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Denny Vågerö

Publications and source records attributed to Denny Vågerö.

13 recordsLinked to original sources
PubMed2006

Major improvements, but persisting inequalities in infant survival in Estonia 1992-2002.

BACKGROUND: Inequality in adult health increased in Estonia during the transition period after 1991. We examined inequality in infant survival from 1992 to 2002. METHODS: All 132 854 singleton live births reported to the Estonian Medical Birth Registry in 1992-2001 were linked to the Estonian Mortality Database. The effect of mother's education, nationality, marital status, and place of residence on neonatal (0-27 days) and post-neonatal (28-364 days) death was evaluated in logistic regression with adjustments for maternal age, parity, smoking, sex of the infant, birth weight, and gestational age. RESULTS: Infant mortality decreased substantially. Risk of death in neonatal period was lowest in Tartu, with a decline from 4.9/1000 in infants born in 1992-1996 to 2.1/1000 in those born in 1997-2001. Decline in neonatal mortality in other regions was from 9.2/1000 to 5.1/1000. Persisting regional differences were unexplained by mothers' nationality, education, or marital status, or the infants' length of gestation. Decline in post-neonatal mortality was less marked and although risk differences between different socio-economic groups decreased, mothers' marital status and education in particular remained strongly associated with risk of post-neonatal death [odds ratio for infants born to mothers with basic or lower education compared to university education 3.70 (95% confidence interval 2.34-5.85) in 1992-1996 and 3.56 (2.06-6.14) in 1997-2001]. CONCLUSIONS: Infant survival improved appreciably in Estonia after 1991 and risk differences between social groups decreased. The improvements were not accompanied by reduction in the strength of the effects of social characteristics on infant death measured as risk ratios.

Adult↗
PubMed2006

Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice.

STUDY OBJECTIVE: Education, income, and occupational class are often used interchangeably in studies showing social inequalities in health. This procedure implies that all three characteristics measure the same underlying phenomena. This paper questions this practice. The study looked for any independent effects of education, income, and occupational class on four health outcomes: diabetes prevalence, myocardial infarction incidence and mortality, and finally all cause mortality in populations from Sweden and Germany. DESIGN: Sweden: follow up of myocardial infarction mortality and all cause mortality in the entire population, based on census linkage to the Cause of Death Registry. Germany: follow up of myocardial infarction morbidity and all cause mortality in statutory health insurance data, plus analysis of prevalence data on diabetes. Multiple regression analyses were performed to calculate the effects of education, income, and occupational class before and after mutual adjustments. SETTING AND PARTICIPANTS: Sweden (all residents aged 25-64) and Germany (Mettman district, Nordrhein-Westfalen, all insured persons aged 25-64). MAIN RESULTS: Correlations between education, income, and occupational class were low to moderate. Which of these yielded the strongest effects on health depended on type of health outcome in question. For diabetes, education was the strongest predictor and for all cause mortality it was income. Myocardial infarction morbidity and mortality showed a more mixed picture. In mutually adjusted analyses each social dimension had an independent effect on each health outcome in both countries. CONCLUSIONS: Education, income, and occupational class cannot be used interchangeably as indicators of a hypothetical latent social dimension. Although correlated, they measure different phenomena and tap into different causal mechanisms.

Adult↗
PubMed2005

Self-reported heart symptoms are strongly linked to past and present poverty in Russia: evidence from the 1998 Taganrog interview survey.

BACKGROUND: In this Russian-Swedish collaborative study the question of how symptoms of heart disease are linked to poverty in Russia was addressed. METHOD: A random sample household survey was conducted in Taganrog, southern Russia. It covered questions about living circumstances, poverty and health. Health questions included both symptoms of heart problems, such as chest pain and high blood pressure, psychological problems such as depression and anxiety, as well as health-related behaviours such as alcohol drinking. Answers from 1972 women and men aged 18-70 are analysed here. RESULTS: The poorest fifth of the population were more than twice as likely as others to report heart symptoms. Problems in affording vegetables, meat or fish, clothes and footwear were linked to heart symptoms more closely than other economic indicators, such as car ownership or ownership of consumer durables. Psychological symptoms, sleeping problems and alcohol drinking were all related to self-reported heart symptoms, but explained little of the excess risks attributable to present poverty. Childhood poverty was also linked to present heart symptoms. CONCLUSION: Life-time accumulated experience of economic hardship contributes to present levels of heart disease symptomology in Russia.

Adolescent↗
PubMed2005

Morning cortisol does not mediate the association of size at birth with blood pressure in children born from full-term pregnancies.

OBJECTIVE: It had been suggested that programming of the hypothalamo-pituitary-adrenal axis may underlie the associations of reduced size at birth with raised blood pressure in later life. We investigated whether morning salivary cortisol mediates the inverse association of birthweight with systolic blood pressure in children. DESIGN: Subjects and measurements--a historical cohort study involving 1152 Swedish children aged 5-14 years, who took part in a family study comprised of mother, father, and two full-sibs delivered in 1987-1995 after 38-41 weeks gestation within 36 months of each other. Birthweight and gestational age were available from obstetric records. Blood pressure, weight, height and puberty stage were measured at a clinic. Cortisol was measured by radioimmunoassay in morning salivary samples taken at home, within 30 min of waking. RESULTS: Morning cortisol showed a weak negative association with length of gestation in siblings, was not related to birthweight or to systolic or diastolic blood pressure. There was no change in the strength of the negative association between birthweight and systolic blood pressure on adjustment for cortisol (-1.4 mmHg/kg, 95% CI -2.7, -0.2; adjusted for age, sex, puberty stage, weight and height, and cortisol). CONCLUSIONS: Morning cortisol was not associated with size at birth, and did not mediate the birthweight-blood pressure association in children born from full-term pregnancies. It is possible that basal cortisol levels are of more importance in explaining associations of size at birth with later blood pressure in older subjects, or in populations with more varied length of gestation. Alternatively, our results may be caused by misclassification of the hypothalamo-pituitary-adrenal activity.

Adolescent↗
PubMed2004

Increasing ethnic differences in mortality in Estonia after the collapse of the Soviet Union.

STUDY OBJECTIVE: This study examined the change in ethnic differences in mortality in Estonia 1989-2000. DESIGN: Two unlinked cross sectional census based analyses were compared. Total and cause specific mortality was analysed for ethnic Estonians and Russians. The absolute differences in mortality were evaluated through life expectancy at birth and age standardised mortality rates. Relative differences were assessed by mortality rate ratios with 95% confidence intervals, calculated using Poisson regression. SETTING: Estonia before and after the fall of the Soviet Union. PARTICIPANTS: Individual cause specific death data for 1987-1990 (69549 deaths) and for 1999-2000 (33809 deaths) came from the national mortality database. Population denominators came from the population censuses of 1989 and 2000. MAIN RESULTS: In the period 1989-2000, ethnic differences in life expectancy increased from 0.4 years to 6.1 years among men and from 0.6 years to 3.5 years among women. In 2000, Russians had a higher mortality than Estonians in all age groups and for almost all selected causes of death. The largest differences were found for some alcohol related causes of death especially in 2000. CONCLUSIONS: Political and economic upheaval, increasing poverty, and alcohol consumption can be considered the main underlying causes of the widening ethnic mortality gap.

Alcohol Drinking↗
PubMed2003

Long term mortality after severe starvation during the siege of Leningrad: prospective cohort study.

OBJECTIVES: To determine whether starvation during periods of increased growth after birth have long term health consequences. DESIGN: Analysis of cardiovascular risk factors and mortality in a longitudinal follow up after the 1941-4 siege of Leningrad. Mortality measured from 1975 up to the end of 1999. SETTING: St Petersburg, Russia (formerly Leningrad). PARTICIPANTS: 5000 men born 1916-35 who lived in Leningrad, randomly selected to take part in health examinations in 1975-7. Of the 3905 men who participated, a third had experienced the siege. MAIN OUTCOME MEASURES: Relative risk of ischaemic heart disease and mortality from stroke by siege exposure. Odds ratios and means for several cardiovascular risk factors. RESULTS: Three to six decades after the siege, in men who experienced the siege around the age of puberty blood pressure was raised (mean difference in systolic 3.3 mm Hg, in diastolic 1.3 mm Hg) as was mortality from ischaemic heart disease (relative risk 1.39, 95% confidence interval 1.07 to 1.79) and stroke (1.67, 1.15 to 2.43), including haemorrhagic stroke (1.71, 0.90 to 3.22). The effect on mortality was partly mediated via blood pressure but not by any other measured biological, behavioural, or social factor. CONCLUSIONS: Starvation, or accompanying chronic stress, particularly at the onset of or during puberty, may increase vulnerability to later cardiovascular disease.

Adolescent↗
PubMed2003

Estonia 1989-2000: enormous increase in mortality differences by education.

BACKGROUND: Having regained its political autonomy in 1991, Estonia experienced major changes in political, economic, and social realities. We aimed to analyse mortality changes by education from 1989 to 2000 in order to assess the impact of recent changes in Estonia, as well as the delayed effects of pre-transitional developments. METHODS: Two census-based analyses were compared. Individual cause-specific death data for those aged 20+ for 1987-1990 (72 003 deaths) and 1999-2000 (35 477 deaths) came from the national mortality database. Population denominators came from the population censuses of 1989 and 2000. Mortality for all causes combined and for selected causes of death were analysed for high, mid, and low educational groups. The absolute differences in mortality were evaluated through life expectancy at age 25 and age-standardized mortality rates. To assess the relative differences between educational levels, mortality rate ratios with 95% CI were calculated using Poisson regression. RESULTS: Educational differences in mortality increased tremendously from 1989 to 2000: over the 10-year period life expectancy improved considerably for graduates, and worsened for those with the lowest education. In 2000, male graduates aged 25 could expect to live 13.1 years longer than corresponding men with the lowest education; among women the difference was 8.6 years. Large differences were observed in all selected causes of death in 1989 and in 2000 and the trends were invariably much more favourable for the higher educated. Educational differences in total mortality increased in all age groups. CONCLUSIONS: Social disruption and increasing inequalities in wealth can be considered main recent determinants; however, causal processes, shaped decades before recent reforms, also contribute to this widening gap.

Adult↗