| 1. |
- Khanolkar, Amal, et al.
(author)
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Parental influences on cardiovascular risk factors in Swedish children aged 5-14 years
- 2012
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In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 22:6, s. 840-847
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Journal article (peer-reviewed)abstract
- BACKGROUND:Precursors of cardiovascular diseases (CVD) originate in childhood. We investigated relationships of children's CVD risk factors with parent's socio-economic position (SEP) and lifestyle and how CVD risk factors correlate within families.METHODS: We studied 602 families with 2141 individuals comprising two full sibs; aged 5-14 years, and their biological parents (Uppsala Family Study). Parental SEP (occupational class and education) and lifestyle habits [smoking, physical activity (PA), alcohol consumption] were taken from questionnaires. Associations with cholesterol, ApoB/ApoA1, leptin, adiponectin, blood pressure, body mass index (BMI) and overweight/obesity (OW/OB) were analysed by linear/logistic regression. Results were adjusted for child's age, gender, pubertal stage and family clustering.RESULTS:We observed no consistent associations between parental SEP and children's CVD risk factors. Parental lifestyle had stronger effects, independent of parental SEP. Children of smoking fathers had higher BMI (4%, 95% CI 1-7%) and leptin levels (27%, 95% CI 1.00-61.60%). Children of mothers reporting vigorous PA had lower BMI, cholesterol and decreased odds for OW/OB with a possible dose effect. Compared with mothers reporting no vigorous activity, mothers with ≤75 min and 76-150 min/week of vigorous activity had 43% (OR 0.57, 95% CI 0.22-0.89) and 72% (OR 0.28, 95% CI 0.14-0.60) lower risk of having an OW/OB child, respectively, after adjustment for confounders. Independent, consistently stronger and significant associations were found between all studied parents' and children's CVD risk factors.CONCLUSION: Parental behaviours: smoking, alcohol consumption, low PA are associated with higher levels of CVD risk factors (BMI, OW/OB, cholesterol) in children. Strong correlations in CVD risk factors within families not related to parental SEP/lifestyle suggest a role of genetics in influencing children's CVD risk factors. Public health policies should target families with unhealthy lifestyles.
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| 2. |
- Khanolkar, Amal R., et al.
(author)
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2009 IOM guidelines for gestational weight gain : how well do they predict outcomes across ethnic groups?
- 2020
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In: Ethnicity and Health. - : Informa UK Limited. - 1355-7858 .- 1465-3419. ; 25:1, s. 110-125
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Journal article (peer-reviewed)abstract
- Objective: To determine whether the Institute Of Medicine's (IOM) 2009 guidelines for weight-gain during pregnancy are predictive of maternal and infant outcomes in ethnic minority populations.Methods: We designed a population-based study using administrative data on 181,948 women who delivered live singleton births in Washington State between 2006–2008. We examined risks of gestational hypertension, preeclampsia/eclampsia, cesarean delivery, and extended hospital stay in White, Black, Native-American, East-Asian, Hispanic, South-Asian and Hawaiian/Pacific islander women according to whether they gained more or less weight during pregnancy than recommended by IOM guidelines. We also examined risks of neonatal outcomes including Apgar score <7 at 5 min, admission to NICU, requirement for ventilation, and a diagnosis of small or large for gestational age at birth.Results: Gaining too much weight was associated with increased odds for gestational hypertension (adjusted OR (aOR) ranged between 1.53–2.22), preeclampsia/eclampsia (aOR 1.44–1.81), cesarean delivery (aOR 1.07–1.38) and extended hospital stay (aOR 1.06–1.28) in all ethnic groups. Gaining too little weight was associated with decreased odds for gestational hypertension and delivery by cesarean section in Whites, Blacks and Hispanics. Gaining less weight or more weight than recommended was associated with increased odds for small for gestational age and large for gestational age infants respectively, in all ethnic groups.Conclusions: Adherence to the 2009 IOM guidelines for weight gain during pregnancy reduces risk for various adverse maternal outcomes in all ethnic groups studied. However, the guidelines were less predictive of infant outcomes with the exception of small and large for gestational age.
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| 3. |
- Khanolkar, Amal R
(author)
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Inequalities in health : social, biological, ethnic and life-course perspectives
- 2013
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Doctoral thesis (other academic/artistic)abstract
- There is an unmistakable consistency in differences in risks for morbidity and mortality between social groups. The more advantaged, whether measured in terms of income, education, class, status or ethnicity in general fare better when compared to others, emphasizing the importance of the social environment in determining health in all stages of life. The early stages of life; infancy, childhood, and adolescence are particularly vulnerable – exposures and health in these and later periods of life are dependent on both concurrent social environments and on previous parental life experiences and intergenerational influences. This stresses the need to investigate the development of risk factors and disease across the life course. Affluent and high-income countries are increasingly characterized by widening inequalities in health. Less is known about health differences in ethnic minorities in Sweden compared to similar high- income countries with large immigrant and ethnic minority groups. The importance of intergenerational mechanisms and the psychosocial environment in predicting childhood health was highlighted in studies in this thesis. Children (aged 5-14 years) of parents with lower reported levels of physical activity, higher smoking and alcohol consumption had higher mean BMI and cholesterol levels, independent of parental socioeconomic indicators. Overweight/obese parents also had substantially higher risks for having overweight/obese children (compared to parents of normal BMI, an obese mother had an OR of 4.53 (95% CI 1.98–10.38) for having an overweight/obese child. Similarly, OR for obese fathers was 5.07 (95% CI 2.11–12.20)). Results from studies included in this thesis show that some immigrant groups are at higher risk for health outcomes seen in different stages of the life course. Immigrant parents from Poland, Yugoslavia, Iran, South Asia, East Asia and Sub-Saharan Africa had higher risk for early preterm birth (adjusted RR (95% CI) 1.76, (1.24-2.50), 1.57, (1.31-1.87), 1.67, (1.30-2.14), 1.52, (1.07-2.16), 1.51, (1.08-2.10) and 2.03, (1.32-3.12)) respectively). South Asian, Sub-Saharan African and East Asian immigrant groups had a higher risk for late preterm birth (adjusted RR 1.62 (1.42-1.84), 1.31 (1.08-1.60) and 1.20 (1.06-1.36) respectively). North African/Middle eastern, Somali, and Ethiopian/Eritrean groups had increased RR for postterm birth (adjusted RR 1.31, (1.16-1.47), 2.57 (2.31-2.86), 1.85 (1.67-2.04) respectively). Children aged 4-5 years old, with immigrant parents from Turkey, North Africa, Iran and South America had a higher risk for overweight or obesity compared to children of Swedish born parents. In both studies, socioeconomic indicators did not explain the observed increased risk for either non-term birth or overweight/obesity indicating that other factors that constitute ethnicity may play a role. On the other hand, young Swedish males (ages 18 years) of immigrant parents had lower systolic blood pressure when compared to ethnic Swedish males. The established inverse association between foetal growth and adulthood blood pressure while observed in European-origin men was not seen in non-Europeans. While evidence exists to support that certain ethnic groups suffer disproportionately in risk for some of the adverse health outcomes studied in this thesis, there is also an indication that some ethnic groups are protected from the same. Contrary to expectation, variation in socioeconomic indicators did not explain the observed differences in risk. More studies are needed to understand these observed differences in health and guide better public health intervention for reducing inequalities seen in ethnic minorities.
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| 4. |
- Khanolkar, Amal R., et al.
(author)
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Preterm and postterm birth in immigrant- and Swedish-born parents : a population register-based study
- 2015
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In: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 30:5, s. 435-447
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Journal article (peer-reviewed)abstract
- Ethnic minorities/immigrant groups tend to have increased risk for preterm birth. Less is known about this risk in diverse immigrant groups, couples of mixed ethnic-origin and in relation to duration of residence. Data from the Swedish Medical Birth Register on 1,028,303 mothers who gave birth to 1,766,026 singleton live born infants (1982–2002), was linked to the Education and Total Population Registers. Immigrant parents were identified by country of birth. Risk of early preterm, late preterm and postterm birth was analyzed using multinomial logistic regression. Polish, Yugoslavian, Iranian, South Asian, East Asian and Sub-Saharan African parents, Swedish mothers who had children with non-Swedish fathers, and parents from two different immigrant groups had higher risk of early preterm birth [adjusted relative risk (RR) (95 % CI) 1.76 (1.24–2.50), 1.57 (1.31–1.87), 1.67 (1.30–2.14), 1.52 (1.07–2.16), 1.51 (1.08–2.10), 2.03 (1.32–3.12), 1.56 (1.45–1.67), and 1.55 (1.35–1.77) respectively] compared to Swedish-born parents. South Asian, Sub-Saharan African, and East Asian immigrants had a higher risk of late preterm birth compared to Swedish-born parents. North African and Middle Eastern, Somali, and Ethiopian/Eritrean groups had increased risk of postterm birth [adjusted RR 1.31 (1.16–1.47), 2.57 (2.31–2.86), 1.85 (1.67–2.04) respectively]. Adjustment for covariates did not substantially change associations. Immigrant mothers resident <3 years had higher risk for early preterm and postterm birth compared to residents >10 years [adjusted RR 1.46 (1.24–1.71) and 1.16 (1.11–1.23) respectively]. In addition to higher risk of preterm birth in select immigrant groups, some immigrant groups are also at higher risk of postterm birth. Shorter duration of residence is associated with higher risk of non-term deliveries.
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| 5. |
- Khanolkar, Amal R, et al.
(author)
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Socioeconomic position and the risk of brain tumour : a Swedish national population-based cohort study.
- 2016
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In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 70:12, s. 1222-1228
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Journal article (peer-reviewed)abstract
- BACKGROUND: The aim was to investigate associations between different measures of socioeconomic position (SEP) and incidence of brain tumours (glioma, meningioma and acoustic neuroma) in a nationwide population-based cohort.METHODS: We included 4 305 265 individuals born in Sweden during 1911-1961, and residing in Sweden in 1991. Cohort members were followed from 1993 to 2010 for a first primary diagnosis of brain tumour identified from the National Cancer Register. Poisson regression was used to compute incidence rate ratios (IRR) by highest education achieved, family income, occupational group and marital status, with adjustment for age, healthcare region of residence, and time period.RESULTS: We identified 5735 brain tumours among men and 7101 among women during the study period. Highly educated men (≥3 years university education) had increased risk of glioma (IRR 1.22, 95% CI 1.08 to 1.37) compared to men with primary education. High income was associated with higher incidence of glioma in men (1.14, 1.01 to 1.27). Women with ≥3 years university education had increased risk of glioma (1.23, 1.08 to 1.40) and meningioma (1.16, 1.04 to 1.29) compared to those with primary education. Men and women in intermediate and higher non-manual occupations had increased risk of glioma compared to low manual groups. Compared to those married/cohabiting, being single or previously married/cohabiting was associated with decreased risk of glioma in men. Men in non-manual occupations had ∼50% increased risk of acoustic neuroma compared to men in low manual occupations.CONCLUSIONS: We observed consistent associations between higher SEP and higher risk of glioma. Completeness of cancer registration and detection bias are potential explanations for the findings.
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| 6. |
- Khanolkar, Amal, et al.
(author)
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Social determinants of cardiac disease biomarkers : Investigating a Swedish male cohort at ages 50 and 70
- 2012
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In: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 19:3, s. 523-533
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Journal article (peer-reviewed)abstract
- Aims: To investigate relationships between socioeconomic position (SEP) and common CVD biomarkers including adiponectin not previously investigated in a Swedish-population sample, and to assess if these associations changed with age. Design: Population-based longitudinal cohort study of men born 1920-24 with clinical measurements, blood samples, questionnaire data, and register-based information on SEP and cause of death. Methods: A total of 2322 men attended an investigation at age 50 of which 1221 attended a reinvestigation at age 70. Association between SEP and CVD biomarkers [cholesterol, low-density lipoprotein/high-density lipoprotein (LDL/HDL), apolipoprotein (Apo) ApoB/ApoA1, and adiponectin] were analysed by linear regression (adjusted for age, body mass index, and physical activity). SEP was measured as occupational class and educational level. CVD mortality over 36 years of follow-up was analysed by Cox regression. Results: At age 50, we found a significant inverse association of education with cholesterol level, LDL/HDL ratio and ApoB/ApoA1 ratio. Cholesterol was also associated with occupational class, statistically significant after adjustment for all covariates. At age 70, no significant associations were found between either measurement of SEP and any of the biomarkers studied. Highest educated men had decreased risk for CVD mortality during follow-up. Conclusions: Associations of SEP with cholesterol levels and LDL/HDL ratio that exist at age 50 are no longer apparent in the same group of men at age 70. We found no significant association between SEP and adiponectin levels at age 70.
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| 7. |
- Khanolkar, Amal, et al.
(author)
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Socioeconomic and early-life factors and risk of being overweight or obese in children of Swedish- and foreign-born parents
- 2013
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In: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 74:3, s. 356-363
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Journal article (peer-reviewed)abstract
- BACKGROUND: Ethnic minorities/immigrants have differential health as compared with natives. The epidemic in child overweight/obesity (OW/OB) in Sweden is leveling oft but lower socioeconomic groups and immigrants/ethnic minorities may not have benefited equally from this trend. We investigated whether nonethnic Swedish children are at increased risk for being OW/OB and whether these associations are mediated by parental socioeconomic position (SEP) and/or early-life factors such as birth weight, maternal smoking, BMI, and breastfeeding. METHODS: Data on 10,628 singleton children (51% boys, mean age: 4.8 y, born during the period 2000-2004) residing in Uppsala were analyzed. OW/OB was computed using the International Obesity Task Force's sex- and age-specific cutoffs. The mother's nativity was used as proxy for ethnicity. Logistic regression was used to analyze ethnicity-OW/OB associations. RESULTS: Children of North African, Iranian, South American, and Turkish ethnicity had increased odds for being overweight/obese as compared with children of Swedish ethnicity (adjusted odds ratio (OR): 2.60 (95% confidence interval (CI): 1.57-4.27), 1.67 (1.03-2.72), 3.00 (1.86-4.80), and 2.90 (1.73-4.88), respectively). Finnish children had decreased odds for being overweight/obese (adjusted OR: 0.53 (0.32-0.90)). CONCLUSION: Ethnic differences in a child's risk for OW/OB exist in Sweden that cannot be explained by SEP or maternal or birth factors. As OW/OB often tracks into adulthood, more effective public health policies that intervene at an early age are needed.
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| 8. |
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| 9. |
- Mattelin, Erica, et al.
(author)
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Health and health-related behaviours in refugees and migrants who self-identify as sexual or gender minority – A National population-based study in Sweden
- 2022
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In: eClinicalMedicine. - : Elsevier. - 2589-5370. ; 52
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Journal article (peer-reviewed)abstract
- Background To examine health and health-related behaviors in migrant and refugee individuals who identify as sexual or gender minority, and in comparison to their heterosexual peers. Methods The study included 168,952 individuals (aged 16-84 years, males: 45.9%, sexual or gender minorities: 3.1%) who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into Swedish-and Western-born (White) heterosexual, White sexual- or gender minority, migrant heterosexual, migrant sexual- or gender minority, refugee heterosexual, and refugee sexual- or gender minority. Outcomes included mental health (for example suicidal ideation, wellbeing), general health, risky behaviors (risk alcohol use, risk gambling, and substance use), and experiences of violence. Associations between 1) sexual- or gender -ethnic identities and 2) gender-ethnic identities and all outcomes were analyzed using logistic and linear regression adjusting for sex, age, and educational level. Findings Being a sexual- or gender minority, regardless of ethnic minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee sexual- or gender minority individuals (OR 2.42, 95 % CI 1.44-4.08). Ethnic minorities (heterosexual and sexual- or gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling (1.88, 1.49-2.37 for refugee heterosexuals). Transgender refugees had high odds for risk gambling (8.62, 1.94-38.40) and exposure to physical violence (7.46, 2.97-18.70). Interpretation In this national population-based study, sexual and gender minority individuals have worse mental and general health regardless of ethnic minority status. We did not find evidence for worse health in sexual- or gender minority refugees in comparison to migrant, and White sexual- or gender minorities and their heterosexual peers. Transgender individuals (White and ethnic minority) experienced significantly higher levels of physical violence. Public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals, increase access and use of mental healthcare services and sensitise healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities.
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