Native Swedes Research Articles

The Degree of Self-Sufficiency Among Native Swedes and Immigrants: Over Time, Life Cycle and Depending on Time in Sweden

ABSTRACT Social exclusion and individuals’ self-sufficiency have been on the public agenda in Sweden recently. One reason is the large influx of immigrants to Sweden in 2016. This paper aims to measure self-sufficiency over time, across the life cycle, depending on geographical origin, and time spent in Sweden to provide information about how self-sufficiency has developed over time and across the life cycle. To address the potential problem of lack of self-sufficiency knowledge about its extent and predominance in certain groups is essential. Detailed register data on the entire population in Sweden are used to study the ability to support oneself. Results show that the self-sufficiency rate has improved since 2016, the year Sweden received many immigrants. However, among those who are not self-sufficient, the dependence on the public has increased. There are signs that the welfare state’s redistributive role over the life cycle has decreased over time, both in younger and older ages. Furthermore, the self-sufficiency rate is lower for individuals born outside of Sweden but increases the longer they have resided in Sweden.

Understanding preferences for descriptive political representation among citizens with immigrant background

Today, citizens with an immigrant background make up a large minority in many western democracies. However, we still know little about how this growing group of citizens wants to be represented politically, often due to a simple lack of data. This study overcomes this obstacle by using Facebook ad campaigns to target Swedish citizens with immigrant background directly. In a series of experiments the study shows important similarities between native Swedes and citizens of immigrant origin, with both groups emphasizing substantive representation. The study also reveals substantial heterogeneity within the immigrant group: respondents show no preference for being represented by another immigrant in general. Only a shared immigrant background elicits a positive response, thus cautioning against treating “immigrant background” as a homogenous category. The results also highlight an understudied source of discrimination where respondents with immigrant background show a strong negative reaction against immigrants from certain countries.

Childbearing Across Immigrants and Their Descendants in Sweden: The Role of Generation and Gender

Immigrants and their descendants increasingly shape fertility patterns in European societies. While childbearing among immigrants is well explored, less is known with respect to their descendants. Using Swedish register data, we studied differences in fertility outcomes between first- and second-generation individuals in Sweden and compared with the native Swedish population. We studied men and women separately, distinguished between high- and low-fertility backgrounds, and differentiated whether the descendants of immigrants were offspring from endogamous or exogamous relationships. For most migrants who arrived in Sweden as adults, we found elevated first birth rates shortly after arrival. First birth rates among the second generation were generally close to but lower than the rates observed among native Swedes. Male offspring from exogamous unions with a Swedish-born mother tended to have less depressed rates of first birth than other second-generation individuals. Second birth rates were very similar across population subgroups but generally lower among immigrants and their descendants compared to native Swedes. Third birth rates were often polarized into high- and low-fertility backgrounds, when compared to native Swedes. While fertility patterns among the second generation appeared to drift away from patterns of the first generation, the second generation remained a heterogeneous population subgroup. Nevertheless, and as childbearing patterns of the descendants with one immigrant parent increasingly resembled patterns of native Swedes, exogamous partnerships can likely be considered an important factor behind this gradual family-demographic assimilation process.

Immigrant background, incarceration history and recidivism among adults assessed for illicit substance use severity: Findings from a Swedish registry study

BackgroundIn Sweden, as in other countries, individuals with immigrant backgrounds are disproportionately represented within the incarcerated population. This study examined the association between immigrant background and future incarceration for individuals assessed for illicit substance use severity, while considering their prior incarceration history. MethodsUsing data from Swedish Addiction Severity Index (ASI) assessments linked to register data from Statistics Sweden, we employed Zero-Inflated Negative Binomial (ZINB) regression models to analyse differences in incarceration histories within five years before and after ASI assessments based on immigrant backgrounds. Additionally, Cox proportional-hazard models were used to assess the likelihood of post-assessment incarceration among these groups. ResultsImmigrant background was positively associated with pre- and post-assessment incarceration. First- and second-generation immigrants from the Global South had longer periods of incarceration in the five years before assessments compared to native Swedes. Post-assessment, first-generation immigrants showed longer periods of incarceration. Survival analyses supported these findings, indicating a higher risk of prolonged post-assessment incarceration among all immigrant groups, particularly first-generation immigrants from the Global South. ConclusionAmong individuals assessed for illicit drug use within Swedish municipalities, those with immigrant backgrounds faced higher incarceration risks, even after controlling for substance use severity and prior incarceration. Tailored interventions and support systems are vital to prevent re-entry into the criminal justice system. Timely actions can break re-offending cycles, redirecting paths away from reoffending and towards legal reintegration, thereby reducing incarceration and recidivism rates.

Sarcoidosis in first- and second-generation immigrants: a cohort study of all adults 18years of age and older in Sweden.

There is a lack of studies on sarcoidosis among immigrants, which is of interest as there may be genetic and environmental characteristics affecting immigrants from certain countries. We aimed to study hazard ratios (HRs) of sarcoidosis in first- and second-generation immigrants, comparing them with native Swedes in the total adult Swedish population. We conducted a nationwide study of individuals ≥18y of age. Sarcoidosis was defined as at least two registered diagnoses in the National Patient Register between 1 January 1998 and 31 December 2018. Cox regression analysis was used to estimate HRs with 99% confidence intervals (CIs) of first registration of sarcoidosis in first- and second-generation immigrants compared with native Swedes. The Cox regression models were stratified by sex and adjusted for age, comorbidities and sociodemographic characteristics. In total, 6175251 were included in the first-generation study, with 12617 cases of sarcoidosis, and 4585529 in the second-generation study, with 12126 cases. The overall sarcoidosis risk was lower in foreign-born men (fully adjusted HR 0.63 [99% CI 0.57 to 0.69]) but not in foreign-born women (fully adjusted HR 0.98 [99% CI 0.90 to 1.06]). The overall risk was slightly lower in second-generation immigrants (HR 0.82 [99% CI 0.78 to 0.88]). Women from Asia exhibited a higher risk (HR 1.25 [99% CI 1.02 to 1.53)], while a potential trend was observed among women from Africa (HR 1.47 [99% CI 0.99 to 2.19]). Sarcoidosis risk was lower in foreign-born men but not in women and also lower in second-generation immigrants.

The association of copeptin with metabolic risk markers is modified by region of origin

Iraqi born immigrants in Sweden have higher prevalence of metabolic diseases compared to native Swedes. Copeptin, a marker for vasopressin, is associated with increased risk of metabolic disease. In this cross-sectional population study based on the MEDIM cohort we investigated differences in copeptin levels between Iraqi and Swedish born individuals and if the association between copeptin and cardiometabolic risk markers differed by region of origin. We included 1109 Iraqi and 613 Swedish born participants (58% men, mean age 47 years). The Swedish participants had a higher concentration of copeptin compared to the Iraqi born group after age and sex adjustment (p < 0.001). This difference existed only among male individuals with the highest copeptin concentrations, i.e. belonging to copeptin quartile 4 (median (25th; 75th percentile) 20.07 (15.27;33.28) pmol/L for the Swedish born versus 15.57 (13.91;19.00) pmol/L for the Iraqi born, p < 0.001). We found a significant interaction between copeptin (continuous ln-transformed) and being born in Iraq regarding the association with plasma triglycerides (Pinteraction = 0.006). The association between copeptin and BMI was stronger amongst the Iraqi born individuals compared to the Swedish born. Together, this could indicate that copeptin is a more potent marker of metabolic disease among individuals born in Iraq compared to Sweden.

Educational inequality in cause-specific mortality among immigrants and their descendants in Sweden

Abstract Introduction Although immigrants in Western countries often face disadvantages and vulnerabilities such as lower socioeconomic status, they tend to exhibit weaker educational gradients in mortality compared to the native majority populations. However, it is unclear how these gradients vary across specific causes of death and whether they persist among second-generation immigrants. Therefore, this study aims to investigate educational inequalities in cause-specific mortality among first- and second-generation immigrants compared to the native ancestral population in Sweden. Data &amp; Methods Individual-level analysis was conducted on Swedish register data from 2004 to 2016, including men and women aged 25 to 64. Poisson regression was used to examine the association between the highest educational degree attained and mortality due to circulatory diseases, neoplasms, external causes, self-harm, drug and alcohol use. Results The findings indicated that first-generation immigrants exhibited significantly lower educational inequality in all causes of death compared to native ancestral Swedes. In contrast, second-generation immigrants showed similar degrees of educational inequality in all-cause mortality and mortality due to neoplasms when compared to ancestral Swedes. However, they displayed more pronounced educational inequalities in mortality from external causes, self-harm, and drug use. Conclusions The results highlight that while first-generation immigrants experience lower educational inequality in the considered causes of death, second-generation immigrants show pronounced educational inequalities in avoidable causes of death. This study emphasizes the importance of considering heterogeneity in educational disparities in immigrant mortality and calls for policy interventions to address educational inequalities in second-generation immigrants. Key messages • When compared to the native majority population, first-generation immigrants in Sweden demonstrate lower educational inequality in mortality, regardless of the underlying cause. • Conversely, second-generation immigrants display larger educational inequalities, particularly for mortality caused by preventable factors.

Intermarriage and health: Mortality among Finnish migrants in Sweden by spousal country of birth

Abstract Background Finnish migrants in Sweden experience a mortality disadvantage relative to the native population in part due to health behaviours. Interaction between migrants and natives may lead to a convergence of health behaviours and thereby mortality between the groups. Finnish migrants who are married to a native Swede may thus have mortality rates that are more similar to the Swedish population compared to those married to fellow Finns. Conversely, mortality rates of migrants married to a fellow Finn may more closely resemble those of the population in Finland. Methods We use register data to identify all Finnish migrants aged 40-64 in Sweden in 1999 who were married to a native Swede or a fellow Finn. We identify reference groups in both Sweden and Finland, using a combination of inverse probability weighting and direct matching to adjust for differences in sociodemographic characteristics between the groups. We analyse mortality from all causes, CVD, alcohol and smoking related causes during 2000-2017. Results Compared to Finnish migrant men married to a fellow Finn, migrant men who are married to a native Swede have lower mortality rates, closer to that of the native population of Sweden. This difference is largely explained by sociodemographic characteristics, although lower levels of all-cause and CVD mortality remain after adjustment. By contrast, migrant women married to a native Swede have higher smoking-related mortality, closer to that of native Swedish women. Migrant women married to a fellow Finn have lower smoking-related mortality, closer to that of Finnish-born women in Finland. This pattern is especially pronounced when adjusting for sociodemographic characteristics. Conclusions Being married to a native is associated with lower all-cause and CVD mortality for migrant men and higher smoking-related mortality for migrant women. Depending on gender and risk factor intermarriage can be either protective or detrimental for migrant health. Key messages • The mortality risk of Finnish migrants in Sweden vary by spousal country of birth but if intermarriage is protective or detrimental for health depends on gender and risk factor. • Being married to a native Swede is associated with lower CVD mortality for Finnish migrant men and higher smoking-related mortality for Finnish migrant women.

Assimilation, Acculturation, and Social Integration the Psychological Effect on Mixed Marriage in Sweden: Qualitative Study of Immigrants and Native Swedes

Assimilation, acculturation, and social Integration can have adverse psychological effects on marriage between immigrants and native Swedes. The study was conducted in Sweden. Immigrants in Sweden migrated from different countries and ethnic streams, many of which have different cultural norms and beliefs that may not fit well with the mainstream culture in Sweden. The method used in the study was the qualitative method with a semi-structured interview. Purposive and snowball sampling was used to locate the participants. Thus, this study aims to explore how assimilation, acculturation, and social Integration can psychologically affect mixed marriages between immigrants and native Swedes. Previously study focused on the positive assimilation of immigrants in the labor markets but not assimilation in marriage. Immigrants in Sweden have different families and social, cultural, and religious backgrounds with beliefs and norms that can be hard during the process of Integration, assimilation, and acculturation. The result indicated all the participants expressed positive and negative emotions that contributed to the conflict in their marriage during the assimilation, acculturation, and Social Integration process. These negative emotions of scary, worst pain, divorce sucks, gamophobia, bad, and subjection of children to the tragic scene, shameful thing influence mental health and is not a good thing. The results also indicate motivation, cultural beliefs, attitudes, and behavior after divorce. The finding will give awareness during the assimilation, acculturation, and social Integration; most immigrants may gradually lose all the markers, such as language, food, and customs.

Psychosocial Variables Influencing Divorce in Marriages Involving Swedish Immigrants and Native Swedes

This study aimed to explore the perceptions and experiences of divorced Swedish immigrants previously married to Swedish natives through the lenses of their cultural beliefs. Literature in thematic areas was reviewed. For the methodology, the grounded theory was adopted to provide the theoretical underpinning for the study, and the researcher used a qualitative research approach with a semi-structured interview with open-ended questions. Purposive and snowball sampling techniques were used to identify and recruit the participants. The research was conducted in three Swedish cities: Lund, Malm&amp;ouml;, and Karlstad. The participants consisted of ten different immigrant men and women. The ages of participants ranged from 26 to 58 years. The participants were limited to immigrants who were married to Swedish natives but are now divorced. They were married for more than 2 years and divorced for more than 5 years. The result revealed that attitude change, communication, abuse, controlling behavior, &amp;lsquo;studying each other,&amp;rsquo; cultural acceptance, accommodating each other, and traumatic experiences are associated with the high divorce rates in marriages between Swedish immigrants and native Swedes, as opposed to the comparatively lower divorce rates found in marriages between Swedish-born citizens. It can be challenging when immigrants and native Swedes who are married hold on to their cultural norms and beliefs. The findings will help enlighten would-be spouses on the need to familiarize themselves with the cultural values of their would-be partners before they get into marriage and adds insight into the pattern of divorce commonly experienced among immigrants in Sweden.

Quantitative myocardial perfusion during stress using CMR is impaired in healthy Middle Eastern immigrants without CV risk factors

Middle Eastern immigrants constitute a growing proportion of the European population and compared to native Swedes are more insulin resistant, which can contribute to atherosclerosis. Quantitative first pass perfusion (qFPP) using cardiovascular magnetic resonance (CMR) can detect early signs of cardiovascular disease (CVD). The aim was to study if myocardial perfusion differs between healthy male Middle Eastern immigrants and native male Swedes. Eighteen Iraqi- and twelve Swedish born controls, all males, never smokers with no CVD risk factors were included. Global myocardial perfusion at rest and stress was assessed using qFPP and by phase-contrast CMR imaging of coronary sinus flow. Quantitative first pass perfusion analysis (mean ± SD) demonstrated no difference at rest between Iraqi and Swedish males (0.8 ± 0.2 vs 1.0 ± 0.4 ml/min/g, P = 0.38) but lower perfusion during adenosine in Iraqi males (2.9 ± 0.7 vs 3.5 ± 0.7 ml/min/g, P = 0.02). Myocardial perfusion assessed by coronary sinus flow demonstrated similar results with no difference in resting perfusion between groups (0.7 ± 0.2 vs 0.8 ± 0.2 ml/min/g, P = 0.21) but a lower perfusion during adenosine in the Iraqi group (3.0 ± 0.2 vs 3.7 ± 0.6 ml/min/g, P = 0.01. Myocardial perfusion during adenosine stress was lower in healthy Iraqi immigrants compared to Swedish controls suggesting impaired microvascular function and risk of underestimating CVD risk in healthy individuals of Middle Eastern origin.

Mortality Advantage Reversed: The Causes of Death Driving All-Cause Mortality Differentials Between Immigrants, the Descendants of Immigrants and Ancestral Natives in Sweden, 1997–2016

A small but growing body of studies have documented the alarming mortality situation of adult descendants of migrants in a number of European countries. Nearly all of them have focused on all-cause mortality to reveal these important health inequalities. This paper takes advantage of the Swedish population registers to study all-cause and cause-specific mortality among men and women aged 15–44 in Sweden from 1997 to 2016 to a level of granularity unparalleled elsewhere. It adopts a multi-generation, multi-origin and multi-cause-of-death approach. Using extended, competing-risks survival models, it aims to show (1) how the all-cause mortality of immigrants arriving as adults (the G1), immigrants arriving as children (the G1.5) and children of immigrants born in Sweden to at least one immigrant parent (the G2) differs versus ancestral Swedes and (2) what causes-of-deaths drive these differentials. For all-cause mortality, most G1 (not Finns or Sub-Saharan Africans) have a mortality advantage. This contrasts with a near systematic reversal in the mortality of the G1.5 and G2 (notably among men), which is driven by excess accident and injury, suicide, substance use and other external cause mortality. Given that external causes-of-death are preventable and avoidable, the findings raise questions about integration processes, the levels of inequality immigrant populations are exposed to in Sweden and ultimately, whether the legacy of immigration has been positive. Strengths of the study include the use of quality data and advanced methods, the granularity of the estimates, and the provision of evidence that highlights the precarious mortality situation of the seldom-studied G1.5.

Insulin secretion and action with increasing age - A comparison between Middle Eastern immigrants and native Swedes

AimsLittle is known how insulin secretion and action change over time in populations of different ethnicities. We studied changes in insulin secretion and action with increasing age in Iraqi-born immigrants and native Swedes, and investigated if the changes were modified by region of origin. MethodsResidents of Malmö, 30–75 years of age born in Iraq or Sweden, were invited to participate in this population-based, cross-sectional study. Health examination, medical history, lifestyle, sociodemographic data, and fasting blood samples were assessed. Oral glucose tolerance tests were performed and insulin secretion (disposition index, DIo) and insulin sensitivity index (ISI) calculated using the Matsuda indices. ResultsIn total 1881 people participated; 1193 Iraqi- and 688 Swedish born. DIo decreased with increasing age in the total study population (β for the effect of age on ln DIo: -0.018, 95% CI -0.023 to -0.013, P < 0.001), adjusted for origin, lifestyle and anthropometric measures. DIo was generally lower in Iraqis vs. Swedes (median: 12,712.9 vs. 14,659.2, P = 0.004), but the difference disappeared when adjusted for BMI.Further, ISI declined with increasing age in both Iraqis and Swedes. ISI was generally lower among Iraqis compared to Swedes, (median: 76.9 vs. 102.3, p < .001). The difference could not be fully explained by age, sex, lifestyle, and anthropometric measures. No significant interactions were observed. ConclusionsThe levels of DIo and ISI were lower among Iraqis compared to Swedes and declined with increasing age, irrespective of origin.

Is an elevated family-genetic risk for major psychiatric disorders specific to creative occupations?

Despite a large descriptive literature linking creativity and risk for psychiatric illness, the magnitude and specificity of this relationship remain controversial. We examined, in 1 137 354 native Swedes with one of 59 3-digit official and objective occupational codes in managerial and educated classes, their familial genetic risk score (FGRS) for ten major disorders, calculated from 1st through 5th degree relatives. Mean FGRS across disorders were calculated, in 3- and 4-digit occupational groups, and then controlled for those whose disorder onset preceded occupational choice. Using sequential analyses, p values were evaluated using Bonferroni correction. 3-digit professions considered to reflect creativity (e.g. 'artists' and 'authors') were among those with statistically significant elevations of FGRS. Among more specific 4-digit codes, visual artists, actors, and authors stood out with elevated genetic risks, highest for major depression (MD), anxiety disorders (AD) and OCD, more modest for bipolar disorders (BD) and schizophrenia and, for authors, for drug and alcohol use disorders. However, equal or greater elevations in FGRS across disorders were seen for religious (e.g. ministers), helping (e.g. psychologists, social workers), and teaching/academic occupations (e.g. professors). The potential pathway from FGRS → Disorder → Occupation accounts for a modest proportion of the signal, largely for MD and AD risk. While traditional creative occupations were associated with elevated genetic risk for a range of psychiatric disorders, this association was not unique, as similar, or greater elevations were seen for religious, helping and teaching professions and was stronger for internalizing than psychotic disorders.

Narcolepsy among first- and second-generation immigrants in Sweden: A study of the total population.

AimsTo study incident narcolepsy in first‐ and second‐generation immigrant groups using Swedish‐born individuals and native Swedes as referents.MethodsThe study population included all individuals registered and alive in Sweden at baseline. Narcolepsy was defined as having at least one registered diagnosis of narcolepsy in the Swedish National Patient Register. The incidence of narcolepsy in different immigrant groups was assessed by Cox regression, with hazard ratios (HRs) and 95% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, co‐morbidities, and neighbourhood socioeconomic status.ResultsIn the first‐generation study, 1225 narcolepsy cases were found; 465 males and 760 females, and in the second‐generation study, 1710 cases, 702 males and 1008 females. Fully adjusted HRs (95% CI) in the first‐generation study was for males 0.83 (0.61–1.13) and females 0.83 (0.64–1.07), and in the second‐generation study for males 0.76 (0.60–0.95) and females 0.91 (95% CI 0.76–1.09). Statistically significant excess risks of narcolepsy were found in first‐generation males from North America, and second‐generation males with parents from North America, and second‐generation females with parents from Latin America.ConclusionsThere were only significant differences in incident narcolepsy between native Swedes and second‐generation male immigrants. The observed differences can partly be explained by differences in Pandemrix® vaccinations and are probably not attributable to genetic differences between immigrants and natives.

Status inconsistency and return to work among foreign-born and native Swedes

&#x0D; We investigated potential differences in status inconsistency and time to return to work (RTW) from sickness absence between foreign-born and native Swedes, whether inconsistency was associated with RTW, and if this association was stronger for foreign-borns than natives. Significantly fewer native than foreign-born Swedes reported negative status inconsistency, but RTW did not differ between the groups and inconsistency was not associated with RTW. A positive selection of individuals to the Swedish labour market might help explain the findings. This first study of status inconcistency and RTW requires follow-ups in different settings of labour markets and insurance regulations.&#x0D;

Earnings dynamics of immigrants and natives in Sweden 1985–2016

This paper analyzes earnings inequality and earnings dynamics in Sweden over 1985–2016. The deep recession in the early 1990s marks a historic turning point with a massive increase in earnings inequality and earnings volatility, and the impact of the recession and the recovery from it lasted for decades. In the aftermath of the recession, we find steady growth in real earnings across the entire distribution for men and women and decreasing inequality over more than 20 years. Despite the positive trend, large gender differences in earnings dynamics persist. While earnings growth for men is more closely tied to the business cycle, women face much higher volatility overall. Earnings volatility is also substantially higher among foreign‐born workers, reflecting weaker labor market attachment and high risk of large negative shocks for low‐income immigrants. We document an important role of social benefits usage for the overall trends and for differences across subpopulations. Higher benefits enrollment, especially for women and immigrants, is associated with higher earnings volatility. As the generosity and usage of benefit programs declined over time, we find stronger earnings growth among low‐income workers, consistent with higher self‐sufficiency.

Trends in alcohol intoxication among native and immigrant youth in Sweden, 1999-2017: A comparison across family structure and parental employment status.

Developing a better understanding of drinking patterns across immigrant generations and how these change over time is important for the development of effective alcohol polices. This study investigates the direction and rate of change in youth alcohol intoxication over time, based on immigrant status, and by family structure and parental employment status. The study is based on eight nationally representative school surveys conducted by the Swedish National Council for Crime Prevention between 1999 and 2017, with a combined sample of 50,657 adolescents. Group by time interactions were examined to compare rates of change of alcohol intoxication over time across immigrant generations. The results show a decreasing trend in alcohol intoxication among both first and second generation immigrant youth, and also among immigrant youth across different family structures and parental employment statuses. The results also show that the decrease in alcohol intoxication over time is greater for youths born abroad and for youths with two immigrant parents than for native Swedes, and that the decrease over time is greater for youths from intact families than for native Swedish youths from non-intact families and youths with one immigrant parent. Native and first- and second-generation immigrant youth may differ substantially from one another in many ways, and may therefore manifest different patterns of drinking behaviours. From a policy and prevention perspective, the data in this study imply that native youths and youths with one immigrant parent should be a central target group for alcohol prevention policy in Sweden.

Pro-Enkephalin and its association with renal function in Middle Eastern immigrants and native Swedes

Iraqi-born immigrants residing in Sweden exhibit lower blood pressure as well as better renal function despite an overall worse metabolic risk profile in comparison with native Swedes. This may indicate the presence of cardiorenal protective mechanisms in the Middle Eastern population. Hence, the aim of this study was to investigate whether the association between renal function and Pro-Enkephalin (PENK), a biomarker predictive of both acute and chronic kidney dysfunction, differs across ethnicities. The MEDIM population-based study including a cohort of women and men, born in Iraq or Sweden, aged 30–75 years was conducted in Malmö, Sweden, from 2010 to 2012. The study included fasting blood samples, physical examinations and self-administrated questionnaires. Despite significantly better renal function assessed by creatinine-based eGFR in the Iraqi group, levels of PENK did not differ between the groups, (70.0 pmol/L, born in Iraq (n = 1263) vs 71.1, born in Sweden (n = 689), p = .4). However, the association between PENK and renal function was relatively weaker in the Iraqi born group, as supported by a significant interaction between PENK and country of birth (P Interaction= Country of birth x PENK = 0,010). This observational study suggests that the association between renal function and PENK was weaker in Middle Eastern immigrants. This is of interest as PENK may exhibit a direct effect on renal function, however further research is needed including studies on causality.

Alcohol use disorder and non-fatal suicide attempt: findings from a Swedish National Cohort Study.

Alcohol use disorder (AUD) is associated with increased risk of non-fatal suicide attempt. We aimed to measure the strength and mechanistic nature of the association between AUD and increased suicide attempt and determine any causal pathways and/or shared risk factors. We used Cox proportional hazards models in population-level and co-relative analyses to evaluate the risk of first non-fatal suicide attempt as a function of previous AUD. We used continuously updated longitudinal nationwide Swedish registry data on native Swedes born from 1950 to 1970 (n=2 229 619) and followed from age 15 until 2012. AUD and suicide attempt were identified using International Classification of Diseases (ICD)-8, ICD-9, and ICD-10 codes. AUD was also identified using pharmacy and criminal records. Genetic and family environmental risks were derived based on relatedness via the Multi-Generation Register and shared residency via the Population and Housing Census and the Total Population Register. AUD was robustly associated with suicide attempt in crude models (hazard ratio [HR]=15.24 [95% CI: 14.92, 15.56]). In models adjusted for sociodemographic factors and psychiatric comorbidity, the association was attenuated: for women, HRs declined gradually across time, ranging from 5.55 (3.72, 8.29) during the observation period that ranged from age 15 to 19years to 1.77 (1.65, 1.90) at age 40 or older. For men, the corresponding figures were 6.12 (4.07, 9.19) and 1.83 (1.72, 1.94); in contrast to women, risk of suicide attempt among men increased from age 15 to 29 before declining. In co-relative models, a residual association remained, consistent with a causal path from AUD to suicide attempt. In Sweden, alcohol use disorder appears to be an important predictor of suicide attempt even in the context of other psychiatric disorders. The observed association is likely the result of features that jointly impact risk of alcohol use disorder and suicide attempts (genetic liability, psychiatric illness, and childhood stressors) and a potentially causal pathway, acting independently or in conjunction with one another.