Native Swedes Research Articles

Lung cancer among native and foreign-born Swedes: histopathology, treatment, and survival

Background: Lung cancer (LC) is the leading cause of cancer-related death worldwide, including Sweden. Several studies have shown that socioeconomic status affects the risk, treatment, and survival of LC. Due to immigration after Second World War, foreign-born people constitute 12.5% of the Swedish population. We wanted to investigate if there were any differences in LC management, treatment and survival among the foreign-born Swedes (FBS) compared to the native Swedish population (NatS) in Stockholm.Material and methods: A retrospective analysis of all patients diagnosed with non-small cell lung cancer (NSCLC) at the Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna from 1 January 2003 to 31 December 2008 was made. In all, 2041 cases of LC were diagnosed, thereof 1803 with NSCLC. Of these, 211 (11.7%) were FBS.Results: The mean age of NatS and FBS patients was 69.9 years, median 70 (range 26–96) and 66.0 years, median 66 (range 38–94), respectively (p < 0.001). In all, 89.8% of NatS and 90.0% of FBS were either smokers or former smokers. Adenocarcinoma was the most common subtype in both groups (NatS 54.7%, FBS 48.3%). In 140 (8.8%) of the NatS and 17 (8.1%) of the FBS the diagnosis was clinical only. There were no significant differences in stage at diagnosis, nor in performance status (PS) or different therapies between the groups. The median overall survival time for the NatS was 272 days and for FBS 328 days, again no significant difference. However, the median overall survival time for female NatS was 318 days and for female FBS 681 days (p = 0.002).Conclusion: FBS patients were significantly younger than NatS at diagnosis, and female FBS lived longer than female NatS, but otherwise there were no significant differences between NatS and FBS patients with LC regarding diagnosis, treatment, and survival.

Dynamics of employment assimilation

Abstract This paper investigates the dynamics of immigrants’ employment assimilation in comparison with the standard static assimilation model. When the effect of past employment experience on current employment possibilities differs between immigrants and natives, then the static assimilation model might produce biased and unrealistic predictions of the relative employment probabilities of immigrants. Using a high-quality panel dataset collected in Sweden and a state-of-the-art non-linear dynamic assimilation model, we find a large employment status persistence that substantially differs between immigrants and native Swedes. We show that failing to control for the differential past labor market experience leads to an incorrect account of the host country-specific human capital that results to a large overestimation (underestimation) of the short-run (long-run) marginal assimilation rates when using the standard static assimilation model. JEL Classification: C33, J15, J61

Experiences and preferences of care among Swedish immigrants following a prenatal diagnosis of congenital heart defect in the fetus: a qualitative interview study.

BackgroundImmigrants experience significant challenges when in contact with healthcare and report less satisfaction with maternity care compared to native Swedes. Research that gives voice to pregnant immigrant women and their partners following a prenatal diagnosis of a fetal anomaly is scarce. Thus, the aim of this study was to explore experiences and preferences of care following a prenatal diagnosis of congenital heart defect among Swedish immigrants.MethodsPregnant immigrants and their partners were consecutively recruited following a prenatal diagnosis of a congenital heart defect in the fetus. Nine respondents were interviewed in five interviews, four with the aid of a professional interpreter. The material was analyzed using manifest qualitative content analysis.ResultsThe analysis resulted in five categories: 1) “Trustworthy information”, 2) “Language barriers”, 3) “Psychosocial situation”, 4) “Peer support”, and 5) “Religious positions”.ConclusionThe potential need for interpreter services, visual information, psychosocial support, coordination with welfare officers, and respect for religious positions about termination of pregnancy are all important aspects for health professionals to consider when consulting immigrants faced with a prenatal diagnosis of fetal anomaly in the fetus. Peer support within this context needs to be further explored in future studies.

Partner Choice in Sweden Following a Failed Intermarriage.

This paper is based on the assumption that divorced and separated individuals bring with them the experience of a failed union which may shape their future choices on the marriage market. It aims to contribute to our knowledge of intermarriage, and social interaction in Sweden in general, by comparing the repartnering choices of immigrants and natives in Sweden who had made what is still considered an atypical choice of entering a native-immigrant union with the partner choices of natives and immigrants whose previous union was endogamous. The empirical analysis in this paper is based on the Swedish register data from the STAR data collection (Sweden over Time: Activities and Relations) and covers the period 1990-2007. All the analyses in the paper include individuals aged 20-55 at the time of union dissolution. The multivariate analysis is based on discrete-time multinomial logistic regression. The results show that for all four groups defined by sex and nativity (native men, native women, immigrant men, and immigrant women), there is a positive association between the previous experience of intermarriage and the likelihood of initiating another intermarriage after union dissolution. Another important finding is that the magnitude of this positive association increases with the degree of social distance between the groups involved in the union. Gender differences are modest among natives and somewhat more pronounced among immigrants.

Discrimination in the Credit Market? Access to Financial Capital among Self‐employed Immigrants

SummaryWe present results from a unique combination of survey and register data regarding access to financial capital conducted among immigrants who are self‐employed in private firms in Sweden's retail, trade, and service sectors. This study is the first to examine discrimination against self‐employed immigrants in the credit market of a developed economy outside the US. The results demonstrate that non‐European immigrants consider access to financial capital a more serious impediment to their self‐employment activities than do native Swedes and European immigrants. Self‐employed non‐European immigrants report more discrimination by banks, suppliers, and customers than do natives and immigrants from European countries. Immigrant‐owned firms apply for bank loans to a larger extent than do firms owned by natives. Non‐European immigrants especially are more likely than natives to have a loan denied, and they are also charged higher interest rates on their bank loans than natives. The results are robust to various different robustness checks. The occurrence of ethnic discrimination in the market for bank loans is put forward as an explanation for these results. Limited or lack of access to financial capital is a major obstacle to self‐employment among certain immigrant groups. This obstacle may be one explanation for the high exit rates from self‐employment among immigrants, a finding that has been documented in several countries including Sweden.

Origin and schizophrenia in young refugees and inter-country adoptees from Latin America and East Africa in Sweden: a comparative study.

BackgroundMigrants’ socioeconomic adversity has been linked to schizophrenia.AimsTo investigate whether the more favourable socioeconomic situation of adoptees prevents them from the high risk of schizophrenia found in other migrants.MethodRegister study in a cohort of refugees and inter-country adoptees aged 16–40 years, born in East Africa (n=8389), Latin America (n=11 572) and 1.2 million native Swedes. Cox-regression models estimated hazard ratios (HRs) of schizophrenia in data from psychiatric care.ResultsDespite diverse income levels, HRs for schizophrenia were similar for refugees and adoptees, with East Africans having the highest HRs: 5.83 (3.30–10.27) and 5.80 (5.03–6.70), followed by Latin Americans: HRs 3.09 (2.49–3.83) and 2.31 (1.79–2.97), compared with native Swedes. Adjustment for income decreased these risks slightly for refugees, but not for adoptees.ConclusionsThis study suggests that risk factors associated with origin are more important determinants of schizophrenia than socioeconomic adversity in the country of settlement.Declaration of interestNone.Copyright and usage© 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Attitudes Regarding Participation in a Diabetes Screening Test among an Assyrian Immigrant Population in Sweden.

Immigrants from the Middle East have higher prevalence and incidence of type 2 diabetes (T2D) compared with native Swedes. The aim of the study was to describe and understand health beliefs in relation to T2D as well as attitudes regarding participation in a screening process in a local group of Assyrian immigrants living in Sweden. A qualitative and quantitative method was chosen in which 43 individuals participated in a health check-up and 13 agreed to be interviewed. Interviews were conducted, anthropometric measurements and blood tests were collected, and an oral glucose tolerance test was performed. In total, 13 of the 43 participants were diagnosed with impaired glucose metabolism, 4 of these 13 had TD2. The interviewed participants perceived that screening was an opportunity to discover more about their health and to care for themselves and their families. Nevertheless, they were not necessarily committed to taking action as a consequence of the screening. Instead, they professed that their health was not solely in their own hands and that they felt safe that God would provide for them. Assyrians' background and religion affect their health beliefs and willingness to participate in screening for TD2.

Association Between Socioeconomic Status and Mortality, Cardiovascular Disease, and Cancer in Patients With Type 2 Diabetes.

The association between socioeconomic status and survival based on all-cause, cardiovascular (CV), diabetes-related, and cancer mortality in type 2 diabetes has not been examined in a setting of persons with equitable access to health care with adjustment for important confounders. To determine whether income, educational level, marital status, and country of birth are independently associated with all-cause, CV, diabetes-related, and cancer mortality in persons with type 2 diabetes. A study including all 217 364 individuals younger than 70 years with type 2 diabetes in the Sweden National Diabetes Register (January 1, 2003, to December 31, 2010) who were monitored through December 31, 2012, was conducted. A Cox proportional hazards regression model with up to 17 covariates was used for analysis. All-cause, CV, diabetes-related, and cancer mortality. Of the 217 364 persons included in the study, mean (SD) age was 58.3 (9.3) years and 130 839 of the population (60.2%) was male. There were a total of 19 105 all-cause deaths with 11 423 (59.8%), 6984 (36.6%), and 6438 (33.7%) CV, diabetes-related, or cancer deaths, respectively. Compared with being single, hazard ratios (HRs) for married individuals, determined using fully adjusted models, for all-cause, CV, and diabetes-related mortality were 0.73 (95% CI, 0.70-0.77), 0.67 (95% CI, 0.63-0.71), and 0.62 (95% CI, 0.57-0.67), respectively. Marital status was not associated with overall cancer mortality, but married men had a 33% lower risk of prostate cancer mortality compared with single men, with an HR of 0.67 (95% CI, 0.50-0.90). Comparison of HRs for the lowest vs highest income quintiles for all-cause, CV, diabetes-related, and cancer mortality were 1.71 (95% CI, 1.60-1.83), 1.87 (95% CI, 1.72-2.05), 1.80 (95% CI, 1.61-2.01), and 1.28 (95% CI, 1.14-1.44), respectively. Compared with native Swedes, HRs for all-cause, CV, diabetes-related, and cancer mortality for non-Western immigrants were 0.55 (95% CI, 0.48-0.63), 0.46 (95% CI, 0.38-0.56), 0.38 (95% CI, 0.29-0.49), and 0.72 (95% CI, 0.58-0.88), respectively, and these HRs were virtually unaffected by covariate adjustment. Hazard ratios for those with a college/university degree compared with 9 years or less of education were 0.85 (95% CI, 0.80-0.90), 0.84 (95% CI, 0.78-0.91), and 0.84 (95% CI, 0.76-0.93) for all-cause, CV, and cancer mortality, respectively. Independent of risk factors, access to health care, and use of health care, socioeconomic status is a powerful predictor of all-cause and CV mortality but was not as strong as a predictor of death from cancer.

Exposure to different lengths of sick leave and subsequent work absence among young adults.

BackgroundSweden has a public and easily accessible sickness insurance. Research shows, however, downsides to taking sick leave. Both short and longer periods of sick leave have been seen to increase the risk for subsequent work absence. The aim of this study was to investigate whether there was an association between sick leave claimed in 1993 and work absence in the subsequent 15 years, i.e. up to 2008. A further aim was to explore differences in this relation with regard to gender, origin and educational level at baseline.MethodsOur cohort consisted of all immigrants aged 21–25 years in Sweden in 1993 and a control group of native Swedes in the same age group.ResultsSubsequent work absence increased from 313 days among persons with no days of claimed sick leave in 1993 to 567 days among persons with 1–7 days of claimed sick leave in 1993. Thereafter there was a lower, but steady increase in days of future work absence, to 611 days among persons with 8–14 days of sick leave claimed in 1993. There was an interaction between sick leave and gender, education and origin respectively regarding later work absence.ConclusionPeriods of sick leave claimed were associated with subsequent work absence. Immigrants, women and persons with low education had the most risk of future work absence after a period of sick leave.

Length of accumulated sick leave and later work absence

The aim of this register-based longitudinal study was to explore the relationship between exposure to unemployment and sick leave at a young age and later health and work related outcomes. A comparison was also made between immigrants and native Swedes. The study population consisted of all immigrants, born between 1968 and 1972, and a random sample of native Swedes in the same age range. The follow-up period was 15 years, divided into three 5-year periods. Unemployment in 1992 was associated with later ≥60 days of sickness absence, disability pension and, for all subjects except native Swedish women, also mortality during follow-up. The risk of future sickness absence was about the same in all three follow-up periods. There was an increased risk of ≥100 days of unemployment in all three follow-up periods, but the risk declined, however, until the last follow-up period. Higher level of education at baseline as well as education attained between 1993 and 1997 decreased the risk of future unemployment. Participating in active labour market programmes was associated with higher risk of future unemployment. The risk of both future unemployment and future sickness absence increased with the length of unemployment in 1992. Immigrants had a higher risk of unemployment both at baseline and at follow-up compared with native Swedes, but matched the pattern of native Swedes during follow-up. Exposure to ≥60 days of sickness absence in 1993 was associated with increased risk for ≥60 days of sickness absence, ≥100 days of unemployment, disability pension and mortality during follow-up compared with no sick leave at baseline. The income from work, during the follow-up period, among individuals with spells of sick leave ≥60 days in 1993 was around two-thirds of that of individuals not on >60 days of sick leave. There was a rapid increase in future work absence for the first 1–7 days of sick leave claimed. Thereafter there was a lower, but steady increase in days of future work absence for every increase in sick leave. This of course affects the individual in the first place and to a society it means substantial costs in the form of increased welfare payments, and loss of productivity and tax income.

Patterns of Psycho-Social Distress Among Ageing Swedes

This paper examines psycho-social distress among middle-aged and elderly Swedes. We analysed data on 3221 individuals who were 55 to 99 years old. Based on a latent class analysis, we identified four latent classes. Two classes were associated with higher levels of psycho-social problem accumulation. The class with the lowest level of problem accumulation contained the greatest number of individuals, whereas the classes with the highest level of psycho-social distress contained the least number of individuals. The analysis showed that being a man, being married, being a native Swede, or having several hobbies was associated with a low likelihood of belonging to a latent class that was characterised by psycho-social distress. Moreover, being a woman, being between 55 and 65 years of age, or being a widow was associated with a high likelihood of belonging to a latent class that was characterised by the highest levels of problem accumulation.

Age Differences Between Spouses: Sociodemographic Variation and Selection

Throughout the world, marriages in which the husband is older than his wife are more common than same-age and women-older marriages. Yet there is surprisingly little systematic knowledge about within-country variation in spousal age differences. This study used comprehensive Swedish register data to investigate how age differences in newly married couples were associated with spouses' age, gender, education, income, and birthplace. Among both women and men, small age differences were most common among the highly educated, high-income earners, and native Swedes, whereas persons with low education, low income, and non-Swedish origin more often entered marriages with large age differences, particularly men-older marriages. Findings are discussed in relation to theoretical attempts to explain spousal age differences and sociodemographic selection into couples with different age relationships.

Impact of ethnicity on progress of glycaemic control in 131 935 newly diagnosed patients with type 2 diabetes: a nationwide observational study from the Swedish National Diabetes Register

ObjectivesStudies on ethnic disparities in glycaemic control have been contradictory, and compromised by excessively broad categories of ethnicity and inadequate adjustment for socioeconomic differences. We aimed to study the effect...

Mortality in adult offspring of immigrants: a Swedish national cohort study.

BackgroundHigher risks of psychiatric disorders and lower-than-average subjective health in adulthood have been demonstrated in offspring of immigrants in Sweden compared with offspring of native Swedes, and linked to relative socioeconomic disadvantage. The present study investigated mortality rates in relation to this inequity from a gender perspective.MethodsWe used data from national registers covering the entire Swedish population aged 18-65 years. Offspring of foreign-born parents who were either Swedish born or had received residency in Sweden before school age (<7 years) were defined as “offspring of immigrants.” We used Cox regression models to examine the association between parental country of birth and mortality between 1990 and 2008, with adjustment for education, income, age and family type.ResultsMale offspring of immigrants from the Middle East (HR:2.00, CI:1.66-2.26), other non-European countries (HR:1.80, CI:1.36-2.36) and Finland (HR:1.56, CI:1.48-1.65) showed an age-adjusted excess mortality risk from all causes of death when compared to offspring with Swedish-born parents. Income, but not education, greatly attenuated these increased mortality risks. No excess mortality rates were found among female offspring of immigrants, with the exception of external cause of death among offspring of Finnish immigrants.ConclusionThe study demonstrates high mortality rates in male offspring of immigrants from Finland and non-European countries that are associated with economic, but not educational, disadvantage. No increased mortality rates were found among female offspring of immigrants. Future studies are needed to explain this gender differential and why income, but not education, predicts mortality in male offspring of immigrants.

Vigorous Physical Activity May Be Important for the Insulin Sensitivity in Immigrants from the Middle East and Native Swedes

Purpose: To compare physical activity measures and their associations with insulin sensitivity, β-cell function and body mass index (BMI) between Iraqi immigrants and native Swedes. Methods: A cross-sectional study of 493 Iraqis (58% men) and 469 Swedes (54% men) aged 30 to 75 years living in the city of Malmö, Sweden. Accelerometry was used for physical activity measures (sedentary time, breaks in sedentary time, moderate and vigorous physical activity, total counts). Insulin sensitivity index and oral disposal index were determined from an oral glucose tolerance test and BMI by body weight and height. Results: Iraqi men were less physically active than Swedish men, while the physical activity was more similar in the women. BMI was a strong predictor of insulin sensitivity and β-cell function and frequently associated with the physical activity measures. BMI modified the associations of insulin sensitivity and β-cell function with the physical activity measures to such extent that only VPA and total counts show direct associations with insulin sensitivity in addition to the indirect associations via BMI. Iraqi women demonstrated weaker associations compared with Swedish women. Conclusions: Physical activity and performed at vigorous intensity may be important mainly for the insulin sensitivity in Iraqi immigrants and native Swedes.

Sickness absence at a young age and later sickness absence, disability pension, death, unemployment and income in native Swedes and immigrants.

Background: Sickness absence with cash benefits from the sickness insurance gives an opportunity to be relieved from work without losing financial security. There are, however, downsides to taking sickness absence. Periods of sickness absence, even short ones, can increase the risk for future spells of sickness absence and unemployment. The sickness period may in itself have a detrimental effect on health. The aim of the study was to investigate if there is an association between exposure to sickness absence at a young age and later sickness absence, disability pension, death, unemployment and income from work. Methods: Our cohort consisted of all immigrants aged 21–25 years in Sweden in 1993 (N = 38 207) and a control group of native Swedes in the same age group (N = 225 977). We measured exposure to sickness absence in 1993 with a follow-up period of 15 years. We conducted separate analyses for men and women, and for immigrants and native Swedes. Results: Exposure to ≥60 days of sickness absence in 1993 increased the risk of sickness absence [hazard ratio (HR) 1.6–11.4], unemployment (HR 1.1–1.2), disability pension (HR 1.2–5.3) and death (HR 1.2–3.5). The income from work, during the follow-up period, among individuals with spells of sick leave for ≥60 days in 1993 was around two-thirds of that of the working population who did not take sick leave. Conclusions: Individuals on sickness absence had an increased risk for work absence, death and lower future income.

Accumulation and Persistence of Welfare Problems over Time

This paper uses longitudinal Swedish data and investigates the accumulation and persistence of welfare problems over time. The data set was compiled in a first wave in 1979, a second wave in 1986–1987, a third wave in 1994–1995, and a fourth wave in 2002–2003 (N = 7,967). First, the results demonstrate that all welfare problems have a tendency to become persistent. For example, the probability of suffering from the lack of a close friend in the fourth wave was 57.1 % if the individual suffered from this welfare problem in the third wave. Second, economic problems constituted the welfare problem with the most associations with other welfare problems. Third, the accumulation of welfare problems significantly differed between different categories of individuals. For example, the accumulation of welfare problems was higher in men compared with women, immigrants compared with native Swedes, single individuals compared with individuals in couples, and poorly educated individuals compared with highly educated individuals. Finally, longitudinal analyses indicated individuals in certain categories have experienced cumulative disadvantages in welfare even during periods when individuals in other categories have experienced a positive trend in welfare. One such example is single parents during the period between 1979 and 1986–1987.

Ethnic concentration and economic outcomes of natives and second-generation immigrants

Purpose – The purpose of this paper is to investigate the link between childhood neighbourhood ethnic composition and short- and long-run economic outcomes of second-generation immigrants and natives in Sweden. Design/methodology/approach – The author uses Swedish longitudinal register data and apply regression analysis methods to investigate the correlation between three ethnic neighbourhood variables(share of immigrants, share of immigrants with the same ethnic background and share of immigrants with other descent) in childhood with short- and long-run economic outcomes (earnings, unemployment, reliance on social assistance and educational attainment). Findings – The results show that second-generation immigrants raised in immigrant-dense neighbourhoods have a lower probability to continue to higher education, whereas, their earnings, unemployment and social assistance tendencies are unaffected. On the contrary, natives’ earnings and educational attainment are negatively correlated with, and the probability of social assistance and unemployment are positively associated with a high immigrant concentration. Moreover, the social assistance and unemployment of non-Nordic second-generation immigrants appears to be negatively correlated with the neighbourhood share of co-ethnics and positively correlated with the neighbourhood proportion of other ethnic groups. Overall, the author finds that the results are very similar in the short and long run. Originality/value – This paper expands the literature on children and ethnic segregation and in contrast to earlier research in this context, it focuses on second-generation immigrants and their performance in comparison to natives. This study contributes to this research area by investigating a large variety of outcomes, looking at both immigrant, own ethnic group and other ethnic group concentration and including both short- and long-run correlations.

Where Do Immigrants Fare Worse? Modeling Workplace Wage Gap Variation with Longitudinal Employer-Employee Data

The authors propose a strategy for observing and explaining workplace variance in categorically linked inequalities. Using Swedish economy-wide linked employer-employee panel data, the authors examine variation in workplace wage inequalities between native Swedes and non-Western immigrants. Consistent with relational inequality theory, the authors' findings are that immigrant-native wage gaps vary dramatically across workplaces, even net of strong human capital controls. The authors also find that, net of observed and fixed-effect controls for individual traits, workplace immigrant-native wage gaps decline with increased workplace immigrant employment and managerial representation and increase when job segregation rises. These results are stronger in high-inequality workplaces and for white-collar employees: contexts in which one expects status-based claims on organizational resources, the central causal mechanism identified by relational inequality theory, to be stronger. The authors conclude that workplace variation in the non-Western immigrant-native wage gaps is contingent on organizational variationin the relative power of groups and the institutional context in which that power is exercised.

Country of birth modifies the associations of body mass and hemoglobin A1c with office blood pressure in Middle Eastern immigrants and native Swedes.

Immigrant populations from the Middle East are at high risk of obesity and diabetes, but paradoxically hypertension is reported to be less prevalent. Studies of the risk factors for hypertension in these populations are scarce. The aim was to study the distribution of cardiovascular and metabolic risk factors in the Middle East immigrant population compared with native Swedes. A population-based, cross-sectional study of men and women, aged 30-75 years, born in Iraq or Sweden, was conducted in 2010-2012 in Malmö, Sweden. A 75-g oral glucose tolerance test was performed, and sociodemographic and lifestyle data were collected. In participants born in Iraq (n = 1311) vs. participants born in Sweden (n = 698), without a history of cardiovascular disease (CVD), the metabolic syndrome (MetS) was more prevalent in the Iraqis (49.2 vs. 40.3%, P < 0.001). Iraqis presented with higher prevalence rates of all but one MetS entity: elevated blood pressure (BP; 46.0 vs. 61.3%, P < 0.001, data adjusted for age, sex and antihypertensive medication). Being born in Iraq independently decreased the risk of elevated SBP and DBP. Furthermore, higher BMI, waist circumference, pulse rate and hemoglobin A1c (HbA1c) values presented weaker associations with SBP and DBP in Iraqis than in Swedes. These relationships were confirmed by interactions with the country of birth. BP-regulating mechanisms seem to differ in the Middle Eastern compared with a nonmigrated native European population. Further studies are needed for reaching a better understanding of the mechanisms contributing to CVD in populations of mixed ethnic backgrounds.