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Smith, K. A., Burkill, S., Hiyoshi, A., Olsson, T., Bahmanyar, S., Wormser, D., . . . Montgomery, S. (2020). Comorbid disease burden among MS patients 1968-2012: A Swedish register-based cohort study. Multiple Sclerosis
Open this publication in new window or tab >>Comorbid disease burden among MS patients 1968-2012: A Swedish register-based cohort study
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2020 (English)In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: People with multiple sclerosis (pwMS) have increased comorbid disease (CMD) risk. Most previous studies have not considered overall CMD burden.

OBJECTIVE: To describe lifetime CMD burden among pwMS.

METHODS:  = 251,170). Prevalence, prevalence ratios (PRs), survival functions, and hazard ratios by MS status, age, and time period compared seven CMD: autoimmune, cardiovascular, depression, diabetes, respiratory, renal, and seizures.

RESULTS: The magnitude of the PRs for each CMD and age group decreased across time, with higher PRs in earlier time periods. Before 1990, younger age groups had higher PRs, and after 1990, older age groups had higher PRs. Male pwMS had higher burden compared with females. Overall, renal, respiratory, and seizures had the highest PRs. Before 2001, 50% of pwMS received a first/additional CMD diagnosis 20 years prior to people without MS, which reduced to 4 years after 2001. PwMS had four times higher rates of first/additional diagnoses in earlier time periods, which reduced to less than two times higher in recent time periods compared to people without MS.

CONCLUSION: Swedish pwMS have increased CMD burden compared with the general population, but this has reduced over time.

Place, publisher, year, edition, pages
Sage Publications, 2020
Keywords
Multiple sclerosis, Sweden, burden, chronic disease, cohort, comorbidity, prevalence, registries
National Category
Geriatrics
Identifiers
urn:nbn:se:oru:diva-80606 (URN)10.1177/1352458520910497 (DOI)32162580 (PubMedID)
Available from: 2020-03-13 Created: 2020-03-13 Last updated: 2020-03-13Bibliographically approved
Brand, J., Hiyoshi, A., Cao, Y., Lawlor, D. A., Cnattingius, S. & Montgomery, S. (2020). Maternal smoking during pregnancy and fractures in offspring: national register based sibling comparison study. BMJ. British Medical Journal, 368, Article ID l7057.
Open this publication in new window or tab >>Maternal smoking during pregnancy and fractures in offspring: national register based sibling comparison study
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2020 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 368, article id l7057Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study the impact of maternal smoking during pregnancy on fractures in offspring during different developmental stages of life.

DESIGN: National register based birth cohort study with a sibling comparison design.

SETTING: Sweden.

PARTICIPANTS: 1 680 307 people born in Sweden between 1983 and 2000 to women who smoked (n=377 367, 22.5%) and did not smoke (n=1 302 940) in early pregnancy. Follow-up was until 31 December 2014.

MAIN OUTCOME MEASURE: Fractures by attained age up to 32 years.

RESULTS: During a median follow-up of 21.1 years, 377 970 fractures were observed (the overall incidence rate for fracture standardised by calendar year of birth was 11.8 per 1000 person years). The association between maternal smoking during pregnancy and risk of fracture in offspring differed by attained age. Maternal smoking was associated with a higher rate of fractures in offspring before 1 year of age in the entire cohort (birth year standardised fracture rates in those exposed and unexposed to maternal smoking were 1.59 and 1.28 per 1000 person years, respectively). After adjustment for potential confounders the hazard ratio for maternal smoking compared with no smoking was 1.27 (95% confidence interval 1.12 to 1.45). This association followed a dose dependent pattern (compared with no smoking, hazard ratios for 1-9 cigarettes/day and >= 10 cigarettes/day were 1.20 (95% confidence interval 1.03 to 1.39) and 1.41 (1.18 to 1.69), respectively) and persisted in within-sibship comparisons although with wider confidence intervals (compared with no smoking, 1.58 (1.01 to 2.46)). Maternal smoking during pregnancy was also associated with an increased fracture incidence in offspring from age 5 to 32 years in whole cohort analyses, but these associations did not follow a dose dependent gradient. In within-sibship analyses, which controls for confounding by measured and unmeasured shared familial factors, corresponding point estimates were all close to null. Maternal smoking was not associated with risk of fracture in offspring between the ages of 1 and 5 years in any of the models.

CONCLUSION: Prenatal exposure to maternal smoking is associated with an increased rate of fracture during the first year of life but does not seem to have a long lasting biological influence on fractures later in childhood and up to early adulthood.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-79884 (URN)10.1136/bmj.l7057 (DOI)000510390400002 ()31996343 (PubMedID)2-s2.0-85078689979 (Scopus ID)
Note

Funding Agencies:

Orebro University Hospital Research Foundation Nyckelfonden OLL-695391

Economic & Social Research Council (ESRC) ES/JO19119/1

Medical Research Council UK (MRC) MC_UU_00011/6

National Institute for Health Research (NIHR) NF-0616-10102

Available from: 2020-02-14 Created: 2020-02-14 Last updated: 2020-02-14Bibliographically approved
Leepe, K. A., Li, M., Fang, X., Hiyoshi, A. & Cao, Y. (2019). Acute effect of daily fine particulate matter pollution on cerebrovascular mortality in Shanghai, China: a population-based time series study. Environmental science and pollution research international, 26(25), 25491-25499
Open this publication in new window or tab >>Acute effect of daily fine particulate matter pollution on cerebrovascular mortality in Shanghai, China: a population-based time series study
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2019 (English)In: Environmental science and pollution research international, ISSN 0944-1344, E-ISSN 1614-7499, Vol. 26, no 25, p. 25491-25499Article in journal (Refereed) Published
Abstract [en]

Numerous studies have investigated the impacts of ambient fine particulate matter (PM2.5) on human health. In this study, we examined the association of daily PM2.5 concentrations with the number of deaths for the cerebrovascular disease on the same day, using the generalized additive model (GAM) controlling for temporal trend and meteorological variables. We used the data between 2012 and 2014 from Shanghai, China, where the adverse health effects of PM2.5 have been of particular concern. Three different approaches (principal component analysis, shrinkage smoothers, and the least absolute shrinkage and selection operator regularization) were used in GAM to handle multicollinear meteorological variables. Our results indicate that the average daily concentration of PM2.5 in Shanghai was high, 55 μg/m3, with an average daily death for cerebrovascular disease (CVD) of 62. There was 1.7% raised cerebrovascular disease deaths per 10 μg/m3 increase in PM2.5 concentration in the unadjusted model. However, PM2.5 concentration was no longer associated with CVD deaths after controlling for meteorological variables. The results were consistent in the three modelling techniques that we used. As a large number of people are exposed to air pollution, further investigation with longer time period including individual-level information is needed to examine the association.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Cerebrovascular mortality, Fine particulate matter, Generalized additive model, Least absolute shrinkage and selection operator, Multicollinearity, Principal component analysis, Shrinkage smoother
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-75607 (URN)10.1007/s11356-019-05689-8 (DOI)000483698500009 ()31264151 (PubMedID)2-s2.0-85068737714 (Scopus ID)
Note

Funding Agencies:

Karolinska Institutet, Sweden  C62400032 

Junior Faculty Grant of the Institute of Environmental Medicine, Karolinska Institutet  C62412022 

Joint China-Sweden Mobility Grant of the Swedish Foundation for International Cooperation Research and Education  CH2015-6145 

Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-11-15Bibliographically approved
Smith, K. A., Burkill, S., Hiyoshi, A., Olsson, T., Bahmanyar, S., Wormser, D., . . . Montgomery, S. (2019). Burden of comorbid diseases among MS patients in Sweden. Paper presented at 35th Congress of the European-Committee-for-Treatment-and-Research-in-Multiple-Sclerosis (ECTRIMS 2019) / 24th Annual Conference of Rehabilitation in MS, Stockholm, Sweden, September 11-13, 2019. Multiple Sclerosis, 25(Suppl. 2), 646-646
Open this publication in new window or tab >>Burden of comorbid diseases among MS patients in Sweden
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2019 (English)In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 25, no Suppl. 2, p. 646-646Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: A raised risk for several comorbid diseases among MS patients has been identified. Most previous studies examined diseases separately rather than considering the overall burden of comorbidity. Multiple comorbidities may have important implica-tions for clinicians managing MS patients.

Aims: To describe the lifetime burden of comorbid diseases among MS patients and the rate of these diseases compared with the general population in Sweden.

Methods: MS patients identified using the MS Register and the Patient Register (PR) between 1964-2012 (n=25476) were matched by sex, age and county of residence with up to 10 general population comparators (n=251170). Prevalent and incident diag-noses of diseases other than MS for seven diseases categories were identified using the PR between 1987-2012. The total num-ber of comorbid diseases were compared using chi-square tests and prevalence rate ratios (PRR) were calculated. Hazard ratios (HR) were estimated using Cox regression and flexible non-para-metric survival models with age as the underlying time scale, MS as exposure, an additional comorbid disease as the outcome, adjusted for matching variables, education, number of previous comorbid diseases, and duration since study entry.

Results: The proportion of MS patients with 1,2 or 3+ comorbid disease diagnoses was greater than in the comparison cohort across all age groups (p< 0.001). The largest PRR (range 1.22-9.99) were among younger age groups (6-18,19-40,41-60 years) in autoim-mune, cardiovascular, diabetes and seizure disease categories. Additionally, PRR were elevated in depression and respiratory dis-eases, but not for renal diseases. PRR between 61-80 and 81-100 years were reduced compared to younger groups across all comorbid diseases, but remained elevated for respiratory, seizure and renal dis-eases. The adjusted HR for an additional diagnosis in MS patients was 1.7 (95% CI 1.66-1.75). Flexible modelling showed signifi-cantly higher risk for all ages of an additional disease diagnosis in MS patients; twice the risk (95% CI 1.8-2.2) up to age 35 years and decreasing with age to 1.3 (95% CI 1.5-1.25) over age 80 years.

Conclusions: MS patients in Sweden experience an increased burden of comorbidity and tend to be diagnosed with these dis-eases at an earlier age than the general population. This increased disease burden demonstrates the clinical reality of treating MS, indicating the need for integrated treatment approaches over sev-eral medical specialties.

Place, publisher, year, edition, pages
Sage Publications, 2019
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-77233 (URN)000485303102374 ()
Conference
35th Congress of the European-Committee-for-Treatment-and-Research-in-Multiple-Sclerosis (ECTRIMS 2019) / 24th Annual Conference of Rehabilitation in MS, Stockholm, Sweden, September 11-13, 2019
Available from: 2019-10-16 Created: 2019-10-16 Last updated: 2019-10-16Bibliographically approved
Vingeliene, S., Hiyoshi, A., Lentjes, M., Fall, K. & Montgomery, S. (2019). Longitudinal analysis of loneliness and inflammation at older ages: English longitudinal study of ageing. Psychoneuroendocrinology, 110, Article ID 104421.
Open this publication in new window or tab >>Longitudinal analysis of loneliness and inflammation at older ages: English longitudinal study of ageing
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2019 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 110, article id 104421Article in journal (Refereed) Published
Abstract [en]

Loneliness has been associated with adverse health outcomes, including age-related diseases with an inflammatory etiology such as cardiovascular disease. We aimed to identify potential biological pathways linking loneliness with morbidity and mortality by examining associations of loneliness with biomarkers. Participants in the English Longitudinal Study of Ageing (n = 3239) aged 50 years or older with an average age of 64 years, provided data in waves 4 (2008/2009) and 6 (2012/2013). Linear regression conditional change models had three outcomes: C reactive protein (CRP) measured in mg/L (log transformed), fibrinogen in g/L and ferritin in g/dL. In men, the onset of loneliness indicated by answering 'no' at wave 4 and 'yes' at wave 6 to question "Much of the time during the past week, you felt lonely?" was associated with a statistically significant increase in levels of CRP (β = 0.36, 95% confidence interval (0.09 to 0.62)), plasma fibrinogen (0.18 (0.04 to 0.31)) and ferritin (41.04 (6.58 to 75.50)), after full adjustment. A statistically significant increase in CRP in men was also observed for onset of loneliness assessed with the question "How often do you feel lonely?" (0.20 (0.03 to 0.38)). These associations were not mediated by depressive symptoms. Persistent loneliness (loneliness experienced at both baseline and follow-up) assessed using the University of California Los Angeles (UCLA) loneliness scale was associated with an increase in CRP (0.11 (0.004 to 0.22)) among men. Associations of the two latter loneliness measures with fibrinogen and ferritin were mainly null. Among women, the only statistically significant association was for persistent loneliness (loneliness at both waves) identified by question "Much of the time during the past week, you felt lonely?" with a reduction in levels of ferritin (-20.62 (-39.78 to -1.46)). Men may be more susceptible to loneliness-associated disease risks signaled by biological changes, including systemic inflammation. Combined social and targeted medical interventions may help to reduce health risks associated with loneliness.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
C-reactive protein, Ferritin, Fibrinogen, Inflammation, Loneliness
National Category
Psychology Microbiology in the medical area
Identifiers
urn:nbn:se:oru:diva-78573 (URN)10.1016/j.psyneuen.2019.104421 (DOI)000500388600005 ()31494341 (PubMedID)2-s2.0-85071665998 (Scopus ID)
Note

Funding Agencies:

Economic & Social Research Council (ESRC) ES/J019119/1

Örebro University 

Available from: 2019-12-12 Created: 2019-12-12 Last updated: 2019-12-19Bibliographically approved
Lindner, H. Y., Montgomery, S. & Hiyoshi, A. (2019). Risk of depression following traumatic limb amputation: a general population-based cohort study. Scandinavian Journal of Public Health, Article ID 1403494819868038.
Open this publication in new window or tab >>Risk of depression following traumatic limb amputation: a general population-based cohort study
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494819868038Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Individuals with traumatic limb amputation (TLA) may be at risk of depression, but evidence of increased depression after TLA from longitudinal studies has been limited. It is also unknown whether physical function, cognitive function, and employment prior to amputation affects depression risk. We aimed to examine longitudinal associations between TLA and depression in working age men, and to explore the role of pre-amputation occupational and individual characteristics.

Methods: A Swedish national register-based cohort of 189,220 men born between 1952 and 1956, and who attended conscription assessments in adolescence, was followed from 1985 to 2009. Physical, cognitive, and psychological characteristics were measured at the conscription examination, and occupational information was obtained from the 1985 census. Main outcome measures were hospital inpatient and outpatient admissions for depression.

Results: In total, 401 men underwent TLA; mean age at amputation was 42.5 years (SD 7.4). Cox regression produced an unadjusted hazard ratio (95% confidence interval) of 2.61 (1.62–4.21) for risk of subsequent depression associated with TLA compared with the general population. Adjustment for occupational, physical, cognitive, and psychological characteristics did not change the association much, producing a hazard ratio of 2.53 (1.57–4.08).

Conclusions: TLA is associated with an increased risk of depression in men over more than two decades of follow up. Occupational and individual characteristics prior to amputation did not greatly change depression risk following amputation. We speculate that a coordinated combination of social support and medical management may help reduce persistent depression risk in men who experience amputation.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Amputation, cohort, depression, traumatic
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:oru:diva-75828 (URN)10.1177/1403494819868038 (DOI)000482801800001 ()31405332 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-01236
Note

Funding Agencies:

Örebro University Hospital Research Foundation  OLL-488821  429431 

UK Economic and Social Research Council (ESRC)  RES-596-28-0001  ES/JO19119/1 

Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-11-15Bibliographically approved
Bergh, C., Hiyoshi, A., Eriksson, M., Fall, K. & Montgomery, S. (2019). Shared unmeasured characteristics among siblings confound the association of Apgar score with stress resilience in adolescence. Acta Paediatrica, 108(11), 2001-2007
Open this publication in new window or tab >>Shared unmeasured characteristics among siblings confound the association of Apgar score with stress resilience in adolescence
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 11, p. 2001-2007Article in journal (Refereed) Published
Abstract [en]

AIM: We investigated the association between low Apgar score, other perinatal characteristics and low stress resilience in adolescence. A within-siblings analysis was used to tackle unmeasured shared familial confounding.

METHODS: We used a national cohort of 527,763 males born in Sweden between 1973 and 1992 who undertook military conscription assessments at mean age 18 years (17-20). Conscription examinations included a measure of stress resilience. Information on Apgar score and other perinatal characteristics was obtained through linkage with the Medical Birth Register. Analyses were conducted using ordinary least squares and fixed-effects linear regression models adjusted for potential confounding factors.

RESULTS: Infants with a prolonged low Apgar score at five minutes had an increased risk of low stress resilience in adolescence compared to those with highest scores at one minute, with an adjusted coefficient and 95% confidence interval of -0.26 (-0.39, -0.13). The associations were no longer statistically significant when using within-siblings models. However, the associations with stress resilience and birthweight remained statistically significant in all analyses.

CONCLUSION: The association with low Apgar score seems to be explained by confounding due to shared childhood circumstances among siblings from the same family, while low birthweight is independently associated with low stress resilience.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
Keywords
Apgar score, adolescence, low birth weight, psychological stress, resilience
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Identifiers
urn:nbn:se:oru:diva-74554 (URN)10.1111/apa.14881 (DOI)000489595000011 ()31140196 (PubMedID)2-s2.0-85067475196 (Scopus ID)
Note

Funding Agencies:

Nyckelfonden  OLL-507161

Grants to the International Centre for Life Course Studies  RES-596-28-0001, ES/JO19119/1

ALF research funding from Region Örebro County 

Available from: 2019-06-05 Created: 2019-06-05 Last updated: 2019-11-13Bibliographically approved
Sato, Y., Hiyoshi, A., Melinder, C., Suzuki, C. & Montgomery, S. (2018). Asthma and atopic diseases in adolescence and antidepressant medication in middle age. Journal of Health Psychology, 23(6), 853-859
Open this publication in new window or tab >>Asthma and atopic diseases in adolescence and antidepressant medication in middle age
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2018 (English)In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 23, no 6, p. 853-859Article in journal (Refereed) Published
Abstract [en]

This Swedish register-based cohort study examined whether asthma, hay fever and allergic dermatitis in late adolescence identified in the early 1970s are associated with antidepressant medication in middle age, between 2006 and 2009. After adjustment for childhood and adulthood sociodemographic characteristics, psychological, cognitive and physical function, and comorbidity, the magnitude of the associations diminished for asthma, while hay fever and atopic dermatitis retained associations. Hay fever and atopic dermatitis in adolescence have potentially important implications for future mental health, while asthma may already have influenced an individual's ability to cope with stress by late adolescence.

Place, publisher, year, edition, pages
London, United Kingdom: Sage Publications, 2018
Keywords
Adolescence, adults, allergy, asthma, cohort, depression
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-51473 (URN)10.1177/1359105316660181 (DOI)000430332700009 ()27466290 (PubMedID)2-s2.0-85045628411 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-01365
Note

Funding Agencies:

UK Economic and Social Research Council (ESRC)  RES-596-28-0001  ES/J019119/1 

Japan Allergy Foundation  

Scandinavia-Japan Sasakawa Foundation  15-15 

Lindhes Advokatbyrå AB  LA2015-0219 

Available from: 2016-08-05 Created: 2016-08-02 Last updated: 2018-07-19Bibliographically approved
Cable, N., Hiyoshi, A., Kondo, N., Aida, J., Sjöqvist, H. & Kondo, K. (2018). Identifying Frail-Related Biomarkers among Community-Dwelling Older Adults in Japan: A Research Example from the Japanese Gerontological Evaluation Study. BioMed Research International, Article ID 5362948.
Open this publication in new window or tab >>Identifying Frail-Related Biomarkers among Community-Dwelling Older Adults in Japan: A Research Example from the Japanese Gerontological Evaluation Study
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2018 (English)In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 5362948Article in journal (Refereed) Published
Abstract [en]

We examined correlating clinical biomarkers for the physical aspect of frailty among community-dwelling older adults in Japan, using Japanese Gerontological Evaluation Study (JAGES). We used information from the JAGES participants (N = 3,128) who also participated in the community health screening in 2010. We grouped participants' response to the Study of Osteoporotic Fracture (SOF) Frailty Index into robust (=0), intermediate frail (=1), and frail (=2+) ones to indicate physical aspect of frailty. Independent of sex and age, results from multinomial logistic regression showed above normal albumin and below normal HDL and haemoglobin levels were positively associated with intermediate frail (RRR = 1.99, 95% CI = 1.22-3.23; RRR = 1.36, 95% CI = 1.33-1.39; RRR = 1.36, 95% CI = 1.23-1.51, resp.) and frail cases (RRR = 2.27, 95% CI = 1.91-2.70; RRR = 1.59, 95% CI = 1.51-1.68; RRR = 1.40, 95% CI = 1.28-1.52, resp.). Limited to women, above normal Hb1Ac level was similarly associated with intermediate frail and frail cases (RRR = 1.18, 95% CI = 1.02, 1.38; RRR = 2.56, 95% CI = 2.23-2.95, resp.). Use of relevant clinical biomarkers can help in assessment of older adults' physical aspect of frailty.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2018
National Category
Medical Biotechnology (with a focus on Cell Biology (including Stem Cell Biology), Molecular Biology, Microbiology, Biochemistry or Biopharmacy)
Identifiers
urn:nbn:se:oru:diva-64827 (URN)10.1155/2018/5362948 (DOI)000422965600001 ()
Note

Funding Agencies:

UK Economic and Social Research Council (ESRC)  ES/J019119/1 

Research Committee of Orebro County Council  OLL-346981 

MEXT (Ministry of Education, Culture, Sports, Science and Technology, Japan) Supported Program for the Strategic Research Foundation at Private Universities  

JSPS (Japan Society for the Promotion of Science) KAKENHI  JP22330172  JP22390400  JP23243070  JP23590786  JP23790710  JP24390469  JP24530698  JP24683018  JP25253052  JP25870573  JP25870881 

Health Labour Sciences Research Grants from the Japan Ministry of Health, Labour and Welfare  H22-Choju-Shitei-008  H24-Junkanki[Seishu]-Ippan-007  H24-Chikyukibo-Ippan-009  H24-Choju-Wakate-009  H25-Kenki-Wakate-015  H26-Irryo-Shitei-003[Fukkou]  H25-Choju-Ippan-003  H26-Choju-Ippan-006 

Research and Development Grants for Longevity Science from AMED (Japan Agency for Medical Research and Development)  

National Centre for Geriatrics and Gerontology, Japan  24-17  24-23 

Available from: 2018-02-06 Created: 2018-02-06 Last updated: 2018-08-20Bibliographically approved
Hiyoshi, A., Kondo, N. & Rostila, M. (2018). Increasing income-based inequality in suicide mortality among working-age women and men, Sweden, 1990-2007: is there a point of trend change?. Journal of Epidemiology and Community Health, 72(11), 1009-1015
Open this publication in new window or tab >>Increasing income-based inequality in suicide mortality among working-age women and men, Sweden, 1990-2007: is there a point of trend change?
2018 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 11, p. 1009-1015Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Income inequalities have risen from the 1990s to 2000s, following the economic recession in 1994, but little research has investigated socioeconomic inequalities in suicide mortality for working-age men and women (aged between 30 and 64 years) over the time using longitudinal data in Sweden.

METHODS: Using Swedish national register data between 1990 and 2007 as a series of repeated cohort studies with a 3-year follow-up (sample sizes were approximately 3.7 to 4.0 million in each year), relative and slope indices of inequality (RII and SII respectively) based on quintiles of individual disposable income were calculated and tested for temporal trends.

RESULTS: SII for the risk of suicide mortality ranged from 27.6 (95% CI 19.5 to 35.8) to 44.5 (36.3 to 52.6) in men and 5.2 (0.2 to 10.4) to 16.6 (10.7 to 22.4) in women (per 100 000 population). In men, temporal trends in suicide inequalities were stable in SII but increasing in RII by 3% each year (p=0.002). In women, inequalities tended to increase in both RII and SII, especially after the late-1990s, with 10% increment in RII per year (p<0.001).

CONCLUSIONS: Despite universal social security and generous welfare provision, income inequalities in suicide were considerable and have widened, especially in women. The steeper rise in women may be partially related to higher job insecurity and poorer working conditions in the female dominated public sector after the recession. To reduce health consequences following an economic crisis and widened income inequalities, additional measures may be necessary in proportion to the levels of financial vulnerability.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
Keywords
cohort studies, health inequalities, socio-economic, suicide
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-70021 (URN)10.1136/jech-2018-210696 (DOI)000450417500008 ()30021795 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Note

Funding Agencies:

Ministry of Education, Culture, Sports, Science and Technology, MEXT, Japan  21119002  25253052  18H04071 

Ministry of Health, Labour and Welfare, Japan  H24-chikyukibo-ippan-009 

Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2018-12-05Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-2088-0530

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