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1.	Agahi, Neda, et al. (författare) Smoking and Physical Inactivity as Predictors of Mobility Impairment During Late Life : Exploring Differential Vulnerability Across Education Level in Sweden 2018 Ingår i: The journals of gerontology. Series B, Psychological sciences and social sciences. - : Oxford University Press (OUP). - 1079-5014 .- 1758-5368. ; 73:4, s. 675-683 Tidskriftsartikel (refereegranskat)abstract Objectives: To test whether older adults from high and low educational groups are differentially vulnerable to the impact of smoking and physical inactivity on the progression of mobility impairment during old age.Methods: A nationally representative sample of older Swedish adults (n = 1,311), aged 57-76 years at baseline (1991), were followed for up to 23 years (2014). Multilevel regression was used to estimate individual trajectories of mobility impairment over the study period and to test for differences in the progression of mobility impairment on the basis of smoking status, physical activity status, and level of education.Results: Compared to nonsmokers, heavy smokers had higher levels and steeper increases in mobility impairment with advancing age. However, there were only small and statistically nonsignificant differences in the impact of heavy smoking on mobility impairment in high versus low education groups. A similar pattern of results was found for physical inactivity.Discussion: Differential vulnerability to unhealthy behaviors may vary across populations, age, time-periods, and health outcomes. In this study of older adults in Sweden, low and high education groups did not differ significantly in their associations between heavy smoking or physical inactivity, and the progression of mobility impairment.
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.	Allers, Katharina, et al. (författare) Socioeconomic position and risk of unplanned hospitalization among nursing home residents : a nationwide cohort study 2021 Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 31:3, s. 467-473 Tidskriftsartikel (refereegranskat)abstract Background: Socioeconomic inequalities in health and healthcare use in old age have been on the rise during the past two decades. So far, it is unknown whether these inequalities have permeated the nursing home setting. This study aimed to assess whether the socioeconomic position of newly admitted nursing home residents had an influence on their risk of unplanned hospitalization. Methods: We identified older persons (similar to 75 years) who were newly admitted to a nursing home between March 2013 and December 2014 using a set of linked routinely collected administrative and healthcare data in Sweden. The number of unplanned hospitalizations for any cause and the cumulative length of stay were defined as primary outcomes. Unplanned hospitalizations for potentially avoidable causes (i.e. fall-related injuries, urinary tract infections, pneumonia and decubitus ulcers) were considered as our secondary outcome. Results: Among 40 545 newly admitted nursing home residents (mean age 86.8 years), the incidence rate of unplanned hospitalization ranged from 53.9 per 100 person-years among residents with tertiary education up to 55.1 among those with primary education. After adjusting for relevant confounders, we observed no meaningful difference in the risk of unplanned hospitalization according to the education level of nursing home residents (IRR for tertiary vs. primary education: 0.96, 95% CI 0.92-1.00) or to their level of income (IRR for highest vs. lowest quartile of income: 0.98, 0.95-1.02). There were also no differences in the cumulative length of hospital stays or in the risk of experiencing unplanned hospitalizations for potentially avoidable causes. Conclusions: In sum, in this large cohort of newly admitted nursing home residents, we found no evidence of socioeconomic inequalities in the risk of unplanned hospitalization.
4.	Augustsson, Erika, et al. (författare) Can Sex Differences in Old Age Disabilities be Attributed to Socioeconomic Conditions? Evidence from a Mapping Review of the Literature 2023 Ingår i: Journal of Population Ageing. - : Springer Science and Business Media LLC. - 1874-7884 .- 1874-7876. ; 16:3, s. 761-780 Tidskriftsartikel (refereegranskat)abstract Old age disabilities are more common among women than men, and adverse socioeconomic conditions are associated with a higher prevalence of disabilities among older adults. The goal of this study was to complete a mapping review of the available evidence assessing the extent to which the observed sex differences in older adults´ disabilities can be attributed to sex differences in socioeconomic status. We searched three databases for articles published between 2009 and 2019, and after screening and looking at eligibility criteria, 6 articles were included in the review. For those studies that did not directly analyse the contribution of socioeconomic conditions, we used the´difference method´ to estimate the proportion of the sex gap in disabilities among older adults that could be attributed to socioeconomic conditions. Our review demonstrated that women generally have a higher prevalence of disabilities than men. In several studies, these differences could be partly attributed to sex differences in the distribution of socioeconomic conditions. We also find great elasticity in the magnitude of both the sex gap in disabilities and in the proportion that could be attributed to differences in socioeconomic conditions.
5.	Badache, Andreea, 1991- (författare) Beyond the Years : Exploring the role of sensory functions and cognitive abilities in shaping the patterns of old age disabilities and successful aging in an aging population in Sweden and Denmark: An epidemiological perspective of disability 2023 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract AIMS: This research project aims to review the lay perspectives of older adults 75 and above regarding successful aging, as well as estimate the prevalence of sensory difficulties by different subgroups, explore the role of cognition and sensory function in explaining decreasing disability trends over time in Sweden and Denmark and, lastly, longitudinally examine the sensory-cognitive relation in older adults. METHODS: For Study I, a systematic review was conducted, while for Study II the prevalence of sensory functions was estimated. For Study III, the Karlson Holm Breen method was used, whereas Study IV applied a cross-lagged panel model. RESULTS: This research indicates that younger and older adults have different definitions of successful aging, with themes of life, death, and environmental/system influences being important for those aged 75 and above (Study I). Study II shows that the prevalence of sensory difficulties in old age varies among subgroups, and Study III reveals a decreasing prevalence of disability in Sweden and Denmark, attributed to cognitive function, education, reading ability, and hearing ability. Finally, Study IV highlights a reciprocal relationship between sensory functions and cognition among older adults, with better cognitive function associated with better hearing and vision scores over time. DISCUSSION: This research underlines the need for policymakers to cater to the diverse needs of different generations based on gender differences, environmental factors, and access to healthcare and social services. Study II reveals a higher prevalence of sensory difficulties among certain subgroups, which could be targeted by specific interventions. Study III and IV indicate that preserving good sensory functions may mitigate cognitive decline, with interventions including vision and hearing aids and surgeries potentially delaying cognitive decline.
6.	Badache, Andreea-Corina, 1991-, et al. (författare) A descriptive epidemiological study of the prevalence of self-reported sensory difficulties by age group, sex, education, disability, and migration status in Sweden in 2020 Annan publikation (övrigt vetenskapligt/konstnärligt)
7.	Badache, Andreea-Corina, 1991-, et al. (författare) Longitudinal associations between sensory and cognitive functioning in adults 60 years or older in Sweden and Denmark Annan publikation (övrigt vetenskapligt/konstnärligt)
8.	Badache, Andreea C., 1991-, et al. (författare) Why Are Old-Age Disabilities Decreasing in Sweden and Denmark? Evidence on the Contribution of Cognition, Education, and Sensory Functions 2022 Ingår i: The journals of gerontology. Series B, Psychological sciences and social sciences. - : Oxford University Press (OUP). - 1079-5014 .- 1758-5368. ; 78:3, s. 483-495 Tidskriftsartikel (refereegranskat)abstract Objectives: Improvements in educational attainment, cognitive and sensory functions, and a decline in the prevalence of disabilities have been observed in older adults in Sweden and Denmark. In the present study, it was investigated whether better cognition, higher educational attainment, and improved sensory function among older adults aged 60 and older in these countries have contributed to decreasing rates of old-age disabilities.Methods: The analyses were based on repeated cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe for the 2004-2017 period. Descriptive data were used to benchmark the declining prevalence of disabilities, improving cognitive and sensory functions, and increased educational level. The association between time and disabilities was analyzed with logistic regression models, and the contribution of the improved cognitive function, education, and sensory function to the declining prevalence of old-age disabilities was estimated using the Karlson-Holm-Breen method for mediation analysis.Results: The analysis suggests that the declining prevalence of old-age disabilities in Sweden and Denmark between 2004 and 2017 can largely be attributed to improved cognitive function and vision and to a lesser extent by education and hearing ability.Discussion: These findings raise important questions about the causal mechanisms producing the associations between cognition, education, and sensory functions and disability in older age. Future studies should explore the causal nature of the associations between these mediators and old-age disabilities. In addition, they should explore whether these findings differ across regional and cultural contexts and over different time periods.
9.	Badache, Andreea, 1991-, et al. (författare) Longitudinal associations between sensory and cognitive functioning in adults 60 years or older in Sweden and Denmark 2024 Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 121 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The objective of this study is to explore the bidirectional, longitudinal associations between self-reported sensory functions (hearing/vision) and cognitive functioning among older adults in Sweden and Denmark during the period 2004-2017.METHODS: The study is based on data from The Survey of Health, Ageing and Retirement in Europe and consists of 3164 persons aged 60 to 93 years. Within-person associations between sensory and cognitive functions were estimated using random intercept cross-lagged panel models.RESULTS: The results indicated that cognitive and sensory functions were associated within their respective domains over time. The results on the bidirectional associations between sensory functions and cognition over time showed weak and statistically non-significant estimates.CONCLUSION: Our study showed no clear evidence for cross-lagged effects between sensory functions and cognitive functioning. Important to note, however, is that using longitudinal data to estimate change within persons is a demanding statistical test and various factors may have contributed to the absence of conclusive evidence in our study. We discuss several of these factors.
10.	Bell, Max, et al. (författare) Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic : a population-based cohort study 2023 Ingår i: BMC Medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 21:1 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.
11.	Berndt, Hanna, et al. (författare) Childhood living conditions, education and health among the oldest old in Sweden 2016 Ingår i: Ageing & Society. - 0144-686X .- 1469-1779. ; 36:3, s. 631-648 Tidskriftsartikel (refereegranskat)abstract The objectives were to investigate the associations between social and financial living conditions in childhood, education and morbidity in old age. The study population (N = 591; 76+ years old) was assembled from two nationally representative Swedish surveys, in 1968 and 2011, that together made longitudinal analysis possible. Morbidity in old age comprised self-reported measures of musculoskeletal disorders, cardiovascular disease, self-rated health and impaired mobility. There were no independent associations between adverse childhood living conditions and morbidity. However, adverse childhood living conditions were associated with an increased likelihood of low education. Moreover, low education was associated with a higher probability of health problems in old age. The results did not show any associations between adverse childhood conditions and late-life morbidity. However, adverse childhood conditions were associated with lower levels of education which, in turn, was associated with health problems and attrition from the study. These results suggest that adverse childhood conditions may indeed be associated with health and survival in old age, but mainly through mechanisms acting earlier in the lifecourse.
12.	Chen, Tuo-Yu, et al. (författare) Prevalence and Correlates of Falls Among Centenarians : Results from the Five-Country Oldest Old Project (5-COOP) 2020 Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1079-5006 .- 1758-535X. ; 75:5, s. 974-979 Tidskriftsartikel (refereegranskat)abstract Background: Many studies have been conducted to investigate risk factors of falls in older people, but little is known about falls among centenarians. We analyzed the cross-sectional data from the Five-Country Oldest Old Project (5-COOP) to investigate the prevalence and correlates of falls among centenarians. Methods: Data collection was carried out in 2011-2014 in Japan, France, Switzerland, Sweden, and Denmark. The sample consisted of 1,165 centenarians who were at least 100 years old in 2011. The outcome variable was falls in the past 6 months. Demographics, chronic conditions, pain, visual impairment, global cognitive function, dizziness and syncope, number of medications, functional limitation (ie, dressing, bathing, toileting, transferring, incontinence, and feeding), mobility difficulty, poor strength, and assistive device usage were included in the analysis. Results: The prevalence of falls within the last 6 months was 33.7%, ranging from 21.6% (Japan) to 40.9% (France). Being male, experiencing dizziness, syncope, incontinence, and using assistive devices indoors were associated with an increased risk of falls among centenarians. Significant cross-country differences in the relationships between some risk factors (ie, gender, difficulty with bathing, toileting, transferring, and feeding, and using assistive devices for walking indoors and outdoors) and falls were observed. Subsample analysis using data from each country also showed that factors related to falls were different. Conclusions: The prevalence of falls among centenarians is high and fall-related factors may be different than those for their younger counterparts. Given that centenarians is an emerging population, more studies investigating risk factors are needed to better understand falls among centenarians.
13.	Córdoba Doña, Juan Antonio, 1962- (författare) Withstanding austerity : economic crisis and health inequalities in Spain 2017 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background: Along with the austerity measures introduced in many countries, the economic crisis affecting Europe since 2008 seems to have impacted many aspects of the health of the Spanish population and has had a negative effect on the provision health services. An increasing body of knowledge has shown a clear impact of the current crisis on suicidal behaviour and mental health, and a less consistent effect on physical health and access to healthcare. However, little is known about the impact of the crisis on social inequalities in health and healthcare access, an area on which the present study seeks to shed light in the context of Spain, and specifically Andalusia, a region hit very hard by the crisis.Objective: To study the impact of the economic crisis starting in 2008 on health, health inequalities and health service utilisation in Spain and Andalusia and the roles of socio-demographic factors in these associations.Methods: Death rates were analysed to study the annual percent change in overall and cause-specific mortality in Spain between 1999 and 2011, and the Longitudinal Database of the Andalusian Population was used to study educational inequalities in overall mortality from 2002 to 2010 (study 1). To calculate suicide attempt rates, information from 2003 to 2012 on 11,494 men and 12,886 women provided by the Health Emergencies Public Enterprise Information System in Andalusia was utilised. The association between unemployment and suicide attempts was studied through linear regression models (study 2). Two waves of the Andalusian Health Survey (2007 and 2011–12) provided data for the third and fourth studies of this thesis. Educational and employment status inequalities in poor mental health in relation with the crisis were analysed through Poisson regression models (study 3). The change in inequalities (pre-crisis–crisis) in health care utilisation outcomes (general practitioner, specialist, hospitalisation and emergency attendance) was measured by the change in horizontal inequality indices. A decomposition analysis of change in inequality between periods was performed using the Oaxaca approach (study 4).Results: Study 1: Overall mortality in Spain decreased steadily during the period, with annual percent changes of -2.44% in men and -2.20% in women. An increase in educational inequality in mortality was observed in men in Andalusia. In women, the inequalities instead remained stable. Suicide mortality showed a downward trend in both sexes in Spain. Study 2: A sharp increase in suicide attempts in Andalusia was detected after the onset of the crisis in both sexes, with adults aged 35 to 54 years being the most affected. Suicide attempts were associated with unemployment rates only in men. Study 3: Poor mental health increased in working individuals with secondary and primary studies during the crisis compared to the pre-crisis period, while it decreased in the university study group. However, in unemployed individuals poor mental health increased only in the secondary studies group. Financial strain could partly explain the crisis effect on mental health among the unemployed. Study 4: Horizontal inequality in utilisation changed to a greater equality or a more pro-poor inequality in both sexes. In the decomposition analysis, socioeconomic position and health status showed greater contributions to the changes in inequalities.Conclusion: This thesis illustrates the complexity of the influences of the current economic crisis on health inequalities in a Southern European region. Specifically, no noticeable effects of the crisis on overall and suicide mortality were detected; instead, increasing educational inequalities in mortality in men and a large increase in suicide attempts in middle aged men and women were observed. The deterioration in poor mental health was mainly detected in those of intermediate educational level. Economic conditions such as unemployment and financial strain proved to be relevant. Finally, in the light of no increased inequalities in healthcare utilisation, the universal coverage health system seems to buffer the deleterious effect of the crisis and austerity policies in this context.
14.	Darin-Mattsson, Alexander, et al. (författare) Are Occupational Complexity and Socioeconomic Position Related to Psychological Distress 20 Years Later? 2015 Ingår i: Journal of Aging and Health. - : Sage Publications. - 0898-2643 .- 1552-6887. ; 27:7, s. 1266-1285 Tidskriftsartikel (refereegranskat)abstract Objective: To assess occupational complexity in midlife in relation to psychological distress in older adulthood (69+ years) and explore the role of socioeconomic position.Method: Baseline data from the Swedish Level of Living Survey and follow-up data from the Swedish Longitudinal Study ofLiving Conditions of the Oldest Old were combined, resulting in 20+ years of follow-up. Data were analyzed using ordered logistic regressions.Results: Higher occupational complexity was associated with less psychological distress 20 years later adjusted for age, sex, follow-up year, hours worked the year before baseline, and psychological distress at baseline. Higher socioeconomic position yielded the same pattern of results. Socioeconomic position partially accounted for the association between occupational complexity and psychological distress.Discussion: With social gradient not easily amenable to modification, efforts to increase engagement at work may offer a viable option to attenuate the influence of work environment on psychological distress later in life.
15.	Darin-Mattsson, Alexander, et al. (författare) Different indicators of socioeconomic status and their relative importance as determinants of health in old age 2017 Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 16:1 Tidskriftsartikel (refereegranskat)abstract Background: Socioeconomic status has been operationalised in a variety of ways, most commonly as education, social class, or income. In this study, we also use occupational complexity and a SES-index as alternative measures of socioeconomic status. Studies show that in analyses of health inequalities in the general population, the choice of indicators influence the magnitude of the observed inequalities. Less is known about the influence of indicator choice in studies of older adults. The aim of this study is twofold: i) to analyse the impact of the choice of socioeconomic status indicator on the observed health inequalities among older adults, ii) to explore whether different indicators of socioeconomic status are independently associated with health in old age.Methods: We combined data from two nationally representative Swedish surveys, providing more than 20 years of follow-up. Average marginal effects were estimated to compare the association between the five indicators of SES, and three late-life health outcomes: mobility limitations, limitations in activities of daily living (ADL), and psychological distress.Results: All socioeconomic status indicators were associated with late-life health; there were only minor differences in the effect sizes. Income was most strongly associated to all indicators of late-life health, the associations remained statistically significant when adjusting for the other indicators. In the fully adjusted models, education contributed to the model fits with 0-3% (depending on the outcome), social class with 0-1%, occupational complexity with 1-8%, and income with 3-18%.Conclusions: Our results indicate overlapping properties between socioeconomic status indicators in relation to late-life health. However, income is associated to late-life health independently of all other variables. Moreover, income did not perform substantially worse than the composite SES-index in capturing health variation. Thus, if the primary objective of including an indicator of socioeconomic status is to adjust the model for socioeconomic differences in late-life health rather than to analyse these inequalities per se, income may be the preferable indicator. If, on the other hand, the primary objective of a study is to analyse specific aspects of health inequalities, or the mechanisms that drive health inequalities, then the choice of indicator should be theoretically guided.
16.	Dupraz, Julien, et al. (författare) Use of healthcare services and assistive devices among centenarians : results of the cross-sectional, international 5-COOP study 2020 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:3 Tidskriftsartikel (refereegranskat)abstract Objectives To measure the use of healthcare services and assistive devices by centenarians in five countries. Design Cross-sectional study using a survey questionnaire. Setting Community-dwelling and institutionalised centenarians living in Japan, France, Switzerland, Sweden and Denmark. Participants 1253 participants aged 100 or in their 100th year of life, of whom 1004 (80.1%) were female and 596 (47.6%) lived in institutions. Main outcome measures Recent use of medical visits, nursing care at home, home-delivered meals, acute care hospital stays overnight, professional assessments such as sight tests, mobility aids and other assistive devices. A set of national healthcare system indicators was collected to help interpret differences between countries. Results There was considerable variability in the healthcare services and assistive devices used by centenarians depending on their country and whether they were community-dwelling or institutionalised. In contrast to the relatively homogeneous rates of hospitalisation in the past year (around 20%), community-dwelling centenarians reported widely ranging rates of medical visits in the past 3 months (at least one visit, from 32.2% in Japan to 86.6% in France). The proportion of community-dwellers using a mobility device to get around indoors (either a walking aid or a wheelchair) ranged from 48.3% in Japan to 79.2% in Sweden. Participants living in institutions and reporting the use of a mobility device ranged from 78.6% in Japan to 98.2% in Denmark. Conclusions Our findings suggest major differences in care received by centenarians across countries. Some may result from the characteristics of national healthcare systems, especially types of healthcare insurance coverage and the amounts of specific resources available. However, unexplored factors also seem to be at stake and may be partly related to personal health and cultural differences.
17.	Enroth, Linda, et al. (författare) Are there educational disparities in health and functioning among the oldest old? Evidence from the Nordic countries 2019 Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9372 .- 1613-9380. ; 16:4, s. 415-424 Tidskriftsartikel (refereegranskat)abstract With the ageing of the population and recent pressures on important welfare state arrangements, updated knowledge on the linkage between socioeconomic status and health in old age is pertinent for shedding light on emerging patterns of health inequalities in the Nordic countries. This study examined self-rated health (SRH), mobility and activities of daily living (ADL) according to level of education in the three oldest old age groups 75-84, 85-94, and 95+, in four Nordic countries. Altogether, 6132 individuals from Danish Longitudinal Study of Ageing, Norwegian Life Course, Ageing and Generation study, Swedish Panel Study of Living Conditions of the Oldest Old, the 5-Country Oldest Old (Sweden) and Vitality 90 + Study were analysed. First, associations of education level with SRH, mobility, and ADL were estimated for each individual study by means of age- and gender-adjusted logistic regression. Second, results from individual studies were synthesized in a meta-analysis. Older adults with higher education level were more likely to report good SRH, and they were more often independent in mobility and ADL than those with basic education when all age groups were combined. In mobility and ADL, differences between education groups remained stable across the age groups but for SRH, differences seemed to be weaker in older ages. With only a few exceptions, in all age groups, individuals with higher education had more favourable health and functioning than those with basic education. This study shows remarkable persistence of health and functioning inequalities in the Nordic countries throughout later life.
18.	Enroth, Linda, et al. (författare) Changes in socioeconomic differentials in old age life expectancy in four Nordic countries : the impact of educational expansion and education-specific mortality 2022 Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9372 .- 1613-9380. ; 19:2, s. 161-173 Tidskriftsartikel (refereegranskat)abstract Overall progress in life expectancy (LE) depends increasingly on survival in older ages. The birth cohorts now reaching old age have experienced considerable educational expansion, which is a driving force for the social change and social inequality. Thus, this study examines changes in old age LE by educational attainment in the Nordic countries and aims to fnd out to what extent the change in national LEs is attributable to education-specifc mortality and the shifting educational composition. We used national register data comprising total 65+populations in Denmark, Finland, Norway and Sweden to create period life tables stratifed by fve-year age groups (65–90+), sex and educational attainment. Difference in LE between 2001 and 2015 was decomposed into the contributions of mortality changes within each educational group and changes in educational composition. Increasing LE at all ages and in all educational groups coincided with persistent and growing educational inequalities in all countries. Most of the gains in LE at age 65 could be attributed to decreased mortality (63–90%), especially among those with low education, the largest educational group in most countries. The proportion of the increase in LE attributable to improved education was 10–37%, with the highest contributions recorded for women in Norway and Sweden. The rising educational levels in the Nordic countries still carry potential for further gains in national LEs. However, the educational expansion has contributed to uneven gains in LE between education groups, which poses a risk for the future increase of inequalities in LE.
19.	Enroth, Linda, et al. (författare) Trends in the Social Class Inequalities in Disability and Self-Rated Health : Repeated Cross-Sectional Surveys from Finland and Sweden 2001-2018 2021 Ingår i: International Journal of Public Health. - : Frontiers Media SA. - 1661-8556 .- 1661-8564. ; 66 Tidskriftsartikel (refereegranskat)abstract Objectives: To assess time trends in the social class inequalities and in total inequality in disability and self-rated health (SRH) in two oldest old populations.Methods: The data came from the Finnish Vitality 90+ Study (2001, 2003, 2007, 2010, 2014 and 2018; n = 5,440) and from the Swedish Panel Study of Living Conditions of the Oldest Old (2002, 2004, 2011 and 2014; n = 1,645). Inequalities in mobility and activities of daily living (ADL) disability and SRH were examined cross-sectionally and over time using relative and absolute measures.Results: Lower social classes had greater mobility and ADL disability and worse SRH than higher social classes and the inequalities tended to increase over time. Findings were remarkably similar in both studies and with absolute and relative measures. Total inequality, referring to the variance in health outcome in the total population, remained stable or decreased.Conclusion: The study suggests that the earlier findings of improved mobility and ADL are largely driven by the positive development in higher social classes while findings of decline in SRH are related to the worsening of SRH in lower social classes.
20.	Ericsson, Malin Christina, et al. (författare) Validation of abridged mini-mental state examination scales using population-based data from Sweden and USA 2017 Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9372 .- 1613-9380. ; 14:2, s. 199-205 Tidskriftsartikel (refereegranskat)abstract The objective of this study is to validate two abridged versions of the mini-mental state examination (MMSE): one intended for use in face-to-face interviews, and the other developed for telephonic interviews, using data from Sweden and the US to validate the abridged scales against dementia diagnoses as well as to compare their performance to that of the full MMSE scale. The abridged versions were based on eight domains from the original MMSE scale. The domains included in the MMSE-SF were registration, orientation, delayed recall, attention, and visual spatial ability. In the MMSE-SF-C, the visual spatial ability item was excluded, and instead, one additional orientation item was added. There were 794 participants from the Swedish HARMONY study [mean age 81.8 (4.8); the proportion of cognitively impaired was 51 %] and 576 participants from the US ADAMS study [mean age 83.2 (5.7); the proportion of cognitively impaired was 65 %] where it was possible to compare abridged MMSE scales to dementia diagnoses and to the full MMSE scale. We estimated the sensitivity and specificity levels of the abridged tests, using clinical diagnoses as reference. Analyses with both the HARMONY and the ADAMS data indicated comparable levels of sensitivity and specificity in detecting cognitive impairment for the two abridged scales relative to the full MMSE. Receiver operating characteristic curves indicated that the two abridged scales corresponded well to those of the full MMSE. The two abridged tests have adequate validity and correspond well with the full MMSE. The abridged versions could therefore be alternatives to consider in larger population studies where interview length is restricted, and the respondent burden is high.
21.	Ericsson, Malin, et al. (författare) Childhood social class and cognitive aging in the Swedish Adoption/Twin Study of Aging 2017 Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : National Academy of Sciences. - 0027-8424 .- 1091-6490. ; 114:27, s. 7001-7006 Tidskriftsartikel (refereegranskat)abstract In this report we analyzed genetically informative data to investigate within-person change and between-person differences in late-life cognitive abilities as a function of childhood social class. We used data from nine testing occasions spanning 28 y in the Swedish Adoption/Twin Study of Aging and parental social class based on the Swedish socioeconomic index. Cognitive ability included a general factor and the four domains of verbal, fluid, memory, and perceptual speed. Latent growth curve models of the longitudinal data tested whether level and change in cognitive performance differed as a function of childhood social class. Between-within twin-pair analyses were performed on twins reared apart to assess familial confounding. Childhood social class was significantly associated with mean-level cognitive performance at age 65 y, but not with rate of cognitive change. The association decreased in magnitude but remained significant after adjustments for level of education and the degree to which the rearing family was supportive toward education. A between-pair effect of childhood social class was significant in all cognitive domains, whereas within-pair estimates were attenuated, indicating genetic confounding. Thus, childhood social class is important for cognitive performance in adulthood on a population level, but the association is largely attributable to genetic influences.
22.	Ericsson, Malin, et al. (författare) Life-course socioeconomic differences and social mobility in preventable and non-preventable mortality : a study of Swedish twins 2019 Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 48:5, s. 1701-1709 Tidskriftsartikel (refereegranskat)abstract BackgroundDespite advances in life expectancy, low socioeconomic status is associated with a shorter lifespan. This study was conducted to investigate socioeconomic differences in mortality by comparing preventable with non-preventable causes of death in 39 506 participants from the Swedish Twin Registry born before 1935.MethodsChildhood social class, own education, own social class and social mobility were used as separate indicators of socioeconomic status. These data were linked to the Swedish Cause of Death Register. Cause of death was categorized as preventable or non-preventable mortality according to indicators presented in the Avoidable Mortality in the European Union (AMIEHS) atlas. Using Cox proportional hazard models, we tested the association between the socioeconomic measures and all-cause mortality, preventable mortality and non-preventable mortality. Additional co-twin control analyses indicated whether the associations reflected genetic confounding.ResultsThe social gradient for mortality was most prominent for the adult socioeconomic measures. There was a social gradient in both preventable mortality and non-preventable mortality, but with an indication of a moderately stronger effect in preventable causes of death. In analyses of social mobility, those who experienced life-time low socioeconomic status (SES) or downward social mobility had an increased mortality risk compared with those with life-time high SES and upward social mobility. Adjustments for genetic confounding did not change the observed associations for education, social class or social mobility and mortality. In the co-twin control analyses of reared-apart twins, the association between childhood social class and mortality weakened, indicating possible genetic influences on this association.ConclusionsOur results indicate that there is an association between low adult socioeconomic status and increased mortality independent of genetic endowment. Thus, we do not find support for indirect social selection as the basis for mortality inequalities in Sweden
23.	Fors, Andreas, 1977, et al. (författare) Effects of a person-centred approach in a school setting for adolescents with chronic pain-The HOPE randomized controlled trial 2020 Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 24:8, s. 1598-1608 Tidskriftsartikel (refereegranskat)abstract Background Chronic pain among adolescents is common but effective interventions applicable in a school setting are rare. Person-centred care (PCC) is a key factor in improving health by engaging persons as partners in their own care. Methods In this randomized controlled trial, a total of 98 adolescents in secondary school or upper secondary school (aged 14 - 21 years) with chronic pain were randomly assigned to a PCC intervention or standard school healthcare. In the intervention group a pain management programme, based on a PCC approach, comprising four face-to-face sessions with a school nurse over a period of 5 weeks was added to standard school healthcare. The main outcome measure was self-efficacy in daily activities (SEDA scale) and rating scales for pain intensity and pain impact were used as secondary outcome measures. Results At the follow-up, no significant differences were found between the groups in the SEDA scale (p = .608) or in the rating scales for pain intensity (p = .261) and pain impact (p= .836). In the sub-group analysis, a significant improvement in the SEDA scale was detected at the secondary school in favour of the PCC intervention group (p = .021). Conclusion In this pain management programme based on a PCC approach, we found no effect in the total sample, but the programme showed promising results to improve self-efficacy in daily activities among adolescents at secondary school. Significance This study evaluates the effects of a pain management programme based on a PCC approach in a school setting addressing adolescents at upper secondary and secondary schools with chronic pain. No overall effects were shown, but results illustrate that the intervention improved self-efficacy in adolescents at secondary school. Implementation of a PCC approach in a school setting may have the potential to improve self-efficacy in daily activities for adolescents with chronic pain at secondary school.
24.	Fors, Stefan, 1976- (författare) Blood on the tracks : Life-course perspectives on health inequalities in later life 2010 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The overall aim of the thesis was to explore social inequalities in: a) mortality during mid-life, b) health in later life, and c) old-age mortality, from a life-course perspective. The studies are based on longitudinal Swedish survey and registry data. The results from Study I showed substantial inequalities in health, based on social class and gender, among older adults (aged 55+). Moreover, the magnitude of these inequalities did not change during the period 1991-2002. The results from Study II revealed social inequalities in cognitive functioning among the oldest old (aged 77+). Social turbulence and social class during childhood, education and social class in adulthood were all independently associated with level of cognitive functioning in later life. In Study III, social inequalities in mortality during mid-life (i.e., between ages 25 and 69) were explored. The results showed that childhood living conditions were associated with marital status and social class in adulthood and that, in turn, these conditions were associated with mid-life mortality. Thus, the results suggested that childhood disadvantage may serve as a stepping stone to a hazardous life-course trajectory. Study IV explored the association between income in mid-life, income during retirement and old-age mortality (i.e., mortality during retirement). The results showed that both income during mid-life and income during retirement were associated with old-age mortality. Mutually adjusted models showed that income in mid-life was more important for women’s mortality and that income during retirement was more important for men’s. Thus, the results of the present thesis suggest that there are substantial social inequalities in the likelihood of reaching old age, as well as in health and mortality among older adults. These inequalities are shaped by differential exposures throughout the life-course that affect health in later life both through direct effects and through processes of accumulation.
25.	Fors, Stefan, et al. (författare) Childhood Living Conditions, Socioeconomic Position in Adulthood, and Cognition in Later Life : Exploring the Associations 2009 Ingår i: The journals of gerontology. Series B, Psychological sciences and social sciences. - : Oxford University Press (OUP). - 1079-5014 .- 1758-5368. ; 64:6, s. 750-757 Tidskriftsartikel (refereegranskat)abstract Objectives This study examined the association between childhood living conditions, socioeconomic position in adulthood, and cognition in later life. Two questions were addressed: Is there an association between childhood living conditions and late-life cognition, and if so, is the association modified or mediated by adult socioeconomic position?Methods Nationally representative data of the Swedish population aged 77 years and older were obtained from the 1992 and 2002 Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Cognition was assessed with an abbreviated version of the Mini-Mental State Examination scale. Childhood living conditions were assessed by self-reports of childhood living conditions.Results The results showed independent associations between conflicts in the household during childhood, father's social class, education, own social class in adulthood, and cognition in later life. Exposure to conflicts during childhood, having a father classified as a manual worker, low education, and/or being classified as a manual worker in adulthood was associated with lower levels of cognition in old age. There seemed to be no modifying effect of adult socioeconomic position on the association between childhood conditions and cognition in later life.Discussion This suggests the importance of childhood living conditions in maintaining cognitive function even in late life.
26.	Fors, Stefan, et al. (författare) Coexisting Social, Economic, and Health-Related Disadvantages in More than 2.4 Million Swedes : Combining Variable-Centred and Person-Centred Approaches 2019 Ingår i: Social Indicators Research. - : Springer Science and Business Media LLC. - 0303-8300 .- 1573-0921. ; 143:1, s. 115-132 Tidskriftsartikel (refereegranskat)abstract The notion of coexisting disadvantages has been recognised in social welfare policy and welfare research, not least in the Nordic countries. The prevalence and patterning of coexisting disadvantages in society have far reaching implications for well-being, social policy, and social inequality. Using longitudinal register-based data for the years 1998‒2008 for all Swedish individuals born 1946‒1965 (n > 2.4 million), this exploratory study maps out the occurrence of coexisting disadvantages in the Swedish working-age population, and examines to what extent observed prevalence rates are associated with sex, age, immigrant status, and marital status. Coexisting disadvantages are analysed in terms of four broad register-based indicators intended to capture individuals’ resources in key areas of the society: education, income, labour market, and mental health. The results show that while most individuals are not disadvantaged in these areas, coexisting disadvantages do occur and its prevalence varies according to sex, age, immigrant status, and marital status. This study shows that combinations of person-centred and variable-centred analyses of register-based indicators can play a part when developing effective systems for policy surveillance.
27.	Fors, Stefan, 1976-, et al. (författare) Cohort-specific disability trajectories among older women and men in Europe 2004–2017 2022 Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9372 .- 1613-9380. ; 19:4, s. 1111-1119 Tidskriftsartikel (refereegranskat)abstract As the population of Europe grows older, one crucial issue is how the incidence and prevalence of disabilities are developing over time in the older population. In this study, we compare cohort-specific disability trajectories in old age across subsequent birth cohorts in Europe, during the period 2004–2017.We used data from seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Mixed effects logistic regression models were used to model trajectories of accumulation of ADL limitations for subsequent birth cohorts of older women and men in different European regions. The results showed that there were sex differences in ADL and IADL limitations in all regions for most cohorts. Women reported more limitations than men, particularly in Eastern and Southern rather than Northern and Western Europe. Among men in Eastern, Northern and Western Europe, later born cohorts reported more disabilities than did earlier born birth cohorts at the same ages. Similar patterns were observed for women in Northern and Western Europe. In contrast, the risk of disabilities was lower in later born cohorts than in earlier born birth cohorts among women in Eastern Europe. Overall, results from this study suggest that disability trajectories in different cohorts of men and women were by and large similar across Europe. The trajectories varied more depending on sex, age and region than depending on cohort.
28.	Fors, Stefan, et al. (författare) Do actions speak louder than words? : Self-assessed and performance based measures of physical and visual function among old people 2006 Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9372 .- 1613-9380. ; 3:1, s. 15-21 Tidskriftsartikel (refereegranskat)
29.	Fors, Stefan, et al. (författare) Enduring inequality : educational disparities in health among the oldest old in Sweden 1992-2011 2015 Ingår i: International Journal of Public Health. - : Springer Science and Business Media LLC. - 1661-8556 .- 1661-8564. ; 60:1, s. 91-98 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: Although the past two decades have involved changes in the living conditions of the oldest old in Sweden, little is known about how health inequalities have developed in this group during the period. This study explores the educational disparities in a wide range of health outcomes among the oldest old in Sweden between 1992 and 2011.METHODS: The study uses the repeated cross-sectional design of the SWEOLD survey, a nationally representative survey of the oldest old in Sweden with comparable data from 1992, 2002, and 2011. The development of educational disparities in health was tracked across the three waves.RESULTS: The results show that although the prevalence of most health problems increased during the period, the prevalence of disability in activities of daily living decreased. Despite these changes, educational disparities in health remained largely unaffected.CONCLUSIONS: The results of the study suggest that the association between education and health is remarkably robust. It prevailed into the oldest age groups, was consistently found for a wide range of health problems, and tended to be stable over extended periods of time.
30.	Fors, Stefan, et al. (författare) Growing Income-Based Inequalities in Old-Age Life Expectancy in Sweden, 2006-2015 2021 Ingår i: Demography. - : Duke University Press. - 0070-3370 .- 1533-7790. ; 58:6, s. 2117-2138 Tidskriftsartikel (refereegranskat)abstract Sweden is known for high life expectancy and economic egalitarianism, yet in recent decades it has lost ground in both respects. This study tracked income inequality in old-age life expectancy and life span variation in Sweden between 2006 and 2015, and examined whether patterns varied across levels of neighborhood deprivation. Income inequality in remaining life expectancy at ages 65, 75, and 85 increased. The gap in life expectancy at age 65 grew by more than a year between the lowest and the highest income quartiles, for both men (from 3.4 years in 2006 to 4.5 years in 2015) and women (from 2.3 to 3.4 years). This widening income gap in old-age life expectancy was driven by different rates of mortality improvement: individuals with higher incomes increased their life expectancy at a faster rate than did those with lower incomes. Women with the lowest incomes experienced no improvement in old-age life expectancy. Furthermore, life span variation increased in the lowest income quartile, while it decreased slightly among those in the highest quartile. Income was found to be a stronger determinant of old-age life expectancy than neighborhood deprivation.
31.	Fors, Stefan, et al. (författare) Health inequalities among older adults in Sweden 1991–2002 2008 Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 18:2, s. 138-143 Tidskriftsartikel (refereegranskat)abstract Current research has shown a decline in health amongolder adults in Sweden. This study examines health inequalitiesamong older adults in Sweden in 1991–1992 and 2000–2002and explores the development of these inequalities during thisperiod.Methods: A data set was constructed out of four levelsof living surveys, comprising 4085 individuals aged 55 and above.Multivariate logistic regressions were used to assess the associationbetween social class, sex, age and four different domains ofself-reported health: global self-rated health, impaired mobility,musculoskeletal pain and psychological distress. Adjustmentswere made for period of interview. Interaction terms were alsoused to assess change over time. Levin's attributable risk wasused to assess the magnitude of the health inequalities.Results:The results indicate an increase in reports of all specifichealth problems, but not in the global health measure duringthe period. Significant sex differences and a clear social gradientin health were discernible during both periods. Women were morelikely than men to report problems with impaired mobility, painand psychological distress. Manual workers were significantlymore likely than non-manuals to report problems in all fourdomains of health. However, both the sex differences and thesocial gradient seemed to remain constant during the period.Conclusion: Although it seems there are significant differencesin health depending on sex and social class among older adultsin Sweden, these inequalities appear to be unaffected by thegeneral increase in ill health that has been observed in thesegroups over the last decade.
32.	Fors, Stefan, et al. (författare) Intervjustudie om de allra äldstas levnadsvillkor : äldre har fått fler hälsoproblem, men klarar vardagen bättre 2013 Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205. ; 110, s. CA33- Tidskriftsartikel (refereegranskat)
33.	Fors, Stefan, et al. (författare) Is childhood intelligence associated with coexisting disadvantages in adulthood? Evidence from a Swedish cohort study 2018 Ingår i: Advances in Life Course Research. - : Elsevier BV. - 1040-2608. ; 38, s. 12-21 Tidskriftsartikel (refereegranskat)abstract Intelligence has repeatedly been linked to a range of different outcomes, including education, labour market success and health. Lower intelligence is consistently associated with worse outcomes. In this study, we analyzed the associations between intelligence measured in childhood, and the risk of experiencing a range of different configurations of coexisting disadvantages in adulthood. We also examined the role of educational achievements in shaping the associations. The analyses are based on the Stockholm Birth Cohort, a data material that encompasses more than 14,000 individuals born in 1953, with follow up until 2008. Latent class analysis was used to identify four different outcome configurations characterized by varying levels of disadvantages, measured in terms of unemployment, social assistance recipiency, and mental health problems. The results show that those who scored lower on an intelligence test in childhood were at an increased risk of experiencing all configurations characterized by increased levels of disadvantages during adulthood. However, these associations were contingent on educational achievement. Once the models were adjusted for school marks and educational attainment, no association between intelligence and disadvantages remained. These findings highlight the importance of developing strategies to facilitate optimal educational opportunities for all children, at all levels of cognitive performance.
34.	Fors, Stefan, et al. (författare) Live long and prosper? Childhood living conditions, marital status, social class in adulthood and mortality during mid-life : A cohort study 2011 Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 39:2, s. 179-186 Tidskriftsartikel (refereegranskat)abstract Aims: The aim of the present study was to investigate the impact of childhood living conditions, marital status, and social class in adulthood on the risk of mortality during mid-life. Two questions were addressed: Is there an effect of childhood living conditions on mortality risk during mid-life and if so, is the effect mediated or modified by social class and/or marital status in adulthood? Methods: A nationally representative, Swedish, level of living survey from 1968 was used as baseline. The study included those aged 25—69 at baseline (n = 4082). Social conditions in childhood and adulthood were assessed using self-reports. These individuals were then followed for 39 years using registry data on mortality. Results: The results showed associations between childhood living conditions, marital status, social class in adulthood and mortality during mid life. Social class and familial conditions during childhood as well as marital status and social class in adulthood all contributed to the risk of mortality during mid-life. Individuals whose father’s were manual workers, who grew up in broken homes, who were unmarried, and/or were manual workers in adulthood had an increased risk of mortality during mid life. The effects of childhood conditions were, in part, both mediated and modified by social class in adulthood. Conclusions: The findings of this study suggest that there are structural, social conditions experienced at different stages of the life course that affect the risk of mortality during mid-life.
35.	Fors, Stefan (författare) Ojämlikhet och hälsa i ett livsloppsperspektiv 2012 Ingår i: Jämlik ålderdom?. - Malmö : Liber. - 9789147096961 ; , s. 112-136 Bokkapitel (övrigt vetenskapligt/konstnärligt)
36.	Fors, Stefan, et al. (författare) Paying the price? The impact of smoking and obesity on health inequalities in later life 2012 Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 41:2, s. 134-141 Tidskriftsartikel (refereegranskat)abstract Aims: The aims of the study are twofold: (i) to explore the impact of socioeconomic position, as measured 13 years earlier, on cognitive functioning and mobility impairment in later life, and (ii) to explore the extent to which obesity and smoking status can explain socioeconomic inequalities in cognitive and mobility impairments in later life. Methods: Data from a nationally representative sample of Swedish adults aged 56-76 in 1991 who were re-interviewed 13 years later in 2004, was analysed to explore the impact of socioeconomic position, smoking, and obesity on cognitive and physical functioning in late life. Results: The results showed that both smoking and obesity in late mid-life were stratified by socioeconomic position. Moreover, the results showed significant associations between socioeconomic position and both cognitive and physical functioning in later life. However, these inequalities in late life function could only partially be explained by the socioeconomic differences in smoking and obesity. Conclusions: The findings of this study suggest that socioeconomic differences in the rates of smoking and obesity may explain some, but not all, of the socioeconomic inequalities in physical and cognitive functioning during old age.
37.	Fors, Stefan, et al. (författare) Social mobility, geographical proximity and intergenerational family contact in Sweden 2008 Ingår i: Ageing & Society. - 0144-686X .- 1469-1779. ; 28, s. 253-270 Tidskriftsartikel (refereegranskat)abstract This study examined intergenerational family contact. Three questions were considered: Is there a relationship between parent's class, child's class and family contact? Can class-related differences in family contact be explained by differences in geographical distance between parent and child? Is intergenerational family contact affected by children's social mobility? The questions were explored using data from a nationally-representative level of living survey. The results from logistic regressions showed that parent's class as well as the child's class were associated with intergenerational geographical distance and family contact more often than once a week. Those in or retired from non-manual occupations were less likely than manual workers to live close and to have family contact more than once a week. We found no evidence that a change in class position, upward nor downward, had any effect on family contacts. Rather, class-stable non-manual families socialise less frequently than other families, even when they live relatively close. The results therefore suggest that familial class-cohesiveness is a stronger determinant of inter-generational family contacts than social mobility. Future research should address the complex connection between social mobility and other forms of relations and transfers between generations.
38.	Fors, Stefan, et al. (författare) Socioeconomic inequalities in circulatory and all-cause mortality after retirement : the impact of mid-life income and old-age pension. Evidence from the Uppsala Birth Cohort Study 2012 Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 66:7, s. e16- Tidskriftsartikel (refereegranskat)abstract Background: The aim of this study was to explore the impact of mid-life income and old-age pensions on the risk of mortality in later life. Furthermore, the study explored whether income inequalities in old-age mortality can be explained by differences in early childhood development, social class during childhood, education or marital status.Methods: The study sample comprises all individuals born at Uppsala Academic Hospital during the period 1915–1924 who had retired but not died or emigrated by 1991 (n=4156). Information on social and biological conditions was retrieved from national registries.Results: The results show that income during mid-life and income during retirement were associated with old-age mortality. However, mutually adjusted models showed that income in mid-life was more important for women's late-life mortality and that income during retirement was more important for men's late-life mortality. Furthermore, differences in education and marital status seemed to explain a substantial part of income inequalities in late-life mortality.Conclusions: It is unlikely that egalitarian social policies aimed at older populations can eradicate health inequalities accumulated over the life course. However, retirement income appears to have an effect on late-life mortality that is independent of the effect of income in mid-life, suggesting that egalitarian pension schemes could affect health inequalities in later life or, at the very least, slow down further accumulation of inequalities.
39.	Gudjonsdottir, Hrafnhildur, et al. (författare) Cohort Profile : The Stockholm Diabetes Prevention Programme (SDPP) 2022 Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 51:6, s. e401-e413 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)].
40.	Heap, Josephine, 1980-, et al. (författare) Coexisting Disadvantages in later Life : Demographic and Socio-Economic Inequalities 2017 Ingår i: Journal of Population Ageing. - : Springer Science and Business Media LLC. - 1874-7884 .- 1874-7876. ; 10:3, s. 247-267 Tidskriftsartikel (refereegranskat)abstract In this study, we aimed to identify which of certain demographic and socio-economic groups in the oldest part of the population that have an increased probability of experiencing simultaneous disadvantages in different life domains - here termed coexisting disadvantages. To do so, we compared analyses of coexisting disadvantages, measured as two or more simultaneous disadvantages, with analyses of single disadvantages and specific combinations of disadvantages. Indicators of physical health problems, ADL limitations, psychological health problems, limited financial resources, and limited social resources were included. We used nationally representative data from 2011 on people aged 76 and older in Sweden (n = 765). Results showed that coexisting disadvantages were associated with specific demographic and socio-economic groups, particularly certain marital status groups. Moreover, the differences between the demographic and socio-economic groups were only found for those who reported coexisting disadvantages, and not for those who reported only one disadvantage, which suggests that demographic and social factors become more important as disadvantages compound. Further, we analysed pairwise combinations of disadvantages. We found that different combinations of disadvantages tended to be associated with different groups, information useful from a social planning perspective since different combinations of disadvantages may imply different needs for help and support.
41.	Heap, Josephine, et al. (författare) Coexisting disadvantages in later life : Demographic and socio-economic inequalities Annan publikation (övrigt vetenskapligt/konstnärligt)
42.	Heap, Josephine, et al. (författare) Duration and accumulation of disadvantages in old age 2015 Ingår i: Social Indicators Research. - : Springer Science and Business Media LLC. - 0303-8300 .- 1573-0921. ; 123:2, s. 411-429 Tidskriftsartikel (refereegranskat)abstract The probability of experiencing simultaneous disadvantages in more than one life domain seems to be higher for the oldest old people than younger age groups. However, the experience of coexisting disadvantages among older adults is relatively underexplored. We set out to analyse whether coexisting disadvantages among older people are long-lasting or temporary, and whether there are patterns of an accumulation of disadvantages in old age or not. We used nationally representative, longitudinal data between 1991 and 2011. Respondents were born between 1916 and 1934. The following disadvantages were included: lack of social resources, lack of political resources, lack of financial resources, psychological health problems, physical health problems and mobility limitations. Results suggest differing experiences of disadvantage in old age. We found that reporting coexisting disadvantages in 1991 increased the probability of reporting coexisting disadvantages in 2011, but the correlation was moderate. This indicates that for some people, coexisting disadvantages in old age is relatively stable, while for others it is a temporary experience. Reporting one disadvantage in 1991 also increased the probability of reporting coexisting disadvantages in 2011, suggesting a pattern of accumulation of disadvantages. Again, this pattern may not be generalised to all people. To a large extent the observed accumulation of disadvantages in old age seemed to be driven by physical health deterioration and mobility limitations.
43.	Herr, Marie, et al. (författare) Frailty and Associated Factors among Centenarians in the 5-COOP Countries 2018 Ingår i: Gerontology. - : S. Karger AG. - 0304-324X .- 1423-0003. ; 64:6, s. 521-531 Tidskriftsartikel (refereegranskat)abstract Background: The global number of centenarians is still strongly growing and information about the health and healthcare needs of this segment of the population is needed. This study aimed to estimate the prevalence of frailty among centenarians included in a multinational study and to investigate associated factors. Methods: The 5-COOP study is a cross-sectional survey including 1,253 centenarians in 5 countries (Japan, France, Switzerland, Denmark, and Sweden). Data were collected using a standardized questionnaire during a face-to-face interview (73.3%), telephone interview (14.5%), or by postal questionnaire (12.2%). The 5 dimensions of the frailty phenotype (weight loss, fatigue, weakness, slow walking speed, and low level of physical activity) were assessed by using self-reported data. Factors associated with frailty criteria were investigated by using multivariate regression models. Results: Almost 95% of the participants had at least 1 frailty criterion. The overall prevalence of frailty (3 criteria or more) was 64.7% (from 51.5% in Sweden to 77.6% in Switzerland), and 32.2% of the participants had 4 or 5 criteria. The most frequent criteria were weakness (84.2%), slow walking speed (77.6%), and low level of physical activity (72.5%), followed by fatigue (43.8%) and weight loss (23.8%). Factors associated with frailty included data collection modes, country of residence, gender, living in institution, depression, dementia, disability, falls, and sensory impairments. Conclusions: This study shows that reaching 100 years of age rarely goes without frailty and sheds light on factors associated with frailty at a very old age.
44.	Hossin, Muhammad Zakir, et al. (författare) Is the Association Between Late Life Morbidity and Disability Attenuated Over Time? Exploring the Dynamic Equilibrium of Morbidity Hypothesis 2019 Ingår i: The journals of gerontology. Series B, Psychological sciences and social sciences. - : Oxford University Press (OUP). - 1079-5014 .- 1758-5368. ; 74:8, s. 97-106 Tidskriftsartikel (refereegranskat)abstract Objective:There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these patterns are due to the attenuation of the morbidity-disability link over time. This study aimed to test this assumption empirically.Methods:Data were drawn from three repeated cross-sections of SWEOLD, a nationally representative survey of the Swedish population aged 77 years and older. Poisson regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined on both multiplicative and additive scales.Results:Between 1992 and 2011, the prevalence of both ADL and IADL disabilities decreased whereas the prevalence of nearly all chronic morbidities increased. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, and psychological distress.Discussion:In agreement with the dynamic equilibrium of morbidity hypothesis, this study concludes that the morbidity-disability associations among the Swedish older adults largely waned between 1992 and 2011.
45.	Høj Jørgensen, Terese Sara, et al. (författare) Ageing populations in the Nordic countries : Mortality and longevity from 1990 to 2014 2019 Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 47:6, s. 611-617 Tidskriftsartikel (refereegranskat)abstract Aims: Cross-country comparisons of mortality and longevity patterns of Nordic populations could contribute with novel insights into the compositional changes of these populations. We investigated three metrics of population ageing: the proportion of the population aged 75+ and 90+ years, the proportion of birth cohorts reaching 75 and 90 years, and life expectancy (LE) at age 75 and 90 years in Sweden, Norway, Iceland, Denmark and Finland, in the period 1990-2014.Methods: Demographic information was collected from national statistical databases and the Human Mortality Database.Results: All metrics on population ageing increased during the study period, but there were some cross-country variations. Finland experienced a notably steep increase in the proportion of 75+ and 90+ year olds compared to the other countries. Regarding the proportion reaching old ages, the Finnish lagged behind from the beginning, but females decreased this difference. The Danes were more similar to the other countries at the beginning, but did not experience the same increase over time. Gender-specific LE at age 75 and 90 years was similar overall in the five countries.Conclusions: Developments in cross-country variation suggest that survival until old age has become more similar for Finnish females and more different for Danish males and females compared with the other countries in recent decades. This provides perspectives on the potential to improve longevity in Denmark and Finland. Similarities in LE in old age suggest that expected mortality in old age has been more similar throughout the study period.
46.	Høj Jørgensen, Terese Sara, et al. (författare) Intergenerational relations and social mobility : Social inequality in physical function in old age 2019 Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 80, s. 58-64 Tidskriftsartikel (refereegranskat)abstract Background: The concept of social foreground describes how adult offspring's socioeconomic resources may influence older adults' health and several studies have shown an association between socioeconomic position of adult offspring and the health of their older parents. However, little is known about the factors that generate these associations. We study 1) how adult offspring's social class is associated with physical function (PF) among older adults, 2) whether geographical closeness and contact frequency with offspring modify the association, and 3) whether intergenerational social mobility of offspring is associated with PF of older adults. Method: Data are obtained from the 2002 (n = 621) and 2011 (n = 931) waves of the Swedish Panel Study of Living Conditions of the Oldest Old. Multivariable linear regression models were employed and adjusted for own and partner's prior social class and offspring's age and gender. Results: Compared to offspring with non-manual occupation, offsprings with manual occupation was associated with poorer PF in older adults ( -0.14, CI95%: -0.28;0.00). In stratified analyses, offspring's social class was only associated with older adults' PF among those who lived geographically close. Contact frequency between the offspring and the older adults did not modify the associations. Older adults whose offspring experienced downward intergenerational social mobility were associated with the poorest PF. Conclusion: This study supports evidence of a relationship between social foreground and older adults' PF where geographical closeness and social mobility are important components.
47.	Høj Jørgensen, Terese Sara, et al. (författare) The importance of close next of kin for independent living and readmissions among older Swedish hip fracture patients 2022 Ingår i: Health & Social Care in the Community. - : Hindawi Limited. - 0966-0410 .- 1365-2524. ; 30:3, s. e727-e738 Tidskriftsartikel (refereegranskat)abstract We investigate the importance of adult children and/or cohabitation with a partner for older hip fracture patients’ probability of independent living, public home care use and hospital readmission. Data from 35,066 Swedish hip fracture patients between 2012 and 2017, aged 65 years, and living at home at the time of the fracture in the Swedish Registry for Hip Fracture Patients and Treatment were linked with national registers. We applied adjusted logistic regression models and Cox proportional hazard models. In total, 959 (4.0%) women and 817 (7.3%) men had no adult children, 13,384 (56.0%) women and 3,623 (32.5%) men had no cohabiting partner and 2,780 (11.6%) women and 1,389 (12.5%) men neither had a cohabiting partner nor adult children. In comparison with women and men who had both a cohabiting partner and adult children, those without a cohabiting partner (i.e. only adult children) and those who neither had a cohabiting partner nor adult children had significantly lower probabilities of returning home (at discharge and after 4 months). They also had a greater probability of both receiving home care and having an increase in the amount of home care they receive. Having a close next of kin and hospital readmission were not associated. In conclusion, absence of a close next of kin, specifically a cohabiting partner, reduces the chance of return to independent living and increases the use of home care after a hip fracture hospitalisation. The findings highlight the importance of family support for older adults living situation after a hip fracture.
48.	Ilinca, Stefania, et al. (författare) Gender differences in access to community-based care : a longitudinal analysis of widowhood and living arrangements 2022 Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9372 .- 1613-9380. ; 19:4, s. 1339-1350 Tidskriftsartikel (refereegranskat)abstract Persistent inequalities in access to community-based support limit opportunities for independent living for older people with care needs in Europe. Our study focuses on investigating how gender, widowhood and living arrangement associate with the probability of receiving home and community-based care, while accounting for the shorter-term associations of transitions into widowhood (bereavement) and living alone, as well as the longer-term associations of being widowed and living alone. We use comparative, longitudinal data from the Survey of Health, Ageing and Retirement in Europe (collected between 2004 and 2015 in 15 countries) specifying sex-disaggregated random-effects within-between models, which allow us to examine both cross-sectional and longitudinal associations among widowhood, living arrangements and community-based care use. We find widowhood and living alone are independently associated with care use for both older women and men, while bereavement is associated with higher probability of care use only for women. Socio-economic status was associated with care use for older women, but not for men in our sample. The gender-specific associations we identify have important implications for fairness in European long-term care systems. They can inform improved care targeting towards individuals with limited informal care resources (e.g. bereaved older men) and lower socio-economic status, who are particularly vulnerable to experiencing unmet care needs. Gender differences are attenuated in countries that support formal care provision, suggesting gender equity can be promoted by decoupling access to care from household and family circumstances.
49.	Jørgensen, Terese S. H., et al. (författare) Adult offspring and their socioeconomic resources for development and survival of stroke : A Swedish and Danish nationwide register-based study 2024 Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 52:2, s. 216-224 Tidskriftsartikel (refereegranskat)abstract Aims: To explore the relationships between adult offspring’s socioeconomic resources and the development of stroke and survival after stroke among older adults in Denmark and Sweden.Methods: The study included 1,464,740 Swedes and 835,488 Danes who had turned 65 years old between 2000 and 2015. Multivariable Cox proportional hazard regression models were used to analyse incident stroke and survival after stroke until 2020.Results: Lower level of offspring’s education, occupation and income were associated with higher hazards of stroke among both men and women in Sweden and Denmark. Associations with offspring’s education, occupation and income were most consistent for death after the acute phase and for educational level. From one to five years after stroke and compared with a high educational level of offspring, low and medium educational level were associated with 1.34 (95% confidence interval (CI): 1.11; 1.62) and 1.18 (95% CI: 1.10; 1.27) as well as 1.26 (95% CI: 1.06; 1.48) and 1.14 (1.07; 1.21) times higher hazard of death in Swedish women and men, respectively. The corresponding estimates in the Danish population were 1.36 (1.20; 1.53) and 1.10 (1.01; 1.20) for women and 1.23 (95% CI: 1.11; 1.32) and 1.13 (95% CI: 1.05; 1.21) for men.Conclusions: Adult offspring socioeconomic resources are, independently of how we measure them and of individual socioeconomic characteristics, associated with development of stroke in old age in both Denmark and Sweden. The relationships between offspring socioeconomic resources and death after stroke are present especially after the acute phase and most pronounced for educational level as a measure of offspring socioeconomic resources.
50.	Kelfve, Susanne, 1974-, et al. (författare) Getting better all the time? Selective attrion and compositional changes in longitudinal and life-course studies Annan publikation (övrigt vetenskapligt/konstnärligt)

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