| 1. |
- Brandén, Maria, et al.
(author)
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Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm : a population-based, observational study using individual-level data
- 2020
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In: The Lancet Healthy Longevity. - : Elsevier. - 2666-7568. ; 1:2, s. e80-e88
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Journal article (peer-reviewed)abstract
- Background Housing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among older adults. The aim of this study was to investigate how individual-level housing and neighbourhood characteristics are associated with COVID-19 mortality in older adults.Methods For this population-based, observational study, we used data from the cause-of-death register held by the Swedish National Board of Health and Welfare to identify recorded COVID-19 mortality and mortality from other causes among individuals (aged ≥70 years) in Stockholm county, Sweden, between March 12 and May 8, 2020. This information was linked to population-register data from December, 2019, including socioeconomic, demographic, and residential characteristics. We ran Cox proportional hazards regressions for the risk of dying from COVID-19 and from all other causes. The independent variables were area (m2) per individual in the household, the age structure of the household, type of housing, confirmed cases of COVID-19 in the borough, and neighbourhood population density. All models were adjusted for individual age, sex, country of birth, income, and education.Findings Of 279 961 individuals identified to be aged 70 years or older on March 12, 2020, and residing in Stockholm in December, 2019, 274 712 met the eligibility criteria and were included in the study population. Between March 12 and May 8, 2020, 3386 deaths occurred, of which 1301 were reported as COVID-19 deaths. In fully adjusted models, household and neighbourhood characteristics were independently associated with COVID-19 mortality among older adults. Compared with living in a household with individuals aged 66 years or older, living with someone of working age (<66 years) was associated with increased COVID-19 mortality (hazard ratio 1·6; 95% CI 1·3–2·0). Living in a care home was associated with an increased risk of COVID-19 mortality (4·1; 3·5–4·9) compared with living in independent housing. Living in neighbourhoods with the highest population density (≥5000 individuals per km2) was associated with higher COVID-19 mortality (1·7; 1·1–2·4) compared with living in the least densely populated neighbourhoods (0 to <150 individuals per km2).Interpretation Close exposure to working-age household members and neighbours is associated with increased COVID-19 mortality among older adults. Similarly, living in a care home is associated with increased mortality, potentially through exposure to visitors and care workers, but also due to poor underlying health among care-home residents. These factors should be considered when developing strategies to protect this group.
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| 2. |
- Drefahl, Sven, et al.
(author)
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A population-based cohort study of socio-demographic risk factors for COVID-19 deaths in Sweden
- 2020
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In: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 11:1
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Journal article (peer-reviewed)abstract
- As global deaths from COVID-19 continue to rise, the world's governments, institutions, and agencies are still working toward an understanding of who is most at risk of death. In this study, data on all recorded COVID-19 deaths in Sweden up to May 7, 2020 are linked to high-quality and accurate individual-level background data from administrative registers of the total population. By means of individual-level survival analysis we demonstrate that being male, having less individual income, lower education, not being married all independently predict a higher risk of death from COVID-19 and from all other causes of death. Being an immigrant from a low- or middle-income country predicts higher risk of death from COVID-19 but not for all other causes of death. The main message of this work is that the interaction of the virus causing COVID-19 and its social environment exerts an unequal burden on the most disadvantaged members of society. Better understanding of who is at highest risk of death from COVID-19 is important for public health planning. Here, the authors demonstrate an unequal mortality burden associated with socially disadvantaged groups in Sweden.
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| 3. |
- Edvinsson, Sören, 1953-, et al.
(author)
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Income inequality in Swedish municipalities 1986-2013 : Development and regional patterns
- 2021
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Reports (other academic/artistic)abstract
- In the present report, we investigate the patterns and trends of inequality in disposable income in the working-age population in Swedish municipalities 1986-2013. This period coincided with when Sweden changed from very lowlevels of inequality to one with substantially increasing inequality. Incomes has increased in all parts of Sweden, but differences in incomes between municipalities have widened. Asa result, large parts of Sweden have become poorer in a relative, although not in a nominative sense. At the same time, income inequality has increased substantially within as well as between municipalities. Present-day Swedes live in much more unequal environments, both at the national level and in the municipalities. The large city areas, or at least part of them, have had a much more advantageous economic development, but they also became more unequal. We see a division between parts of Sweden; there are clear differentiation tendencies between urban and rural parts, centre and periphery. Another finding is that the relation between mean income and income inequality has changed from the 1980s to the present. This association was negative a couple of decades ago, meaning that inequality was somewhat higher in poorer municipalities. From the 1990s onwards, the association is instead positive – affluent municipalities are more unequal.
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| 4. |
- Fors Connolly, Filip, 1981-, et al.
(author)
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Adjustment of daily activities to restrictions and reported spread of the COVID-19 pandemic across Europe
- 2021
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Reports (other academic/artistic)abstract
- This paper addresses adjustments of daily activities in the wake of the COVID-19 pandemic among people aged 50 years and older in Europe, and investigates the extent to which such adjustments are associated with the stringency of governmental restrictions and the overall spread of COVID-19. We use data from the SHARE Corona Survey collected during summer2020, published data on government response stringency, and reported country-specific prevalence and mortality of COVID-19. Our analyses show that older Europeans across the continent have reduced their daily activities quite substantially during the pandemic. However, we observe variation across countries and demographic groups, which may be important to highlight for policymakers. Our explanatory analysis replicates previous studies using mobility data, showing that both restrictions and infections predict a reduction in mobility. Thus, policymakers could potentially rely on both restrictions and voluntary adjustments in order to decrease the spread of the virus. However, it is noteworthy that we find relatively weaker associations with restrictions compared to previous studies using mobility data. One explanation for this discrepancy could be that our study focuses on older people, who face a higher risk of becoming severely ill and therefore have stronger incentives to adjust their behaviours independent of governmental regulations.
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| 5. |
- Lestari, Septi K., et al.
(author)
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A longitudinal study on social support, social participation, and older Europeans' Quality of life
- 2021
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In: Ssm-Population Health. - : Elsevier BV. - 2352-8273. ; 13
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Journal article (peer-reviewed)abstract
- The association between quality of life (QoL) and social relationships is well established. This paper further analyses whether and how participation in social activities as well as providing and receiving social support, independently, are associated with QoL among the older population in 16 European countries. QoL was measured using the CASP-12 scale. The baseline data came from Wave 6 and the outcome from Wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The associations of interest were analysed using multivariable linear regression. The effect of possible non-ignorable dropout was tested. Then, doubly robust estimation and sensitivity analyses for unobserved confounding were performed to evaluate the possible causal interpretation of the associations found. Our findings show that participation in at least one of the socially productive activities was positively associated with QoL at two-year follow-up (Average Causal Effect, ACE: 0.474; 95%CI: 0.361, 0.587). The association was stronger among women, people aged 75+, and those in the Southern European region. Providing social support had a positive association with QoL, but only among people aged 75+ (ACE: 0.410; 95%CI: 0.031, 0.789). Conversely, receiving social support had a negative association (ACE: -0.321; 95%CI: -0.448, -0.195) with QoL, especially for men, people aged 75+, and those in Eastern European countries. Sensitivity analyses for unobserved confounders showed that the associations found cannot be attributed to causal effects.
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| 6. |
- Lestari, Septi K., et al.
(author)
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Changes in the provision of instrumental support by older adults in nine European countries during 2004-2015: a panel data analysis
- 2020
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In: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 20:1
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Journal article (peer-reviewed)abstract
- BackgroundProviding support to others has been shown to be beneficial to older adults. As people age, their health and social relationships change. These changes may also relate to changes in social support provision. We examined the trajectory of instrumental support provision by older people in three European regions throughout 11 years of follow-up. We then examined the extent to which age at baseline, sex, and region (representing welfare state regime) influenced the variations in the trajectory.MethodsData collected from 8354 respondents who had completed at least waves 1 and 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was analysed. Instrumental support provision was determined from asking a single question regarding whether the respondent provided help personally for people outside their household. Region, sex, and age at baseline were the main predictors tested. We used growth modelling to address the aims of this study.ResultsThe northern European region (Sweden and Denmark) had the highest odds ratio of instrumental support provision. The likelihood of being involved in providing instrumental support decreased by 8% annually (OR: 0.916, 95%CI: 0.893,0.940) over the 11 years of follow-up. Older respondents were less likely to provide instrumental support and their trajectories declined faster than those of the younger respondents. Sex difference in instrumental support provision was more apparent among younger-older people in the southern European region.ConclusionsOlder European adults are an important source of instrumental support, especially for their families. The probability of instrumental support provision by European older adults declines over time. Age, sex, and welfare state regime predict this trajectory.
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| 7. |
- Lestari, Septi K, et al.
(author)
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Frailty and types of social relationships among older adults in 17 European countries: A latent class analysis
- 2022
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In: Archives of Gerontology and Geriatrics. - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 101
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Journal article (peer-reviewed)abstract
- Background: Frailty is a syndrome commonly associated with old age. Social relationships are an essential determinant of frailty progression, and frailty can negatively affect social relationships. Objectives: To identify social relationship types among older adults in Europe; to evaluate whether social relationship types differ across European regions; and to assess the association between frailty status and social relationship type.& nbsp;& nbsp;Methods: We used data from 56,226 individuals from 17 European countries who participated in Wave 6 of the Survey of Health, Ageing and Retirement in Europe. We constructed social relationship types from social relationship variables (contacts frequency, perceived emotional support, participation in social activities, providing and receiving instrumental support) using latent class analysis (LCA). Associations between social relationship types and frailty were examined using multinomial regression analyses integrated with LCA.& nbsp;Results: We identified four social relationship types: 'poor'; 'frequent and emotionally close'; 'frequent, emotionally close, and supportive'; and 'frequent, emotionally close, and active'. Type 3 is also characterised by participation in sport/social clubs (in the northern region) or receiving support (in the eastern region). Participation in volunteering/charity activities (in the central and northern regions) and instrumental support provision (in the northern region) are Type 4 & PRIME;s characteristics as well. In all regions, being frail was associated with less active social relationships (Types 1, 2, and 3) relative to the more 'active' type (Type 4).& nbsp;Conclusion: Frailty status was associated with social relationship types. The identified types may help tailor intervention programmes for older adults to prevent worsening frailty.
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| 8. |
- Lestari, Septi Kurnia, 1989-, et al.
(author)
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Volunteering and instrumental support during the first phase of the pandemic in Europe : the significance of COVID-19 exposure and stringent country’s COVID-19 policy
- 2024
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In: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 24:1
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Journal article (peer-reviewed)abstract
- Background: The COVID-19 control policies might negatively impact older adults’ participation in volunteer work, instrumental support provision, and the likelihood of receiving instrumental support. Studies that quantify changes in these activities and the related factors are limited. The current study aimed to examine the level of volunteering, instrumental support provision and receipt before and during the first phase of the COVID-19 pandemic in Europe and to determine whether older adults’ volunteering, instrumental support provision and receipt were associated with individual exposure to COVID-19 and the stringency of country’s COVID-19 control policy during the first phase of the COVID-19 pandemic.Methods: A cross-sectional survey using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) Corona Survey 1 was designed to focus on community-dwelling Europeans aged ≥50 years. History of participation in volunteering work and instrumental support provision or receipt was assessed from the previous SHARE Wave data. The country’s COVID-19 control policy stringency index (S-Index) was from the Oxford COVID-19 Government Response Tracker database. A total of 45,669 respondents from 26 European countries were included in the volunteering analysis. Seventeen European countries were included in the analyses of instrumental support provision (N = 36,518) and receipt (N = 36,526). The multilevel logistic regression model was fitted separately to analyse each activity.Results: The level of volunteering and instrumental support provision was lower during the pandemic, but instrumental support receipt was higher. The country S-Index was positively associated with support provision (OR:1.13;95%CI:1.02–1.26) and negatively associated with support receipt (OR:0.69;95%CI:0.54–0.88). Exposure to COVID-19 was positively associated with support receipt (OR:1.64;95%CI:1.38–1.95). COVID-19 exposure on close ones positively associated with volunteering (OR:1.47;95%CI:1.32–1.65), support provision (OR:1.28;95%CI:1.19–1.39), and support receipt (OR:1.25;95%CI:1.15–1.35).Conclusions: The COVID-19 pandemic impacted older Europeans’ volunteering, instrumental support provision, and instrumental support receipt from outside their household. When someone close to them was exposed to COVID-19, older Europeans were likely to receive instrumental support and to volunteer and provide instrumental support. A stricter country’s COVID-19 control policy might motivate older adults to provide instrumental support, but it prevents them from receiving instrumental support from outside their households.
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| 9. |
- Lundholm, Emma, 1975-, et al.
(author)
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Income distribution in family networks by gender and proximity
- 2020
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In: Population, Space and Place. - : John Wiley & Sons. - 1544-8444 .- 1544-8452. ; 26:7
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Journal article (peer-reviewed)abstract
- Whereas the significance of family networks for support and well‐being has been shown in previous research, few studies have analysed the income distribution within family networks. The aim of this study is to examine income distribution within family networks and how they have changed over time for women and men in different parts of the income distribution and if the incomes are more similar in the geographically proximate family network. The analysis is based on register data and by use of ordinary least squares (OLS) and quantile regressions. The results indicate that men in the lowest income group tend to have become more similar to their family network over time. Gender differences have decreased, possibly as an effect of women's higher labour market participation rate leading to decreased income disparity. This paper contributes by highlighting how the uneven distribution of economic resources in family networks adds to individual's own resources.
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| 10. |
- Malmberg, Gunnar, 1957-
(author)
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Time and space in international migration
- 2020
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In: International migration, immobility and development. - : Routledge. - 9781003136125 - 9781859739716 - 9781859739761 ; , s. 21-48
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Book chapter (peer-reviewed)
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