Constructing and validating an occupational job strain index based on five Norwegian nationwide surveys of living conditions on work environment

Background
It has been claimed that Nordic register data are a “goldmine” for research. However, one limitation is the lack of information on working conditions. Job exposure matrices (JEMs) are one solution to this problem. Thus, the three aims of this study were (i) to investigate the reliability of an occupation-based psychosocial JEM, i.e., a Job Strain Index (job strain or JSI abbreviated), (ii) to examine the construct and criterion-related validity of this measure of job strain (iii) and assesses the concurrent and the predictive validity of an occupation-based Job Strain Index for use in analyses of Norwegian register data.

Method
The study utilized five waves of the nationwide Norway Survey of Living Conditions in the Work Environment with a total sample of 43,977 individuals and register data with a total sample of 1,589,535 individuals. Job strain was composed of items belonging to the two dimensions of Karasek’s DC model, job demands and job control (1979). The reliability of the JSI and its dimensions and components were investigated by measuring the degree of agreement (Cohen’s kappa), sensitivity, specificity, and internal consistency (Cronbach’s alpha). Construct validity was assessed by confirmatory factor analysis, and criterion-related validity was measured by concurrent validity and predictive validity. The selected concurrent criteria were self-reported survey information on long-term sick absence, anxiety, depression, and sleeping difficulty. The predictive criteria were register information on receipt of disability benefits, mortality, and long-term sick leave.

Results
Agreement between individual and occupation-based job strain and components was fair to poor. The sensitivity and specificity of occupation-based job strain and its components varied from acceptable to low. The consistency of the items comprising job demand and job control was clearly acceptable. Regarding concurrent validity, significant associations between (both individual and occupational) job strain, and long-term sick leave and sleeping difficulty were observed for both genders. Occupation-based job strain indicated an elevated risk for anxiety and depression among men, but not among women. As for predictive reliability, significant associations between occupation-based job strain and all three health outcomes were observed for both men and women.

Conclusion
Our occupation-based JSI serves as a reliable and valid indicator of psychosocial job exposure that can be used in analyses of Norwegian register data where individual information on such conditions is missing.

Le, G. H., Hermansen, Å., & Dahl, E. (2023). Constructing and validating an occupational job strain index based on five Norwegian nationwide surveys of living conditions on work environment. Bmc Public Health, 23(1), 50. doi: https://doi.org/10.1186/s12889-022-14957-1

Joint exposure to parental cancer and income loss during childhood and the child’s socioeconomic position in early adulthood: a Danish and Norwegian register-based cohort study

Background: Parental cancer as well as economic hardship in the family during childhood can affect the child negatively. Our aim was to examine the association between the joint exposure to parental cancer and income loss in childhood and the child’s socioeconomic position in early adulthood.

Methods: We conducted a register-based prospective cohort study of children born in Denmark between 1978 and 1986 and in Norway between 1979 and 1987. The children were followed from 1 January 1994 (in Denmark) or 1995 (in Norway). Educational level and personal income were measured at age 30 years. Children who experienced parental cancer between the years they turned 8 and 16 years were identified, and exposure to income loss was measured in the same period. Adjusted multinomial logistic regression model was used to estimate relative risk ratios for the joint exposure of parental cancer and income loss during childhood.

Results: Children who experienced parental cancer and an income loss during childhood had an increased risk of low education and lower income at age 30 years. The associations were weaker for children only exposed to income loss and less clear for those only exposed to parental cancer. Further, exposure to parental cancer with a severe cancer type was associated with lower educational level.

Conclusion: The child’s educational attainment and income level in early adulthood were negatively affected by exposure to income loss in childhood, and even more so if exposed to both parental cancer and income loss. The associations with educational attainment were stronger for more severe cancer types.

Klinte, Mathilde, Åsmund Hermansen, Anne-Marie Nybo Andersen and Stine Kjaer Urhoj. 2022. “Joint Exposure to Parental Cancer and Income Loss During Childhood and the Child’s Socioeconomic Position in Early Adulthood: A Danish and Norwegian Register-Based Cohort Study.” Journal of Epidemiology and Community Health:jech-2022-219374. http://dx.doi.org/10.1136/jech-2022-219374

Gendered health consequences of unemployment in Norway 2000–2017: a register-based study of hospital admissions, health-related benefit utilisation, and mortality

Background: The existing literature indicates that unemployment leads to deteriorated mental and somatic health, poorer self-assessed health, and higher mortality. However, it is not clear whether and to what extent the health consequences of unemployment differ between men and women. According to social role theory, women can alternate between several roles (mother, wife, friend, etc.) that make it easier to deal with unemployment, whereas the worker role is more important for men, and unemployment could therefore be more harmful to them. Thus, gender differences in the health consequences of unemployment should decrease as society grows more gender equal. Accordingly, this study examines changes over time in the gendered health consequences of unemployment in Norway.

Methods: Linked Norwegian administrative register data, covering the period from 2000 to 2017, were analysed by means of linear probability models and logistic regression. Four health outcomes were investigated: hospitalisation, receiving sick pay, disability benefit utilisation, and the likelihood of mortality. Two statistical models were estimated: adjusted for (1) age, and (2) additional sociodemographic covariates. All analyses were run split by gender. Three different unemployment cohorts (2000, 2006, and 2011) that experienced similar economic conditions were followed longitudinally until 2017.

Results: The empirical findings show, first, that hospital admission is somewhat more common among unemployed males than among unemployed females. Second, receiving sick pay is much more common post-unemployment for men than for women. Third, excess mortality is higher among unemployed males than among unemployed females. Fourth, there is no gender component in disability benefit utilisation. There is a remarkable pattern of similarity when comparing the results for the three different unemployment cohorts (2000; 2006; 2011). Thus, the gendered health consequences of unemployment have hardly changed since the turn of the century.

Conclusion: This paper demonstrates that the health consequences of unemployment are serious, gendered, and enduring in Norway. 

Heggebø, Kristian. 2022. “Gendered Health Consequences of Unemployment in Norway 2000–2017: A Register-Based Study of Hospital Admissions, Health-Related Benefit Utilisation, and Mortality.” Bmc Public Health 22(1):2447. doi: https://doi.org/10.1186/s12889-022-14899-8

Parental socio-economic position and the risk of type 1 diabetes in children and young adults in Denmark: A nation-wide register-based study

Aim: Diabetes mellitus type 1 is one of the most common serious chronic diseases in childhood and the incidence is increasing. Insight into risk factors may inform our etiologic understanding of the disease and subsequent prevention. Any socio-economic gradient in disease risk indicates a potential for prevention, since this points towards socially patterned environmental risk factors. The aim of this study was to investigate the association between measures of parental socio-economic position and the onset of type 1 diabetes in offspring based on individual data in the entire Danish population.

Methods: In a study population of all children born in Denmark between 1 January 1987 and 31 December 2010, we examined the association between parental socio-economic position and the risk of type 1 diabetes up to the age of 25 years. The risk of type 1 diabetes was estimated according to maternal education, paternal education and household income using Cox proportional hazards regression, with adjustments for the a priori selected confounding variables: year of birth, maternal age at birth and parental type 1 diabetes.

Results: In the study population of 1,433,584 children, a total of 4610 developed type 1 diabetes. We found no clear pattern in type 1 diabetes risk according to parental educational attainment or parental household income.

Conclusions: In this large population covering study of the risk of type 1 diabetes according to individual-level parental socio-economic position, we found no strong indication of a socially patterned disease risk.

Prætorius, Katrine, Stine Kjaer Urhoj and Anne-Marie Nybo Andersen. 2022. “Parental Socio-Economic Position and the Risk of Type 1 Diabetes in Children and Young Adults in Denmark: A Nation-Wide Register-Based Study.” Scandinavian Journal of Public Health:14034948221082950. doi: https://doi.org/10.1177/14034948221082950

Nordic research on health inequalities: A scoping review of empirical studies published in Scandinavian Journal of Public Health 2000–2021

Aims: An important task for the Scandinavian Journal of Public Health is to address health inequality topics. This scoping review characterises Nordic empirical studies within this research field, published 2000?2021 by the Scandinavian Journal of Public Health.Methods:Original empirical research studies using data from Denmark, Finland, Iceland, Norway and/or Sweden, which linked differences in health or health-related aspects to socioeconomic positions, immigrant status, family structures and/or residential areas, were included in the review. The initial search in the Web of Science article database resulted in 294 possibly relevant articles, and 171 were judged to comply with our criteria.

Results: Only one study was based on qualitative data, while all others used either surveys or register data, or both in combination. A wide variety of outcomes was addressed. Most studies had a social causation design, but 16 studies analysed health-related mobility processes and four reported intervention results. The most common statistical method was logistic regression. Poisson, Cox and ordinary least squares regression were less used. Few studies engaged explicitly with health inequality theories or with rigorous causality designs.

Conclusions: The empirical health inequality studies published by the Scandinavian Journal of Public Health are rich sources for knowledge on a large array of health and health-related inequalities in Nordic countries. Drawbacks are underuse of qualitative data, few theoretical discussions and lack of studies assessing effects of interventions and policies.

Elstad, J. I., et al. (2022). “Nordic research on health inequalities: A scoping review of empirical studies published in Scandinavian Journal of Public Health 2000–2021.” Scandinavian Journal of Public Health: https://doi.org/10.1177/14034948221101304

Health‑related selection into employment among the unemployed

Background: Successful transitions from unemployment to employment are an important concern, yet little is known about health-related selection into employment. We assessed the association of various physical and psychiatric conditions with finding employment, and employment stability.

Methods: Using total population register data, we followed Finnish residents aged 30–60 with an unemployment spell during 2009–2018 (n = 814,085) for two years from the onset of unemployment. We predicted any, stable, and unstable employment by health status using Cox proportional hazards models. The data on specialized health care and prescription reimbursement were used to identify any alcohol-related conditions and poisonings, psychiatric conditions and self-harm, injuries, and physical conditions. We further separated physical conditions into cancer, diabetes, heart disease, and neurological conditions, and psychiatric conditions into depression, anxiety disorders and substance use disorders.

Results: The likelihood of any employment was lower among those who had any of the assessed health conditions. It was lowest among those with alcohol-related or psychiatric conditions with an age-adjusted hazard ratio of 0.45 (95% confidence interval 0.44, 0.46) among men and 0.39 (0.38, 0.41) among women for alcohol-related and 0.64 (0.63, 0.65) and 0.66 (0.65, 0.67) for psychiatric conditions, respectively. These results were not driven by differences in socioeconomic characteristics or comorbidities. All the included conditions were detrimental to both stable and unstable employment, however alcohol-related and psychiatric conditions were more harmful for stable than for unstable employment.

Conclusions: The prospects of the unemployed finding employment are reduced by poor health, particularly alcohol-related and psychiatric conditions. These two conditions may also lead to unstable career trajectories. The selection process contributes to the health differentials between employed and unemployed people. Unemployed people with health problems may therefore need additional support to improve their chances of employment.

Junna, L., Moustgaard, H., & Martikainen, P. (2022). Health-related selection into employment among the unemployed. BMC public health, 22(1), 1-12. https://doi.org/10.1186/s12889-022-13023-0

Trends in the shape of the income–mortality association in Sweden between 1995 and 2017: a repeated cross-sectional population register study.

Objective: We investigate recent trends in income inequalities in mortality and the shape of the association in Sweden. We consider all-cause, preventable and non-preventable mortality for three age groups (30–64, 65–79 and 80+ years).

Design and setting: Repeated cross-sectional design using Swedish total population register data.

Participants: All persons aged 30 years and older living in Sweden 1995–1996, 2005–2006 and 2016–2017 (n=8 084 620).

Methods: Rate differences and rate ratios for all-cause, preventable and non-preventable mortality were calculated per income decile and age group.

Results: From 1995 to 2017, relative inequalities in mortality by income increased in Sweden in the age groups 30–64 years and 65–79 years. Absolute inequalities increased in the age group 65–79 years. Among persons aged 80+ years, inequalities were small. The shape of the income–mortality association was curvilinear in the age group 30–64 years; the gradient was stronger below the fourth percentile. In the age group 65–79 years, the shape shifted from linear in 1995–1996 to a more curvilinear shape in 2016–2017. In the oldest age group (80+ years), varied shapes were observed. Inequalities were more pronounced in preventable mortality compared with non-preventable mortality. Income inequalities in preventable and non-preventable mortality increased at similar rates between 1995 and 2017.

Conclusions: The continued increase of relative (ages 30–79 years) and absolute (ages 65–79 years) mortality inequalities in Sweden should be a primary concern for public health policy. The uniform increase of inequalities in preventable and non-preventable mortality suggests that a more complex explanatory model than only social causation is responsible for increased health inequalities.

Rehnberg, J., Östergren, O., Fors, S., & Fritzell, J. (2022). Trends in the shape of the income–mortality association in Sweden between 1995 and 2017: a repeated cross-sectional population register study. BMJ Open, 12(3), e054507. https://doi.org/10.1136/bmjopen-2021-054507

Social, demographic and health characteristics of men fathering children at different ages

The aim of this study was to examine associations between selected sociodemographic, socioeconomic, and health characteristics and the rates of fatherhood in different age groups. We investigated rates between 2011 and 2015 in a population-based register study including all men born from 1945 to 1995 residing in Denmark in 2011. The study population consisted of 1,867,108 men who fathered 268,612 children during the follow-up. The associations were quantified as incidence rate ratios using Poisson regression. Young men had higher rates of fathering a child if they lived outside the Capital Region, had a relatively high income, were previously diagnosed with cardiovascular disease, psychoactive substance abuse, personality disorders, schizophrenia or behavioural and emotional disorders. Men of advanced age had higher rates of fathering a child when born outside Denmark, living in the Capital Region, were in the lower or upper 10th percentile income group, were self-employed or unemployed or previously diagnosed with depression. Men of advanced age had lower rates of fathering a child if previously diagnosed with somatic diseases, psychoactive substance abuse or mental retardation. The findings highlight the importance of consideration of various sociodemographic, socioeconomic, and health characteristics when studying associations between paternal age and offspring health.

Kornerup N, Andersen AN, Andersen PK, Bilsteen JF, Urhoj SK, (2021). Social, demographic and health characteristics of men fathering children at different ages.. Scientific reports, 11 (1), pp. 21021, https://doi.org/10.1038/s41598-021-00482-5

Contributions of specific causes of death by age to the shorter life expectancy in depression: a register-based observational study from Denmark, Finland, Sweden and Italy

Background: The reasons for the shorter life expectancy of people with depression may vary by age. We quantified the contributions of specific causes of death by age to the life-expectancy gap in four European countries.

Methods: Using register-based cohort data, we calculated annual mortality rates in between 1993 and 2007 for psychiatric inpatients with depression identified from hospital-care registers in Denmark, Finland and Sweden, and between 2000 and 2007 for antidepressant-treated outpatients identified from medication registers in Finland and Turin, Italy. We decomposed the life-expectancy gap at age 15 years by age and cause of death.

Results: The life-expectancy gap was especially large for psychiatric inpatients (12.1 to 21.0 years) but substantial also for antidepressant-treated outpatients (6.3 to 14.2 years). Among psychiatric inpatients, the gap was largely attributable to unnatural deaths below age 55 years. The overall contribution was largest for suicide in Sweden (43 to 45%) and Finland (37 to 40%). In Denmark, ‘other diseases’ (25 to 34%) and alcohol-attributable causes (10 to 18%) had especially large contributions. Among antidepressant-treated outpatients, largest contributions were observed for suicide (18% for men) and circulatory deaths (23% for women) in Finland, and cancer deaths in Turin (29 to 36%). Natural deaths were concentrated at ages above 65 years.

Limitations The indication of antidepressant prescription could not be ascertained from the medication registers.

Conclusions: Interventions should be directed to self-harm and substance use problems among younger psychiatric inpatients and antidepressant-treated young men. Rigorous monitoring and treatment of comorbid somatic conditions and disease risk factors may increase life expectancy for antidepressant-treated outpatients, especially women.

Korhonen K, Moustgaard H, Tarkiainen L, Östergren O, Costa G, Urhoj S, Martikainen P, (2021). Contributions of specific causes of death by age to the shorter life expectancy in depression: a register-based observational study from Denmark, Finland, Sweden and Italy.. Journal of affective disorders, pp. 831-838 https://doi.org/10.1016/j.jad.2021.08.076

Unemployment from stable, downsized and closed workplaces and alcohol‐related mortality

Aims: To assess the importance of health selection in the association between unemployment and alcohol-related mortality by comparing mortalities of those unemployed from workplaces experiencing different levels of downsizing. The more severe the downsizing, the less dependent unemployment would be on personal characteristics and the weaker the role of health selection.

Design: We estimated hazards models of unemployment on alcohol-related diseases and poisonings and external causes with alcohol as a contributing cause over follow-ups of 0–5, 6–10 and 11–20 years and at different levels of downsizing (stable, downsized or closed).

Setting: Finland, 1990 to 2009.

Participants: A register-based random sample of employees aged 25–63 in privately owned workplaces (n = 275 738).

Measurements: The outcome was alcohol-related death and the exposure was unemployment. We adjusted for age, sex, year, education, marital status, health status, workplace tenure, industry, region and unemployment rate.

Findings: Alcohol-disease mortality was elevated among the unemployed throughout the follow-up, regardless of the level of downsizing. At 11–20 years after baseline, those unemployed from stable workplaces had a 2.46 hazard ratio (HR) (95% confidence interval [CI] = 2.14–2.82), those from downsized workplaces 1.94 (95% CI = 1.64–2.30) and those from closed workplaces 2.13 (95% CI = 1.75–2.59), when compared with the controls. Alcohol-related external-cause mortality at 0–5 years follow-up was only associated with unemployment from stable workplaces (HR = 1.39, 95% CI = 1.22–1.58), but over time, an association emerged among those unemployed following downsizing and closure. At 11–20-year follow-up, the HR following downsizing was 1.83 (CI 95% = 1.37–2.45) and 1.54 (95% CI = 1.03–2.28) following closure.

Conclusions: There is some indication that alcohol-related ill-health may lead to unemployment in Finland. However, the persistent long-term association between unemployment and alcohol-related mortality even after workplace closure may imply a causal relation.

Junna L, Moustgaard H, Martikainen P, (2020). Unemployment from stable, downsized and closed workplaces and alcohol‐related mortality. Addiction, https://doi.org/10.1111/add.15106

Does the suddenness matter? Antidepressant use before and after a spouse dies suddenly or expectedly of stroke

Aims: Changes in mental health at the time of widowhood may depend on the expectedness of spousal death, but scant evidence is available for spousal deaths attributable to stroke. Methods: Using register-linkage data for Finland, we assessed changes in antidepressant use before and after spousal death for those whose spouses died suddenly of stroke between 1998 and 2003 (N=1820) and for those whose spouses died expectedly of stroke, with prior hospitalisation for cerebrovascular disease (N=1636). We used both population-averaged logit models and individual fixed-effects linear probability models. The latter models control for unobserved time-invariant heterogeneity between the individuals. Results: Our study indicates that the suddenness of a spouse’s death from stroke plays a role in the well-being of the surviving spouse. Increases in antidepressant use appeared larger following widowhood for those whose spouses died suddenly of stroke relative to those whose spouses had a medical history of cerebrovascular disease. Conclusions: The suddenness of a spouse’s death from stroke plays a role for the surviving spouse. The results suggest multifaceted timings of distress surrounding spousal death, depending on the suddenness of a spouse’s death from stroke.

Einiö E, Metsä-Simola N, Peltonen R, Martikainen P, (2021). Does the suddenness matter? Antidepressant use before and after a spouse dies suddenly or expectedly of stroke. Scandinavian Journal of Public Health, https://doi.org/10.1177/14034948211042501

COVID-19 and the Nordic Paradox: a call to measure the inequality reducing benefits of welfare systems in the wake of the pandemic

The Nordic Paradox of inequality describes how the Nordic countries have puzzlingly high levels of relative health inequalities compared to other nations, despite extensive universal welfare systems and progressive tax regimes that redistribute income. However, the veracity and origins of this paradox have been contested across decades of literature, as many scholars argue it relates to measurement issues or historical coincidences. Disentangling between potential explanations is crucial to determine if widespread adoption of the Nordic model could represent a sufficient panacea for lowering health inequalities, or if new approaches must be pioneered. As newfound challenges to welfare systems continue to emerge, evidence describing the benefits of welfare systems is becoming ever more important. Preliminary evidence indicates that the COVID-19 pandemic is drastically exacerbating social inequalities in health across the world, via direct and indirect effects. We argue that the COVID-19 pandemic therefore represents a unique opportunity to measure the value of welfare systems in insulating their populations from rising social inequalities in health. However, COVID-19 has also created new measurement challenges and interrupted data collection mechanisms. Robust academic studies will therefore be needed—drawing on novel data collection methods—to measure increasing social inequalities in health in a timely fashion. In order to assure that policies implemented to reduce inequalities can be guided by accurate and updated information, policymakers, academics, and the international community must work together to ensure streamlined data collection, reporting, analysis, and evidence-based decision-making. In this way, the pandemic may offer the opportunity to finally clarify some of the mechanisms underpinning the Nordic Paradox, and potentially more firmly establish the merits of the Nordic model as a global example for reducing social inequalities in health.

Friedman, J., Calderon-Villarreal, A., Heggebø, K., Balaj, M., Bambra, C., & Eikemo, T. A. (2021). COVID-19 and the Nordic Paradox: a call to measure the inequality reducing benefits of welfare systems in the wake of the pandemic. Social Science & Medicine, 114455. https://doi.org/10.1016/j.socscimed.2021.114455

Excess mortality by individual and spousal education for recent and long-term widowed

The loss of a spouse is followed by a dramatic but short-lived increase in the mortality risk of the survivor. Contrary to expectations, several studies have found this increase to be larger among those with high education. Having a spouse with high education is associated with lower mortality which suggests that losing a spouse with high education means the loss of a stronger protective factor than losing a spouse with low education. This may disproportionately affect the high educated because of educational homogamy. We use Swedish total population registers to construct an open cohort of 1,842,487 married individuals aged 60 to 89 during 2007—2016, observing 239,276 transitions into widowhood and 277,946 deaths. We use Poisson regression to estimate relative and absolute mortality risks by own and spousal education among the married, recent, and long-term widows.We find an absolute increase in mortality risk, concentrated to the first six months of widowhood across all educational strata. The relative increase in mortality risk is larger in higher educational strata. Losing a spouse with high education is associated with higher excess mortality, which attenuates this difference. When considering the timing and the absolute level of excess mortality we find that the overall patterns of excess mortality are similar across educational strata. We argue that widowhood has a dramatic impact on health, regardless of education.

Östergren, O., Fors, S., & Rehnberg, J. (2021). Excess mortality by individual and spousal education for recent and long-term widowed. The Journals of Gerontology: Series B. https://doi.org/10.1093/geronb/gbab227.

Adolescent Mental Health Disorders and Upper Secondary School Completion – The Role of Family Resources

This article investigates the role of socioeconomic family resources in modifying the relationships with upper secondary school completion (SSC) for three mental health dimensions, i.e., externalizing, internalizing and substance use disorders. Using data from administrative registers, we follow a cohort in Norway born in 1996 into early adulthood. We find that having a mental health disorder in adolescence was associated with 12–17 percentage points lower SSC rate after adjustment for demographic and household factors, comorbidity and educational performance. In girls, high family income attenuated the negative relationships between all three mental health dimensions and SSC, while in boys, this was true only for substance use disorders. The paper concludes that access to family socioeconomic resources “buffers” the negative impact of mental health disorders on SSC, but less so in boys, contributing to aggravate social and health-related inequalities in SSC.

Jensen, M. R., van der Wel, K. A., & Bråthen, M. (2021). Adolescent Mental Health Disorders and Upper Secondary School Completion – The Role of Family Resources. Scandinavian Journal of Educational Research, 1-14. https://doi:10.1080/00313831.2021.1983864

Gestational Age, Parent Education, and Education in Adulthood

Adults born preterm (<37 weeks) have lower educational attainment than those born term. Whether this relationship is modified by family factors such as socioeconomic background is, however, less well known. We investigated whether the relationship between gestational age and educational attainment in adulthood differed according to parents’ educational level in 4 Nordic countries.This register-based cohort study included singletons born alive from 1987 up to 1992 in Denmark, Finland, Norway, and Sweden. In each study population, we investigated effect modification by parents’ educational level (low, intermediate, high) on the association between gestational age at birth (25–44 completed weeks) and low educational attainment at 25 years (not having completed upper secondary education) using general estimation equations logistic regressions. A total of 4.3%, 4.0%, 4.8%, and 5.0% singletons were born preterm in the Danish (n = 331 448), Finnish (n = 220 095), Norwegian (n = 292 840), and Swedish (n = 513 975) populations, respectively. In all countries, both lower gestational age and lower parental educational level contributed additively to low educational attainment. For example, in Denmark, the relative risk of low educational attainment was 1.84 (95% confidence interval 1.44 to 2.26) in adults born at 28 to 31 weeks whose parents had high educational level and 5.25 (95% confidence interval 4.53 to 6.02) in adults born at 28 to 31 weeks whose parents had low educational level, compared with a reference group born at 39 to 41 weeks with high parental educational level. Although higher parental education level was associated with higher educational attainment for all gestational ages, parental education did not mitigate the educational disadvantages of shorter gestational age.

Bilsteen, J. F., Alenius, S., Bråthen, M., Børch, K., Ekstrøm, C. T., Kajantie, E., Lashkariani, M.,Nurhonen, M., Risnes, K., Sandin, S., van der Wel, K.A., Wolke, D. & Andersen, A. M. N. (2021). Gestational Age, Parent Education, and Education in Adulthood. Pediatrics. https://doi.org/10.1542/peds.2021-051959.

Welfare trajectories among vulnerable youth before and after the ‘NAV-reform’: Integrated, cohesive, progressive and effective? [In Norwegian]

This paper takes as a point of departure the observation that there is a gap between the high expectations of coordination and integration of welfare services found in research and white papers, and the empirical basis to support such expectations. Taking as our case young people who have not completed secondary school – a ‘vulnerable’ group assumed to benefit from service integration – we study welfare trajectories before and after the Norwegian welfare service integration reform (the NAV-reform). By means of sequence analyses and data from Statistics Norway and the Medical Birth Registry, we investigate whether prevalent trajectories and outcomes have become more favourable after the reform than before. Although we find small signs of the expected benefits, the dominant story is that the post-reform cohort has had weaker bonds to work and more often are found in unproductive and marginalised trajectories.

van der Wel, K. A., Hermansen, Å., Dahl, E., & Saltkjel, T. (2021). Utsatte unges livsbaner før og etter NAV-reformen: flere «integrerte», sammenhengende, progressive og effektive forløp?. Tidsskrift for velferdsforskning, 24(01), 62- 84. https://doi.org/10.18261/issn.2464-3076-2021-01-06

Interdependent pathways between socioeconomic position and health: A Swedish longitudinal register-based study

Health inequalities are generated by the conditions in which people are born, grow, live, work and age. From a life-course perspective, these conditions are formed by complex causal relationships with mutual and intertwined paths between socioeconomic position and health. This study attempts to disentangle some of these processes by examining pathways between socioeconomic position and health across the life-course. We used yearly Swedish national register data with information from over 31 years for two cohorts born 1941–1945 and 1961–1965. We analyzed associations between several indicators of childhood and adult socioeconomic position and health, measured by number of in-patient hospitalizations. We estimated within- and between-person associations using random intercept cross-lagged panel models. The results showed bi-directional associations between socioeconomic position and health that varied in strength across the life-course. Age variations in the associations were primarily observed when individuals aged into or out of age-stratified institutions. In ages where transitions from education to the labor market are common, the associations from health to income and education were strong. Around and after retirement age, the between-person association from health to income was weak, while the association from income to health strengthened. Within-person estimates showed no association between income and subsequent hospitalization among older persons, indicating no direct causal effect of income change on health in this age group. For persons of middle age, the associations were of similar strength in both directions and present at both the between- and within-person level. Our findings highlight the importance of theoretical frameworks and methods that can incorporate the interplay between social, economic, and biological processes over the life-course in order to understand how health inequalities are generated.

Rehnberg, J., Östergren, O., Esser, I., & Lundberg, O. (2021). Interdependent pathways between socioeconomic position and health: A Swedish longitudinal register-based study. Social Science & Medicine, 280, 114038. https://doi.org/10.1016/j.socscimed.2021.114038

Changes in life expectancy and lifespan variability by income quartiles in four Nordic countries: a study based on nationwide register data

Objectives Levels, trends or changes in socioeconomic mortality differentials are typically described in terms of means, for example, life expectancies, but studies have suggested that there also are systematic social disparities in the dispersion around those means, in other words there are inequalities in lifespan variation. This study investigates changes in income inequalities in mean and distributional measures of mortality in Denmark, Finland, Norway, and Sweden over two decades.

Design Nationwide register-based study.

Setting The Danish, Finnish, Norwegian and Swedish populations aged 30 years or over in 1997 and 2017.

Main outcome measures Income-specific changes in life expectancy, lifespan variation and the contribution of ‘early’ and ‘late’ deaths to increasing life expectancy.

Results Increases in life expectancy has taken place in all four countries, but there are systematic differences across income groups. In general, the largest gains in life expectancy were observed in Denmark, and the smallest increase among low-income women in Sweden and Norway. Overall, life expectancy increased and lifespan variation decreased with increasing income level. These differences grew larger over time. In all countries, a marked postponement of early deaths led to a compression of mortality in the top three income quartiles for both genders. This did not occur for the lowest income quartile.

Conclusion Increasing life expectancy is typically accompanied by postponement of early deaths and reduction of lifespan inequality in the higher-income groups. However, Nordic welfare societies are challenged by the fact that postponing premature deaths among people in the lowest-income groups is not taking place.

Brønnum-Hansen, H., Östergren, O., Tarkiainen, L., Hermansen, Å., Martikainen, P., van der Wel, K. A., & Lundberg, O. (2021). Changes in life expectancy and lifespan variability by income quartiles in four Nordic countries: a study based on nationwide register data. BMJ open, 11(6), e048192. http://dx.doi.org/10.1136/bmjopen-2020-048192

Disability and mortality in the working class – the role of mechanical working conditions [In Norwegian]

This chapter analyses the contribution of mechanical working conditions and education in explaining class inequalities in disability pensioning and mortality over a 10-year period among men and women who were employed in 2007. Mechanical working conditions were measured by a newly constructed Job Exposure Matrix which could be assigned to the individual’s occupational codes (ISCO-88). The results showed that mechanical working conditions explained 32 per cent of the excess mortality among male skilled workers, and less among unskilled workers. For women, mechanical working conditions were of no importance for the observed mortality patterns. Mechanical working condition, however, explained between 16-35 per cent of the excess disability in working class workers, somewhat more in female workers. Compared to the role of education in explaining class differences in mortality and disability pensioning, the influence of mechanical working conditions was limited.

Dahl, E., Elstad, JI., Hermansen, Å., van der Wel, KA. (2021). Uførhet og dødsrisiko i arbeiderklassen – Hva betyr arbeidsmiljø og arbeidsforhold?. Arbeiderklassen. (pp. 275-291). In: Ljungren, J. and Hansen, MN. (Eds.) Arbeiderklassen. Oslo:Cappelen Damm Akademisk.

Exploring the longevity advantage of doctorates in Finland and Sweden: The role of smoking- and alcohol-related causes of death

Aims: Tobacco smoking and alcohol use contribute to differences in life expectancy between individuals with primary, secondary and tertiary education. Less is known about the contribution of these risk factors to differences at higher levels of education. We estimate the contribution of smoking and alcohol use to the life-expectancy differences between the doctorates and the other tertiary-educated groups in Finland and in Sweden. Methods: We used total population data from Finland and Sweden from 2011 to 2015 to calculate period life expectancies at 40 years of age. We present the results by sex and educational attainment, the latter categorised as doctorate or licentiate degrees, or other tertiary. We also present an age and cause of death decomposition to assess the contribution of deaths related to smoking and alcohol. Results: In Finland, deaths related to smoking and alcohol constituted 48.6% of the 2.1-year difference in life expectancy between men with doctorate degrees and the other tertiary-educated men, and 22.9% of the 2.1-year difference between women, respectively. In Sweden, these causes account for 22.2% of the 1.9-year difference among men, and 55.7% of the 1.6-year difference among women, which in the latter case is mainly due to smoking. Conclusions: Individuals with doctorates tend to live longer than other tertiary-educated individuals. This difference can be partly attributed to alcohol consumption and smoking.

Junna, L. M., Tarkiainen, L., Östergren, O., Jasilionis, D., & Martikainen, P. (2020) Exploring the longevity advantage of doctorates in Finland and Sweden: The role of smoking- and alcohol-related causes of death. Scandinavian Journal of Public Health, 0(0), 1403494820969541. https://doi.org/10.1177/1403494820969541

Home and away: mortality among Finnish-born migrants in Sweden compared to native Swedes and Finns residing in Finland 

Background

Most first-generation migrants have lower mortality compared to the native population. Finnish-born migrants in Sweden instead have higher mortality; possibly because of health behaviours established before migration. To increase our understanding of this excess mortality, we compared the cause-specific mortality of Finnish migrants in Sweden to both the native population of Sweden and the native Finnish population residing in Finland.

Methods

We used Swedish and Finnish register data, applying propensity score matching techniques to account for differences in sociodemographic characteristics between the migrants, Swedes and Finns. The index population were Finnish migrants aged 40–60, residing in Sweden in 1995. We compared patterns of all-cause, alcohol- and smoking-related, and cardiovascular disease mortality across the groups in the period 1996–2007.

Results

Finnish migrant men in Sweden had lower all-cause mortality compared to Finnish men but higher mortality compared to the Swedish men. The same patterns were observed for alcohol-related, smoking-related and cardiovascular disease mortality. Among women, all three groups had similar levels of all-cause mortality. However, Finnish migrant women had higher alcohol-related mortality than Swedish women, similar to Finnish women. Conversely, migrant women had similar levels of smoking-related mortality to Swedish women, lower than Finnish women.

Conclusions

Finnish-born migrants residing in Sweden have mortality patterns that are typically in between the mortality patterns of the native populations in their country of origin and destination. Both the country of origin and destination need to be considered in order to better understand migrant health.

Östergren, O., Korhonen, K., Gustafsson, N.-K., & Martikainen, P. (2020). Home and away: mortality among Finnish-born migrants in Sweden compared to native Swedes and Finns residing in Finland. European Journal of Public Health. https://doi.org/10.1093/eurpub/ckaa192