Biomedical subjects

Jan Sundquist

Publications and source records attributed to Jan Sundquist.

At least 37 records · Page 2Linked to original sources

PubMed2005

Incidence of mental disorders in second-generation immigrants in sweden: a four-year cohort study.

BACKGROUND: Few studies have investigated mental health among second-generation immigrants who have reached adulthood. The aim of this study was to examine whether second-generation adult immigrants have a higher risk of being hospitalised for mental disorders than the Swedish majority population after adjustment for socio-economic status. METHODS: In total 1.9 million Swedish-born women and men aged 16-34 were followed from 1 January 1995 to 31 December 1998 for first hospital admissions for mental disorders, categorised in four main diagnosis groups. Second-generation immigrants comprised four groups and the Swedish majority population was used as reference group. Cox proportional hazard models were used to analyse the data. RESULTS: Second-generation immigrants with one parent born in Sweden and second-generation Finns had higher risks of being hospitalised for psychotic disorders, affective disorders, neurotic disorders, and personality disorders than the Swedish majority population. For second-generation Finns the age- and sex-adjusted hazard ratio for psychotic disorders was 2.42 (CI = 2.09-2.80). No significant hazard ratios were found for second-generation labour immigrants. For second-generation refugees the risk of being hospitalised was higher than for the Swedish majority population but only for psychotic disorders. All results remained significant and decreased only slightly after adjustment for income and education. CONCLUSIONS: Many groups of second-generation immigrants have a higher risk of being hospitalised for mental disorder than the majority population. With increasing global migration it is crucial for all industrialised countries to take measures to improve mental health among second-generation immigrants.

Adolescent↗

PubMed2005

The influence of ethnicity and length of time since immigration on physical activity.

OBJECTIVE: This study investigates whether ethnicity and length of time since immigration influence levels of leisure-time physical activity in Sweden. DESIGN/SETTING/PARTICIPANTS: This cross-sectional study analyses data from the Swedish Survey of Living Conditions from the years 1996, 1997 and 1999, which is conducted annually and is a simple, random sample drawn from the register of the total population in Sweden. The total sample was 14,485 men and women aged 20-74 years, who were categorised according to country of origin: born in Sweden, Western Europe, Finland, Southern Europe, Eastern Europe or all other countries. The multivariate analysis was performed using a logistic regression model in order to investigate the effects of possible confounding factors on physical activity. MAIN RESULTS: The risk of reporting low levels of physical activity was significantly higher for men born in Finland, Southern Europe and in the category 'all other countries', and also for women born in Southern Europe, Eastern Europe and 'all other countries', compared with men and women born in Sweden. After the inclusion of the variables education, smoking, body mass index and longstanding illness or disability into the model, the relationship between ethnicity and low levels of physical activity decreased to non-significance for men born in Finland and Southern Europe, but remained significant for men born in the category 'all other countries'. The differences in risk for women observed in the crude model remained significant even after inclusion of all other variables in the multivariate model. A positive gradient was observed between the length of time since immigration to Sweden and low levels of physical activity in women but no relationship was observed in men. CONCLUSIONS: There are significant differences in levels of leisure-time physical activity between different ethnic groups living in Sweden, which could not all be explained by the confounding factors age, education, smoking, body mass index or long-term illness or disability. In women, but not in men, levels of leisure-time physical activity increased with increasing time since immigration to Sweden.

Adult↗

PubMed2005

Smokeless tobacco and coronary heart disease: a 12-year follow-up study.

BACKGROUND: Cigarette smoking has declined whereas the use of smokeless tobacco is increasing. There is an ongoing debate as to whether smokeless tobacco is a recommendable strategy to help smokers to quit. However, very few studies have examined the association between smokeless tobacco, namely snuff, and coronary heart disease, which implies that it has not been possible to provide scientific results for public health policies and clinical guidelines concerning the use of smokeless tobacco. DESIGN: A follow-up study. METHODS: A random sample of 3120 healthy men aged 30-74 years was interviewed in 1988 and 1989 and followed up to the year 2000 with regard to coronary heart disease. Cox regression was used to estimate the relative risk of coronary heart disease in six categories of smoking and snuffing habits, after adjustment for established risk factors for coronary heart disease. RESULTS: Smokers, former smokers, and those who combined smoking and snuffing had significantly higher hazard ratios than never-smokers. The very highest hazard ratio was found among individuals combining smoking and snuffing. Daily snuffers had a hazard ratio of 1.62 (95% confidence interval 0.70-3.03) after adjustment for age. CONCLUSIONS: Even though the association between daily snuffing and coronary heart disease was non-significant, the hazard ratio was markedly increased. Therefore, smokers should not use smokeless tobacco in order to quit smoking, especially as safer alternatives are available. Further studies in different settings are required to provide scientific results for public health policies and clinical guidelines.

Adult↗

PubMed2005

Do immigrants have an increased prevalence of unhealthy behaviours and risk factors for coronary heart disease?

BACKGROUND: Although previous research has demonstrated a high risk of coronary disease in immigrants, the prevalence of unhealthy behaviours and risk factors is less known. The aim of this study was to investigate whether unhealthy behaviours and risk factors for coronary disease are more common in immigrants than in Swedish-born individuals. METHODS: Between 1 January 1996 and 31 December 2002 a simple random sample of the population was drawn and interviewed face to face. Eight immigrant groups in Sweden and a Swedish-born reference group, aged between 27 and 60 years, were studied. A log-binomial model was used to analyse the cross-sectional association between country of birth and unhealthy behaviours as well as coronary disease risk factors. RESULTS: Many of the immigrant groups showed higher risks of smoking, of physical inactivity and of obesity than Swedish-born individuals in age-adjusted models. On also adjusting for the level of education, occupational status and social network, the differences in risk persisted in the majority of groups. However, the over-risks of physical inactivity in Finnish and south European immigrant men and of diabetes in Finnish and Turkish immigrant women disappeared. CONCLUSIONS: The high prevalence of unhealthy behaviours and risk factors for coronary disease in many immigrant groups might be a lifestyle remnant from their country of birth or might be brought about by a stressful migration and acculturation into a new social and cultural environment. Nevertheless, it is important in primary healthcare to be aware of a possible preventable increased risk of unhealthy behaviours and risk factors for coronary disease in some immigrants.

Adult↗

PubMed2005

Does occupational social class predict coronary heart disease after retirement? A 12-year follow-up study in Sweden.

AIMS: To examine whether socioeconomic status and coronary heart disease (CHD) risk factors remain significant predictors of CHD among people aged >or=65 years. Previous studies in this age group are few and inconsistent. METHODS: Follow-up study of a simple random sample of Swedish women and men aged >or=65 years interviewed in a national survey 1988-89 and followed up until 31 December 2000, for CHD incidence rates. Cox regression was used to study the association between socioeconomic status (occupation) and CHD, after adjustment for age, sex, physical activity, smoking, BMI, diabetes, and hypertension. Participants with CHD hospitalization two years before the start of the study and those who rated their general health as poor were excluded. RESULTS: Among manual workers and lower-level employees the risk of CHD was significantly higher than among middle-level employees and professionals (49% and 50%, respectively), after adjustment for age and sex. The association between low socioeconomic status and increased CHD risk disappeared after adjustment for the CHD risk factors, which were more prevalent among those with low socioeconomic status. All the CHD risk factors (with the exception of BMI) were associated with increased CHD incidence rates. CONCLUSIONS: Low socioeconomic status remains a significant predictor of CHD among people aged >or=65 years. Healthcare policies among elderly patients should encourage physical activity and smoking cessation in all socioeconomic groups.

Aged↗

PubMed2004

The long-term effect of physical activity on incidence of coronary heart disease: a 12-year follow-up study.

BACKGROUND: This study analyzed the long-term effect of leisure-time physical activity on incident cases of coronary heart disease (CHD) among women and men. METHODS: A national, random sample of 2,551 women and 2,645 men, aged 35-74, was interviewed in 1988 and 1989 and followed until December 31, 2000, with respect to CHD incident cases. Women and men hospitalized for CHD 2 years before the start of the study and those who rated their general health as poor were not included in the sample. Leisure-time physical activity was divided into four levels according to the frequency of physical activity. The relationship between leisure-time physical activity and CHD was studied in a Cox regression model, adjusted for sex, age, income, smoking, and BMI. RESULTS: When leisure-time physical activity increased, the risk of CHD decreased. Women and men who were physically active at least twice a week had a 41% lower risk of developing CHD than those who performed no physical activity (hazard ratio = 0.59, CI = 0.37-0.95), after adjustment for all the explanatory variables. CONCLUSIONS: The positive long-term effect of leisure-time physical activity on CHD risk among women and men remains even after accounting for income and other important CHD risk factors.

Adult↗

PubMed2004

Social environment and psychiatric illnessA follow-up study of 9,170 women and men in Sweden.

OBJECTIVE: The aim of this follow-up study is to examine whether the individual's social and physical environment predicts incidence rates of psychiatric illness, after adjusting for demographic and socio-economic characteristics. METHODS: A random sample of the Swedish population (9,170 women and men, aged 25-74) were interviewed between 1990 and 1991 and followed through December 1998 for incidence rates of psychiatric illness. A social participation index and a physical environment index were constructed, based on the interview data. Cox's regression was used to estimate relative risks expressed as hazard ratios (HR). We also stratified for self-reported long-term psychiatric illness at the time of the interview. RESULTS: Respondents with low scores in the social participation index exhibited an increased age- and sex-adjusted risk of psychiatric illness with an HR = 2.00 (95 % CI 1.32-3.03) compared with individuals with high scores in the social participation index. After inclusion of education, housing tenure and the physical environment index, the HR of psychiatric illness decreased only slightly to 1.69 (95% CI 1.07-2.66) for respondents with low scores in the social participation index. There was no relationship between the physical environment index and psychiatric illness. CONCLUSIONS: In order to prevent and treat psychiatric illness, it is of importance also to consider the individual's social environment.

Adult↗

PubMed2004

Country of birth and body mass index: a national study of 2,000 immigrants in Sweden.

The aim of this study is to analyse the influence of country of birth on body mass index (BMI) after adjustment for age, educational status, physical activity and smoking habits. Two random samples of men and women, aged 27-60, were used: 1,957 immigrants and 2,975 Swedes, both from 1996. Men and women were analysed in separate models by the use of linear regression. The BMI levels were significantly higher among Polish (0.8 BMI units) and Chilean (0.7 BMI units) men, and Chilean (1.9 BMI units) and Turkish (1.5 BMI units) women than among their Swedish controls, after adjustment for all explanatory variables. Other intermediate risk factors for cardiovascular disease, such as physical inactivity and daily smoking, were also more frequent among almost all the immigrant subgroups. This study shows a strong influence of country of birth on BMI even after adjustment for age, educational status, physical activity and smoking habits.

Adult↗

PubMed2004

Frequent and occasional physical activity in the elderly: a 12-year follow-up study of mortality.

BACKGROUND: The positive health effects of physical activity are well known. However, there are few studies of the association between different levels of physical activity and all-cause mortality among elderly people. METHODS: A national random sample of 3206 women and men aged >/=65 were interviewed in 1988 and 1989 and followed until December 31, 2000, for all-cause mortality. Cox regression was used to analyze the association between five different levels of physical activity and all-cause mortality, after adjustment for gender, age, education, smoking habits, body mass index, diabetes, hypertension, and self-rated health. All analyses were conducted in 2003. RESULTS: For elderly people who were physically active occasionally, the risk of all-cause mortality was 28% lower than for those who were physically inactive (hazard ratio [HR]=0.72; confidence interval [CI]=0.64-0.81), after adjustment for all explanatory variables. For those who were physically active once a week, the risk of all-cause mortality was 40% lower than for those who were physically inactive (HR=0.60; CI=0.50-0.71). For those who were physically active more frequently, the reduction in all-cause mortality risk was about the same as for those who were physically active once a week. Diabetes, hypertension, and daily smoking were, as expected, significant risk factors for all-cause mortality. CONCLUSIONS: Physical activity, even occasionally, decreases the risk of all-cause mortality among elderly people. Preventive resources among the elderly should include moderate exercise such as walking.

Aged↗

PubMed2004

Social participation and coronary heart disease: a follow-up study of 6900 women and men in Sweden.

Few studies have examined the relationship between social, cultural and religious participation, political empowerment and coronary heart disease (CHD). The aim of this study was to examine whether low social participation, as described in a social participation index, predicted incidence rates of CHD. This is a follow-up study, from 1990-91 to 31 December 2000, of 6861 Swedish women and men, who were interviewed about their social participation, education, housing tenure and smoking habits. A social participation index was constructed, based on 18 variables from the survey. The outcome measure was CHD morbidity and mortality. Respondents with a CHD incident from 1986 until interview were excluded from the study. Data were analysed using Cox' regression and the results are presented as hazard ratios (HR) with 95% confidence intervals (CI). In the sex- and age-adjusted model there was a gradient between the social participation index and CHD, so that persons with low social participation had the highest risk of CHD with HR=2.15; CI=1.57-2.94, followed by HR=1.67; CI=1.23-2.27 for those with middle social participation. In the full model, when education, housing tenure and smoking habits were included, the increased risk of CHD for persons with low social participation remained high, with HR=1.69, CI=1.21-2.37. We conclude that persons with low social participation in the social participation index exhibited an increased risk of CHD that remained after adjustment for education, housing tenure and smoking habits.

Adult↗

PubMed2004

Ethnicity, acculturation, and self reported health. A population based study among immigrants from Poland, Turkey, and Iran in Sweden.

STUDY OBJECTIVE: To analyse the association between ethnicity and poor self reported health and explore the importance of any mediators such as acculturation and discrimination. DESIGN: A simple random sample of immigrants from Poland (n = 840), Turkey (n = 840), and Iran (n = 480) and of Swedish born persons (n = 2250) was used in a cross sectional study in 1996. The risk of poor self reported health was estimated by applying logistic models and stepwise inclusion of the explanatory variables. The response rate was about 68% for the immigrants and 80% for the Swedes. Explanatory variables were: age, ethnicity, educational status, marital status, poor economic resources, knowledge of Swedish, and discrimination. MAIN RESULTS: Among men from Iran and Turkey there was a threefold increased risk of poor self reported health than Swedes (reference) while the risk was five times higher for women. When socioeconomic status was included in the logistic model the risk decreased slightly. In an explanatory model, Iranian and Turkish women and men had a higher risk of poor health than Polish women and men (reference). The high risks of Turkish born men and women and Iranian born men for poor self reported health decreased to non-significance after the inclusion of SES and low knowledge of Swedish. The high risks of Iranian born women for poor self reported health decreased to non-significance after the inclusion of low SES, low knowledge of Swedish, and discrimination. CONCLUSIONS: The strong association between ethnicity and poor self reported health seems to be mediated by socioeconomic status, poor acculturation, and discrimination.

Acculturation↗

PubMed2004

Urbanisation and incidence of psychosis and depression: follow-up study of 4.4 million women and men in Sweden.

BACKGROUND: Previous studies of differences in mental health between urban and rural populations are inconsistent. AIMS: To examine whether a high level of urbanisation is associated with increased incidence rates of psychosis and depression, after adjustment for age, marital status, education and immigrant status. METHOD: Follow-up study of the total Swedish population aged 25-64 years with respect to first hospital admission for psychosis or depression. Level of urbanisation was defined by population density and divided into quintiles. RESULTS: With increasing levels of urbanisation the incidence rates of psychosis and depression rose. In the full models, those living in the most densely populated areas (quintile 5) had 68-77% more risk of developing psychosis and 12-20% more risk of developing depression than the reference group (quintile 1). CONCLUSIONS: A high level of urbanisation is associated with increased risk of psychosis and depression for both women and men.

Adult↗

PubMed2003

The influences of place of birth and socioeconomic factors on attempted suicide in a defined population of 4.5 million people.

BACKGROUND: Our knowledge of the influence of place of birth and socioeconomic status on attempted suicide in a defined national population is limited. METHODS: The study population at baseline in 1993 included approximately 4.5 million Swedish persons aged 25 to 64 years, of whom 570 000 had been born abroad. Each individual was tracked until attempted suicide, remigration, death, or the end of the study on December 31, 1998. The Cox regression was used in the analysis. RESULTS: Labor migrants from Finland and other OECD (Organisation for Economic Cooperation and Development) countries and refugees from Poland and Iran had higher hazard ratios of attempted suicide than Swedish-born control subjects. Women born in Latin America, Asia, and Eastern Europe had significantly higher hazard ratios of attempted suicide than Swedish-born women. In contrast, men born in southern Europe and Asia had significantly lower hazard ratios of attempted suicide. The hazard ratios of attempted suicide among women from Iran, Asia, southern Europe, Latin America, and eastern Europe considerably exceeded those of men from the same country of origin. When socioeconomic status was included in the final model, the hazard ratios remained high for women, while the risk of attempted suicide among men declined sharply with increased income. CONCLUSIONS: Place of birth, socioeconomic status, and sex are associated with attempted suicide. Socioeconomic status explains only part of the association between place of birth and attempted suicide.

Adult↗

PubMed2003

Women, international migration and self-reported health. A population-based study of women of reproductive age.

Although our knowledge of the relationship between migration and health in women is increasing, we still have a limited knowledge of the migration and health of women of reproductive age. A cross-sectional analysis of a simple random sample of 10,661 women aged 20-49 in Sweden in 1980-1985 and 9585 such women in 1992-1997 was carried out to assess their health. The risk factors for self-reported, poor health and psychosomatic complaints for female refugees and women from Finland, Southern Europe, Western countries and Sweden were examined. Country of birth was a significant risk factor for poor self-reported health and psychosomatic complaints, with women from Southern Europe, female refugees and Finnish women being at higher risk in this respect than Swedish women. The increased risk remained significant after adjustment for demographic and socio-economic factors. Swedish-born women, female refugees, and Finnish women reported poorer health and had more psychosomatic complaints (not Finns) in the 1990s than in the 1980s.

Adult↗

PubMed2003

Country of birth, instrumental activities of daily living, self-rated health and mortality: a Swedish population-based survey of people aged 55-74.

There is scant knowledge of the effects of country of birth on the health of individuals in the years prior to and after retirement. The aim of this study was to consider country of birth in relation to health status, instrumental activities of daily living (IADL) and all-cause mortality when adjusted for socioeconomic status (SES). Cross-sectional data were collected between 1986 and 1991 on 8959 individuals between the ages of 55 and 74. Self-reported data were analysed using a logistic regression model while the mortality data were analysed by means of a proportional hazard model. In the present study, immigrants from Southern Europe, Eastern Europe and Finland carried significantly increased risks of poor health even after adjustment for SES. Southern Europeans, refugees from Developing countries and Finns exhibited an increased risk of impaired IADL compared to Swedes, even after adjustment for SES. In conclusion, country of birth was associated with poor health status and impaired IADL. This association remained after adjustment for SES. In accordance with pre-study expectations, mortality was predicted by impaired IADL and male gender. Country of birth was not associated with all-cause mortality.

Activities of Daily Living↗

PubMed2003

Psychosocial working conditions and self-reported long-term illness: a population-based study of Swedish-born and foreign-born employed persons.

BACKGROUND: Knowledge pertaining to the relationship between migration status and psychosocial job characteristics and long-term illness is not readily available in the international literature. The aim of this study is to analyse the cross-sectional associations between high psychological job demands and low decision latitude (high job strain), work-related social support and long-term illness among foreign-born and Swedish-born people. METHODS: The present study combines four annual simple random samples covering 1994-97 from the Swedish Annual Level of Living Survey (SALLS). A sub-sample, including only employed persons and consisting of 10,072 Swedish-born persons, 710 labour migrants and 333 refugees aged 25-64 years, was analysed using logistic regression. RESULTS: Refugees had a higher risk (OR=1.33; 95% CI: 1.05-1.69) of long-term illness than Swedes. Moreover, those experiencing both high job demands and a low decision latitude ran an increased risk (OR=1.74; 95% CI: 1.42-2.13) of long-term illness. About 63% of the refugees among the unskilled/skilled manual workers had low decision latitudes in comparison with 17% of the intermediate and senior salaried employees. There were only small differences in job demands between labour immigrants, refugees and Swedes. There was no interaction between migration status and high job strain. However, refugees with low social support had nearly twice as high a risk of long-term illness as Swedes with high-level work-related social support. CONCLUSIONS: Refugees ran a higher risk of long-term illness than Swedes. Although there were no differences in risk between labour immigrants, refugees and Swedes under job strain, refugees with low work-related social support had a high risk of long-term illness. Unskilled/skilled refugee workers had lower decision latitudes than Swedes.

Adult↗

PubMed2003

Migration status and limiting long-standing illness: a longitudinal study of women of childbearing age in Sweden.

BACKGROUND: Despite a number of studies focusing on the health of immigrants, our knowledge of the risk of limiting long-standing illness (LLSI)) in migrant women of reproductive age is restricted. METHODS: A simple random sample of 5037 Swedish-born and 629 foreign-born women (aged 20-41 at the first occasion) were interviewed over the periods 1983-1990 and 1991-1998. The risk of LLSI was estimated by applying logistic regression for correlated data. RESULTS: First-generation labour-migrant women (OR=1.86) and refugee women (OR=1.75) had an increased risk of LLSI compared to Swedish-born women. The risk decreased only marginally (OR=1.64 and 1.48, respectively) after adjustment for marital status, socio-economic status, feelings of insecurity and the longitudinal effect of age. Women without employment, with a low attained level of education, without children, with feelings of insecurity or poor economic resources showed a high risk of LLSI. Similar results were observed when second-generation women were compared to Swedish-born women. However, immigrant women's health did not deteriorate more than that of Swedish-born women. CONCLUSIONS: First- and second-generation immigrant women of reproductive age had an increased risk of LLSI, compared to their Swedish counterparts. Furthermore, immigrant women's health did not become proportionally worse than the health of Swedish women during the 8-year period.

Adolescent↗

PubMed2002

Identification of population subgroups of children and adolescents with high asthma prevalence: findings from the Third National Health and Nutrition Examination Survey.

OBJECTIVES: To provide national estimates of asthma prevalence in African-American, Mexican American and white (non-Latino) children and adolescents using several common definitions; to evaluate familial, sociodemographic, and environmental risk factors that are independently associated with current asthma in children; and to identify subgroups at particular risk for current asthma using 2 complementary data analytic approaches. DESIGN: Cross-sectional study, using the Third National Health and Nutrition Examination Survey, 1988-1994. SETTING: Eighty-nine mobile examination centers in the United States. PARTICIPANTS: Twelve thousand three hundred eighty-eight African American, Mexican American, and white (non-Latino) children and adolescents, aged 2 months through 16 years, selected from a systematic random, population-based, nationally representative sample. MAIN OUTCOME MEASURE: Current asthma, defined by caregivers who reported that their child currently had doctor-diagnosed asthma. RESULTS: The overall prevalence of current asthma was 6.7% (95% confidence interval [CI], 5.6-7.8). Odds ratios for current asthma from the multiple regression analysis were 4.00 (95% CI, 2.90-5.52) for children with a parental history of asthma or hay fever, 1.94 (95% CI, 1.09-3.46) for children with body mass index (calculated as weight in kilograms divided by the square of height in meters) greater than or equal to the 85th percentile, and 1.64 (95% CI, 1.20-2.26) for children of African American ethnicity. African American and Mexican American children showed a consistent prevalence of current asthma across age while white children showed an increase in prevalence with age. The 2 highest-risk subgroups identified by the signal detection analysis were composed of children with a parental history of asthma or hay fever who were 10 years or older with a body mass index greater than or equal to the 85th percentile (31.0% current asthma), and children with a parental history who were 10 years or younger and of African American ethnicity (15.6% current asthma). CONCLUSIONS: The findings from this analysis show a strong independent association between obesity and current asthma in children and adolescents, and confirm previous reports of a parental history of asthma or hay fever and African American ethnicity as additional important risk factors.

Adolescent↗