparro, M. Pia, et al. (författare) Response to Letter to the Editor by Joe Brew, Department of Epidemiology, University of Florida 2015 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 69:8, s. 817-817 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
41.	Cohen, Joachim, et al. (författare) End-of-life decision-making in Belgium, Denmark, Sweden and Switzerland : does place of death make a difference? 2007 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 61:12, s. 1062-1068 Tidskriftsartikel (refereegranskat)abstract Objective: To examine differences in end-of-life decision-making in patients dying at home, in a hospital or in a care home. Design: A death certificate study: certifying physicians from representative samples of death certificates, taken between June 2001 and February 2002, were sent questionnaires on the end-of-life decision-making preceding the patient's death. Setting: Four European countries: Belgium (Flanders), Denmark, Sweden, and Switzerland (German-speaking part). Main outcome measures: The incidence of and communication in different end-of-life decisions: physician-assisted death, alleviation of pain/symptoms with a possible life-shortening effect, and non-treatment decisions. Results: Response rates ranged from 59% in Belgium to 69% in Switzerland. The total number of deaths studied was 12 492. Among all non-sudden deaths the incidence of several end-of-life decisions varied by place of death. Physician-assisted death occurred relatively more often at home (0.3-5.1%); non-treatment decisions generally occurred more often in hospitals (22.4-41.3%), although they were also frequently taken in care homes in Belgium (26.0%) and Switzerland (43.1%). Continuous deep sedation, in particular without the administration of food and fluids, was more likely to occur in hospitals. At home, end-of-life decisions were usually more often discussed with patients. The incidence of discussion with other caregivers was generally relatively low at home compared with in hospitals or care homes. Conclusion: The results suggest the possibility that end-of-life decision-making is related to the care setting where people die. The study results seem to call for the development of good end-of-life care options and end-of-life communication guidelines in all settings.
42.	Collatuzzo, G, et al. (författare) Peptic ulcer as mediator of the association between risk of gastric cancer and socioeconomic status, tobacco smoking, alcohol drinking and salt intake 2022 Ingår i: Journal of epidemiology and community health. - : BMJ. - 1470-2738 .- 0143-005X. ; 76:10, s. 861-866 Tidskriftsartikel (refereegranskat)abstract Peptic ulcer disease (PUD) and gastric cancer (GC) are more prevalent in individuals with low socioeconomic status (SES) and share several risk factors. The aim of this study was to investigate the mediating role of PUD in the association between established risk factors and GC.MethodsWe conducted a pooled analysis of 12 studies from the Stomach Cancer Pooling Project Consortium, including a total of 4877 GC cases and 11 808 controls. We explored the mediating role of PUD in the association between SES, tobacco smoking, heavy alcohol drinking and salt intake, and GC. Also, we assessed the ORs and 95% CIs of the risk factors and both PUD and GC.ResultsPUD mediated 36% of the smoking effect mainly among men. Other risk factors were only slightly mediated by PUD (SES, 5.3%; heavy alcohol drinking, 3.3%; and salt intake, 2.5%). No significant difference was found when excluding PUD diagnosed within 2 years from GC.ConclusionsOur study provides innovative information on the mechanism of stomach mucosal damage leading to PUD and GC, with respect to the effect of tobacco smoking in particular.
43.	Cox, Bianca, et al. (författare) Ambient temperature as a trigger of preterm delivery in a temperate climate 2016 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 70:12, s. 1191-1199 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Recent evidence suggests that elevated ambient temperatures may trigger preterm delivery. Since results from studies in temperate climates are inconclusive, we investigated the association between temperature and the risk of preterm birth in Flanders (Belgium).METHODS: We used data on 807 835 singleton deliveries (January 1998-July 2011). We combined a quasi-Poisson model with distributed lag non-linear models to allow for delayed and non-linear temperature effects, accounting for the daily pregnancies at risk and their gestational age distribution.RESULTS: For moderate heat (95th vs 50th centile) up to 1 day before delivery (lag 0-1), the risk of preterm birth increased by 8.5% (95% CI 2.4% to 15.0%) when minimum temperature increased from 8.3°C to 16.3°C and by 9.6% (95% CI 1.1% to 18.7%) when maximum temperature increased from 14.7°C to 26.5°C. Corresponding estimates for extreme heat (99th vs 50th centile) were 15.6% (95% CI 4.8% to 27.6%) for minimum temperature (19.0°C vs 8.3°C) and 14.5% (95% CI 0.5% to 30.6%) for maximum temperature (30.7°C vs 14.7°C). Despite the increased risk of preterm birth associated with cold at lag 2 (and lag 1 for minimum temperature), cumulative cold effects were small. The per cent change in preterm birth associated with moderate cold (5th vs 50th centile) up to 3 days before delivery (lag 0-3) was 2.1% (95% CI -4.1% to 8.7%) for minimum temperature (-2.0°C vs 8.3°C) and 0.6% (95% CI -7.3% to 9.2%) for maximum temperature (2.5°C vs 14.7°C).CONCLUSIONS: Even in a temperate climate, ambient temperature may trigger preterm delivery, suggesting that pregnant women should avoid temperature extremes.
44.	Crump, Casey, et al. (författare) Transnational research partnerships: leveraging big data to enhance US health. 2015 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 69:11, s. 1029-1030 Tidskriftsartikel (refereegranskat)
45.	Cuypers, Koenraad, et al. (författare) Patterns of receptive and creative cultural activities and their association with perceived health, anxiety, depression and satisfaction with life among adults : the HUNT study, Norway 2012 Ingår i: Journal of Epidemiology and Community Health. - London : BMJ Publishing Group. - 0143-005X .- 1470-2738. ; 66:8, s. 698-703 Tidskriftsartikel (refereegranskat)abstract Background Cultural participation has been used both in governmental health policies and as medical therapy, based on the assumption that cultural activities will improve health. Previous population studies and a human intervention study have shown that religious, social and cultural activities predict increased survival rate. The aim of this study was to analyse the association between cultural activity and perceived health, anxiety, depression and satisfaction with life in both genders. Methods The study is based on the third population-based Nord-Trondelag Health Study (2006-2008), including 50 797 adult participants from Nord-Trondelag County, Norway. Data on cultural activities, both receptive and creative, perceived health, anxiety, depression and satisfaction with life were collected by comprehensive questionnaires. Results The logistic regression models, adjusted for relevant cofactors, show that participation in receptive and creative cultural activities was significantly associated with good health, good satisfaction with life, low anxiety and depression scores in both genders. Especially in men, attending receptive, rather than creative, cultural activities was more strongly associated with all health-related outcomes. Statistically significant associations between several single receptive, creative cultural activities and the health-related outcome variables were revealed. Conclusion This population-based study suggests gender-dependent associations between cultural participation and perceived health, anxiety, depression and satisfaction with life. The results support hypotheses on the effect of cultural activities in health promotion and healthcare, but further longitudinal and experimental studies are warranted to establish a reliable cause-effect relationship.
46.	Dadgar, Iman, et al. (författare) Short-term and long-term effects of GDP on traffic deaths in 18 OECD countries, 1960-2011 2017 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 71:2, s. 146-153 Tidskriftsartikel (refereegranskat)abstract Background Research suggests that increases in gross domestic product (GDP) lead to increases in traffic deaths plausibly due to the increased road traffic induced by an expanding economy. However, there also seems to exist a long-term effect of economic growth that is manifested in improved traffic safety and reduced rates of traffic deaths. Previous studies focus on either the short-term, procyclical effect, or the long-term, protective effect. The aim of the present study is to estimate the short-term and long-term effects jointly in order to assess the net impact of GDP on traffic mortality. Methods We extracted traffic death rates for the period 1960-2011 from the WHO Mortality Database for 18 OECD countries. Data on GDP/capita were obtained from the Maddison Project. We performed error correction modelling to estimate the short-term and long-term effects of GDP on the traffic death rates. Results The estimates from the error correction modelling for the entire study period suggested that a one-unit increase (US$1000) in GDP/capita yields an instantaneous short-term increase in the traffic death rate by 0.58 (p<0.001), and a long-term decrease equal to -1.59 (p<0.001). However, period-specific analyses revealed a structural break implying that the procyclical effect outweighs the protective effect in the period prior to 1976, whereas the reverse is true for the period 1976-2011. Conclusions An increase in GDP leads to an immediate increase in traffic deaths. However, after the mid-1970s this short-term effect is more than outweighed by a markedly stronger protective long-term effect, whereas the reverse is true for the period before the mid-1970s.
47.	Derraik, José G B, et al. (författare) First-borns have greater BMI and are more likely to be overweight or obese : a study of sibling pairs among 26 812 Swedish women 2016 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 70:1, s. 78-81 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: A number of large studies have shown phenotypic differences between first-borns and later-borns among adult men. In this study, we aimed to assess whether birth order was associated with height and BMI in a large cohort of Swedish women.METHODS: Information was obtained from antenatal clinic records from the Swedish National Birth Register over 20 years (1991-2009). Maternal anthropometric data early in pregnancy (at approximately 10-12 weeks of gestation) were analysed on 13 406 pairs of sisters who were either first-born or second-born (n=26 812).RESULTS: Early in pregnancy, first-born women were of BMI that was 0.57 kg/m(2) (2.4%) greater than their second-born sisters (p<0.0001). In addition, first-borns had greater odds of being overweight (OR 1.29; p<0.0001) or obese (OR 1.40; p<0.0001) than second-borns. First-borns were also negligibly taller (+1.2 mm) than their second-born sisters. Of note, there was a considerable increase in BMI over the 18-year period covered by this study, with an increment of 0.11 kg/m(2) per year (p<0.0001).CONCLUSIONS: Our study corroborates other large studies on men, and the steady reduction in family size may contribute to the observed increase in adult BMI worldwide.
48.	Di Gessa, Giorgio, et al. (författare) Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach 2017 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 71:5, s. 431-438 Tidskriftsartikel (refereegranskat)abstract Background Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early. Methods Our data come from waves 2-4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65-74 and women aged 60-69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood. Results Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant. Conclusions Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with.
49.	Di Thiene, Domitilla, et al. (författare) Suicide among first-generation and second-generation immigrants in Sweden : association with labour market marginalisation and morbidity. 2014 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 69:5, s. 467-473 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Previous research suggests that first-generation immigrants have a lower suicide risk than those both born in Sweden and with both parents born in Sweden (natives), while the suicide risk in the second generation seems higher. The aim of this study was to investigate to what extent suicide risk in first-generation and second-generation (both parents born abroad) and intermediate-generation (only one parent born abroad) immigrants compared with natives is associated with sociodemographic factors, labour market marginalisation and morbidity.METHODS: A prospective population-based cohort study of 4 034 728 individuals aged 16-50 years was followed from 2005 to 2010. HRs for suicide were calculated for first-generation, intermediate-generation and second-generation immigrants compared with natives. Analyses were controlled for sociodemographic factors, morbidity and labour market marginalisation.RESULTS: The HR of suicide was significantly lower in first-generation immigrants (HR 0.83 CI 0.76 to 0.91), and higher in second-generation (HR 1.32, CI 1.15 to 1.52) and intermediate-generation immigrants (HR 1.20, CI 1.08 to 1.33) in comparison to natives. The excess risk was explained by differences in sociodemographics, morbidity and labour market marginalisation. In the fully adjusted models, a higher HR remained only for the Nordic second generation (HR 1.29, CI 1.09 to 1.52). There were no sex differences in HRs.CONCLUSIONS: The risk of suicide was shown to be lower in the first generation and higher in the second generation compared with natives. The higher HR in the Nordic second generation was not explained by differences in sociodemographics, labour market marginalisation and morbidity. Further research is warranted to investigate factors underlying this excess risk.
50.	Duggal, AK, et al. (författare) Risk of non-affective psychotic disorder and post-traumatic stress disorder by refugee status in Sweden 2020 Ingår i: Journal of epidemiology and community health. - : BMJ. - 1470-2738 .- 0143-005X. ; 74:3, s. 276-282 Tidskriftsartikel (refereegranskat)abstract Refugees have different experiences of obtaining a refugee status, however it remains unclear if this affects their risk of psychiatric disorders. The aim of this study was to investigate whether risk for non-affective psychotic disorder (NAPD) and post-traumatic stress disorder (PTSD) differs between quota refugees (resettled from refugee camps) and non-quota refugees (former asylum seekers).MethodA register-based cohort with a sample size of 52 561 refugees in Sweden starting 1 January 1997 ending 31 December 2011. Exposure: refugee status (quota or non-quota refugees). Cox regression models estimated adjusted HRs with 95% CIs for NAPD (International Classification of Diseases, Tenth Revision (ICD-10), F20–29) and PTSD (ICD-10, F43.1) by refugee status.ResultsThere were more non-quota refugees (77.0%) than quota refugees (23.0%). In total we identified 401 cases of NAPD, 1.0% among quota refugees and 0.7% among non-quota refugees, and 1070 cases of PTSD, 1.9% among quota refugees and 2.1% among non-quota refugees. Male quota refugees were at increased risk for NAPD compared with male non-quota refugees (HRmale=1.41, 95% CI 1.09 to 1.82 and HRfemale=0.65, 95% CI 0.42 to 1.00). All quota refugees were at a reduced risk of PTSD compared with non-quota refugees (HR=0.74, 95% CI 0.64 to 0.87).ConclusionsThis study suggests that risk of NAPD and PTSD varies for quota and non-quota refugees, highlighting the possibility that different experiences of the migration process differentiate the risk of psychiatric disorders among refugees.

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