Stockholm Public Health Cohort Research Articles

Population trends and demographic disparities in sexual identity in Stockholm County, 2010 to 2021

Abstract Background Sexual identity, linked to experiences of disadvantage and discrimination, is crucial in equality monitoring. Sweden’s gender-neutral marriage laws, introduced in 2009, provide a unique context. This study examines the population trends and demographic disparities in sexual identity over time. Methods We analyzed three population surveys (2010, 2014, 2021) from the Stockholm Public Health Cohort, including around 50,000 individuals per survey. Sexual identity was assessed via self-administered questionnaires. Demographic data were sourced from Swedish national registers. Weighted multivariate Poisson regression with robust variance estimators was used to identify demographic disparities in sexual identity. Results were presented as proportion ratio (PR) with 95% confidence interval (CI). Results Overall, 29,607 (2010), 20,249 (2014), and 22,558 (2021) individuals reported sexual identity. Heterosexual identity decreased from 95.7% (95% CI 95.4-96.0%) in 2010 to 89.0% (88.5-89.4%) in 2021, while bisexual identity increased from 1.4% (1.2-1.6%) in 2010 to 2.0% (1.8-2.3%) in 2014, and further up to 2.7% (2.4-2.9%) in 2021. Homosexual identity increased slightly from 1.5% (1.4-1.7%) in 2010 to 1.8% (1.6-2.0%) in 2021. Multivariate analyses showed that female, older age, and lower education were inversely associated, while never-married status and living alone were positively associated, with homosexual identity. In contrast, female, younger age, lower income (100 SEK/year) ( < =2,500 vs > 4,500: 2010: PR 3.32 [95% CI 1.92-5.75]; 2014: 1.83 [1.28-2.60]; 2021: 1.51 [1.14-2.01]), and never-married status (never vs currently married: 2010: 2.03 [1.47-2.80]; 2014: 1.92 [1.39-2.65]; 2021: 1.50 [1.15-1.95]) were positively associated with bisexual identity. Conclusions Heterosexual identity decreased while homosexual/bisexual identities increased in Stockholm County during 2010-2021. Socioeconomic disparities persist in sexual minorities and vary by sexual identity. Key messages • Marked socioeconomic disparities persist in sexual minorities and vary by sexual identity in Stockholm County, although income and marital status disparities in bisexual group seem narrowing. • Future studies are warranted to investigate the social dynamics that continue to produce sexual minority disadvantages.

Individual fluidity of sexual identity in Stockholm County, 2010 to 2021

Abstract Background Sexual fluidity is key to understanding the size of sexual minority populations and analyzing the socioeconomic disparities these populations face. This study explores the stability and changes in sexual identity over time, and identifies key demographic factors that predict shifts in sexual identity. Methods We analyzed longitudinal data from the Stockholm Public Health Cohort, following 36,398 participants from 2010 to 2021. Sexual identity was measured using a self-administered questionnaire in 2010, 2014, and 2021. Demographic data from 2010 were collected from the Swedish national registers. Multivariate Poisson regression with robust variance estimators was used to identify demographic factors that predicted identity changes. Results were presented as proportion or risk ratio (RR) with 95% confidence interval (CI). Results Overall, 12.1% (95% CI 11.8%-12.5%) changed sexual identity at least once in 2010-2021, including 10.4% (10.0%-10.7%) among those initially identifying as heterosexual in 2010, 41.3% (37.1%-45.6%) as homosexual, 59.6% (55.0%-64.0%) as bisexual, and 65.0% (59.4%-70.3%) as uncertain. Multivariate analyses showed that sexual minorities (homosexual: RR 5.00, 95% CI 4.45-5.61; bisexual: 6.68, 6.04-7.38; uncertain: 3.88, 3.30-4.55), females (1.28, 1.21-1.35), younger (18-29 years: 1.49, 1.30-1.70) and older ( > =60 years: 2.07, 1.92-2.22) ages, born outside Sweden (Europe: 1.21, 1.11-1.32; Outside Europe: 2.90, 2.62-3.21), and lower education ( < =9 years: 2.14, 1.98-2.31; 10-12 years: 1.43, 1.34-1.53) and income (100 SEK/year) ( < =2,500: 1.83, 1.66-2.02; (2,500, 3,500]: 1.32, 1.19-1.46) independently predicted a higher probability of identity changes. Conclusions This study provides the first insights into sexual identity fluidity in a large general population sample in Sweden, highlighting its fluid nature. Future research is needed to unravel the intricate mechanisms underlying the demographic disparities in sexual identity fluidity. Key messages • This study provides the first insights into sexual identity fluidity in Sweden, highlighting its fluid nature. • Future research is needed to unravel the intricate mechanisms underlying the demographic disparities in sexual identity fluidity.

Mode of delivery and subsequent self-perceived sexual life satisfaction: a population-based cohort study

BackgroundThe potential association between mode of obstetric delivery and subsequent gestational parent sexual outcomes remain uncertain and has not been well investigated from a positive sexual life satisfaction perspective. ObjectivesThis study aimed to investigate if there was any association between mode of delivery and subsequent gestational parent sexual life satisfaction. A secondary aim was to assess the extent to which this association changed when stratified by time elapsed since delivery. Study designThe study matched participants in the Stockholm Public Health Cohort with deliveries recorded in the Swedish Medical Birth Registry. Any delivery recorded in the registry, before the participation in the Stockholm Public Health Cohort, were included (n=46 078). The length of time from delivery to outcome assessment varied from 1 month to 41 years (mean 18 years, ±10.8). Mode of delivery was retrieved from the same registry, whereas self-perceived sexual life satisfaction was retrieved from the Stockholm Public Health Cohort Questionnaires where participants had assessed their sexual life satisfaction as one out of five mutually exclusive options. Multinomial logistic regression was used to test for any association between mode of delivery (caesarean delivery, instrumental, and spontaneous vaginal delivery) and sexual life satisfaction, both overall and stratified by time elapsed since delivery. ResultsAfter adjusting for covariates, no statistically significant difference between modes of delivery and subsequent gestational parent sexual life satisfaction was identified. Adjusted odds ratios for assessing sexual life satisfaction as the lowest level (“very unsatisfactory”) were 1.11 (95% confidence interval 0.98-1.25) for caesarean deliveries and 1.16 (95% confidence interval 0.99-1.35) for instrumental deliveries, compared to spontaneous vaginal deliveries. The difference in covariate-adjusted prevalence of the lowest level of sexual life satisfaction in the different time since delivery groups was small, for example 4.0% (95% confidence interval 2.4-5.6%) for caesarean deliveries as compared to 2.8% (95% confidence interval 2.1-3.6%) for spontaneous vaginal deliveries 2 years since delivery. ConclusionsThese findings do not support any impact of mode of delivery on the subsequent self-perceived sexual life satisfaction among birthing people, either overall or across time since delivery.

Analysis of the Stockholm Public Health Cohort: Exploring How Ultraviolet Radiation and Other Factors Associate with Skin Cancer.

The primary aims of the study were to (1) explore the association of skin cancer and four ultraviolet radiation (UVR) indicators (sunbed use, healthcare data on diagnosed melanocytic nevi (MN) and actinic keratosis (AK), and latitude of birthplace), and (2) find factors other than UVR that could explain the increasing trend in incidence of skin cancers, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and cutaneous malignant melanoma (CMM). This population-based cohort study used self-reported questionnaire data from the Stockholm Public Health Cohort, encompassing 103 questions, merged with data from Swedish national registers. The study population included almost 35,000 Swedish-born people aged 30-66 years in 2014. Binomial logistic regression was employed for analysis. A forward stepwise regression was applied to select significant risk factors among all the factors included. We tentatively tested >30 variables separately for any relationship with each of the three skin cancers. A 5% level of significance was applied. Melanoma in situ and SCC in situ were excluded. The four UVR-related factors (sunbed use, being diagnosed with AK or MN, birthplace latitude) had a significant association with at least one of the three skin cancers that remained after adjustment including behavioural, social, hereditary, and medical factors. Sunbed use >10 times before age 30 years was related to all three skin cancers; SCC adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) 1.12-2.47, CMM (aOR 1.57, 95% CI 1.11-2.22), and the clearest dose-response association with BCC (aOR 1.74, 95% CI 1.46-2.06). None of the examined lifestyle factors, except physical activity, had any significant associations with UVR indicators or skin cancer. We did not find any preventable explanatory cause other than UVR exposure for the increasing incidence of skin cancers. This result remained when adjusting for an array of possible confounders including behavioural, social, hereditary, and medical factors.

Migration background, eating disorder symptoms and healthcare service utilisation: findings from the Stockholm Public Health Cohort.

From a global perspective, eating disorders are increasingly common, probably because of societal transformation and improved detection. However, research on the impact of migration on the development of eating disorders is scarce, and previously reported results are conflicting. To explore if eating disorder symptom prevalence varies according to birth region, parents' birth region and neighbourhood characteristics, and analyse if the observed patterns match the likelihood of being in specialist treatment. This study uses data from a large population-based health survey (N = 47 662) among adults in Stockholm, Sweden. A general linear model for complex samples, including adjustment for gender and age, was used to explore self-reported eating disorder symptoms. Odds ratios were calculated for individual symptoms. Eating disorder symptoms are substantially more common in individuals born abroad, especially for migrants from a non-European country. This holds true for all surveyed symptoms, including restrictive eating (odds ratio 5.5, 95% CI 4.5-6.7), compensatory vomiting (odds ratio 6.1, 95% CI 4.6-8.0), loss-of-control eating (odds ratio 2.6, 95% CI 2.3-3.1) and preoccupation with food (odds ratio 2.3, 95% CI 1.9-2.8). Likewise, symptoms are more common in individuals with both parents born abroad and individuals living in districts with a high percentage of migrant residents. A gap exists between district-level symptom scores and the likelihood of being in specialist eating disorder treatment. These findings call for oversight of current outreach strategies, and highlight the need for efforts to reduce stigma and increase eating disorder symptom recognition in broader groups.

Using repeated measures to study the contribution of alcohol consumption and smoking to the social gradient in all-cause mortality: Results from the Stockholm Public Health Cohort.

The social gradient in consumption behaviours has been suggested to partly explain health inequalities. The majority of previous studies have only included baseline measurements and not considered potential changes in behaviours over time. The study aimed to investigate the contribution of alcohol consumption and smoking to the social gradient in mortality and to assess whether the use of repeated measurements results in larger attenuations of the main association compared to using single baseline assessments. Longitudinal survey data from the population-based Stockholm Public Health Cohort from 2006 to 2014 was linked to register data on mortality until 2018 for 13,688 individuals and analysed through Cox regression. Low socioeconomic position (SEP) was associated with increased mortality compared with high SEP; hazard ratios 1.56 (95% CI 1.30-1.88) for occupational status and 1.77 (95% CI 1.49-2.11) for education, after adjustment for demographic characteristics. Using repeated measurements, alcohol consumption and smoking explained 44% of the association between occupational status and all-cause mortality. Comparing repeated and baseline measures, the percentage attenuation due to alcohol consumption increased from 11% to 18%, whereas it remained similar for smoking (25-23%). Smoking and alcohol consumption explained a large part of the association between SEP and mortality. Comparing results from time-fixed and time-varying models, there was an increase in overall percentage attenuation that was mainly due to the increased proportion explained by alcohol consumption. Repeated measurements provide a better estimation of the contribution of alcohol consumption, but not smoking, for the association between SEP and mortality.

Is the association between alcohol use and sickness absence modified by socioeconomic position? findings from the Stockholm public health cohort

BackgroundThe distribution of sickness absence tends to be socially patterned less is however known about the underlying mechanisms and pathways of the social gradient found in sickness absence. The present study aims to investigate (i) if the risk function between average volume of alcohol consumption and sickness absence is modified by socio-economic position (SEP), and (ii) whether such an effect modification can be attributed to differences in drinking patterns and other risk factors including other lifestyle behaviours, health status, and working conditions.MethodsThe study was based on data from the Stockholm public health cohort 2006, with an analytical sample of 13 855 respondents aged 18–64 years. Self-reported information on occupational class (a measure of SEP), alcohol consumption, other lifestyle behaviour, health and working conditions was collected from the survey. The outcome of long-term (> 14 days) sickness absence between 2006 and 2008 was obtained from national registers. Negative binomial regression was used to estimate the Incidence Rate Ratios (IRR) with 95% confidence intervals (CI).ResultsIn the initial analyses, heavy drinking manual workers had a 5-fold increased risk of long-term sickness absence compared to non-manual employees who were moderate drinkers, and approximately 60% of the excess risk among heavy drinking manual workers was attributable to an interaction between alcohol use and SEP. Adjusting for working conditions was associated with the largest attenuation of the risk estimate, compared to other lifestyle behaviors and health. In the fully adjusted model, the IRR was further attenuated for the manual workers and the joint effect of SEP and heavy drinking remained in the final model with an attributable proportion of 49%.ConclusionsIndividuals in Sweden with lower levels of SEP appear to be more vulnerable to alcohol consumption in relation to sickness absence, where differences in working conditions explained a large part but not all of the differential vulnerability.

Does misclassification of former tobacco smokers explain the 'smoker's paradox' in the risk of COVID-19? Insights from the Stockholm Public Health Cohort.

The association between tobacco smoking and the risk of COVID-19 and its adverse outcomes is controversial, as studies reported contrasting findings. Bias due to misclassification of the exposure in the analyses of current versus non-current smoking could be a possible explanation because former smokers may have higher background risks of the disease due to co-morbidity. The aim of the study was to investigate the extent of this potential bias by separating non-, former, and current smokers when assessing the risk or prognosis of diseases. We analysed data from 43,400 participants in the Stockholm Public Health Cohort, Sweden, with information on smoking obtained prior to the pandemic. We estimated the risk of COVID-19, hospital admissions and death for (a) former and current smokers relative to non-smokers, (b) current smokers relative to non-current smokers, that is, including former smokers; adjusting for potential confounders (aRR). The aRR of a COVID-19 diagnosis was elevated for former smokers compared with non-smokers (1.07; 95% confidence interval (CI) =1.00-1.15); including hospital admission with any COVID-19 diagnosis (aRR= 1.23; 95% CI = 1.03-1.48); or with COVID-19 as the main diagnosis (aRR=1.23, 95% CI= 1.01-1.49); and death within 30 days with COVID-19 as the main or a contributory cause (aRR=1.40; 95% CI=1.00-1.95). Current smoking was negatively associated with risk of COVID-19 (aRR=0.79; 95% CI=0.68-0.91). Separating non-smokers from former smokers when assessing the disease risk or prognosis is essential to avoid bias. However, the negative association between current smoking and the risk of COVID-19 could not be entirely explained by misclassification.

The joint effect between fetal growth and health behaviors on the risk of cardiovascular diseases in young adulthood

To investigate the individual and the joint effect of impaired fetal growth and adult health behaviors on the risk of cardiovascular diseases (CVDs). A total of 15,618 individuals were included from three sub-cohorts of the Stockholm Public Health Cohort. Data on participants' birthweight and gestational age were retrieved from the Medical Birth Register. Data on the diagnoses of CVDs were extracted from the Swedish National Patient Register and the Cause of Death Register. Data on health behaviors were identified from self-reported questionnaires, and health behavioral profile was defined based on the recommendations of the American Health Association. The associations of fetal growth and health behaviors with the risk of CVDs were analyzed using Cox proportional hazard model. Individuals born small for gestational age (SGA) had a higher risk of CVDs than those born appropriate for gestational age (AGA), and the adjusted hazard ratio (HR) and 95% confidence interval (CI) was 1.88 (1.44, 2.47). Participants born SGA and having poor health behavioral profile in adulthood had a higher risk of CVDs than those born AGA and having ideal health behaviors with adjusted HR (95% CI) being 3.58 (1.95, 6.56). Impaired fetal growth was associated with an increased risk of CVDs in adulthood, and the risk was highest in individuals with both impaired fetal growth and poor health behaviors in adulthood.

Predictors of beverage-specific, alcohol consumption trajectories: A Swedish population-based cohort study.

Aim: The aim of the study was to examine whether changes in alcohol consumption over time differ according to beverage types, and to what extent socioeconomic, lifestyle and health-related factors predict beverage-specific trajectories in Sweden. Study design: We included participants from the Stockholm Public Health Cohort who were surveyed repeatedly in 2002, 2010 and 2014. Alcohol consumption trajectories were constructed for 13,152 individuals with valid information on amount and frequency of drinking. Preferred beverage types (i.e., beer, wine or spirits) were defined based on the most consumed beverages. Multinomial logistic regression was used to quantify individual predictors of different trajectories, overall and by beverage type. Results: Overall 56.9% of respondents were women, the mean age was 49.2 years, SD (13.1). Wine was cited as the preferred beverage for 72.4% of participants, and stable moderate drinking was the most common trajectory regardless of beverage type (68.2%, 54.9% and 54.2% in individuals with wine, beer and spirits as preferred beverages, respectively). Associations between drinking trajectories and baseline lifestyle factors did not differ by beverage type. Lower socioeconomic position (SEP) was associated with unstable moderate wine drinking (for unskilled manual SEP: adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.23, 1.93), unstable heavy beer drinking (for skilled manual SEP: aOR 1.99, 95% CI 1.14, 3.52; and unskilled manual SEP: aOR 1.72, 95% CI 1.05, 2.82), and former beer drinking trajectory (for skilled manual SEP: aOR 1.81; 95% CI 1.21, 2.72; and unskilled manual SEP: aOR 1.66; 95% CI 1.17, 2.37). Conclusion: Lower SEP was associated with unstable heavy drinking of beer, former beer drinking, and unstable moderate wine drinking trajectories indicating that targeted alcohol prevention programmes need to focus on these groups.

Psychological Distress, Suicidal Ideation, and Suicide Attempt Among Lesbian, Gay, and Bisexual Immigrants: Population-Based Findings from the Stockholm Public Health Cohort.

In a large, population-based sample in Sweden, we sought to examine mental health disparities between lesbian, gay and bisexual (LGB) and heterosexual individuals with different immigration statuses. We conducted a population-based study including 1799 LGB and 69,324 heterosexual individuals, recruited in 2010 and 2014 as part of the Stockholm Public Health Cohort. Data were obtained from self-administered surveys that were linked to nationwide registers. We examined associations between mental health outcomes (i.e., psychological distress, suicidal ideation, and suicide attempt) and sexual orientation (LGB versus heterosexual), immigration status (immigrant versus Nordic-born), and their interaction. Sex-stratified weighted multivariable logistic regression analyses were used to calculate adjusted odds ratios with 95% confidence intervals. LGB individuals demonstrated substantially elevated odds of all mental health outcomes compared to heterosexuals; immigrants reported moderately elevated odds of psychological distress and suicide attempt, but not suicidal ideation, compared to Nordic-born individuals. Interaction terms between sexual orientation and immigration status were significant at p < 0.05 for psychological distress for both sexes and for suicidal ideation and attempt among women. Unexpectedly, models probing interactions generally demonstrated that Nordic-born LGB individuals demonstrated greater risk of psychological distress, suicidal ideation, and suicide attempt than did immigrant LGB individuals, especially among women. Supplemental analyses showed that Nordic-born bisexual women demonstrated the highest risk of all studied outcomes. Being LGB in Sweden is generally a stronger risk factor for poor mental health among Nordic-born than immigrant populations. These findings call for future intersectionality-focused research to delineate the unique cultural, social, and psychological factors associated with mental health and resilience among LGB immigrants.

Work ability and psychological distress in a working population: results from the Stockholm Public Health Cohort.

Psychological distress is a global public health concern with individual and societal implications causing work-related disability and loss of productivity. It is less known how much work ability contributes to the development of psychological distress. This study aimed to assess the association between self-perceived physical and mental work ability in relation to job demands, and the incidence of psychological distress in a Swedish working population. Data were obtained from three subsamples of the Stockholm Public Health Cohort with baseline in 2010 and follow-up in 2014, based on a working population in Stockholm County aged 18-60 years, with no or mild psychological distress at baseline (n=29,882). Self-perceived physical and mental work ability in relation to job demands were assessed at baseline with a subscale from the Work Ability Index. Study participants scoring 4 or more on the General Health Questionnaire 12 at follow-up were classified as having developed psychological distress during the study period. Poisson log linear regression was used to calculate crude and adjusted rate ratios with 95% confidence intervals. At follow-up, 2543 participants (12%) had developed psychological distress. Reporting poor physical and/or poor mental work ability in relation to job demands at baseline was associated with an almost doubled rate ratio of psychological distress at follow-up, compared to reporting good work ability (rate ratio 1.8; 95% confidence interval 1.6-2.0). Poor work ability is associated with a higher incidence of future psychological distress compared to good work ability.

Social factors and chronic pain: the modifying effect of sex in the Stockholm Public Health Cohort Study.

ObjectivesTo assess the relationship between social factors (socio-economic status, household load and job strain) and chronic pain occurrence, and the role of gender in this relationship.MethodsWe used data corresponding to 8 years of follow-up of the Stockholm Public Health Cohort Study (2006–2014) to compute Adjusted Incidence Rate Ratios (IRRs) and additive interaction measures of chronic pain episodes, social factors, and sex in 16 687 subjects.ResultsFor men, increased rates of chronic pain occurrence were observed for skilled workers (IRR = 1.27, 95% CI: 0.99, 1.61) and lower non-manual employees (IRR = 1.37, 95% CI: 1.05, 1.78), compared with unskilled workers; subjects with high household load (IRR = 1.39; 95% CI: 1.03, 1.88), compared with those with a null score; and subjects with active jobs (IRR = 1.27, 95% CI: 1.06, 1.51), compared with those with low-strain jobs. For women, we observed decreased rates of chronic pain occurrence in lower (IRR = 0.82, 95% CI: 0.68, 0.99), intermediate (IRR = 0.74, 95% CI: 0.63, 0.88) and higher non-manual employees (IRR = 0.65, 95% CI: 0.54, 0.79), compared with unskilled workers. Compared with subjects with a null score, women with low household load showed a lower rate of chronic pain occurrence (IRR = 0.85; 95% CI: 0.72, 1.00). Compared with subjects with low-strain jobs, those with passive jobs (IRR = 1.21; 95% CI: 1.02, 1.44) and high-strain jobs (IRR = 1.46; 95% CI: 1.02, 2.09) showed higher rates of chronic pain occurrence.ConclusionIn general, our analysis yielded different, if not opposite, results when data were stratified by sex. Sex may then represent an effect modifier of the relationship between social factors and chronic pain.

Social factors and pain worsening: a retrospective cohort study

BackgroundPain, specifically chronic pain, is a major public health issue worldwide with considerable health-related consequences and large economic impact. The relation between socioeconomic status and pain occurrence is well established. However, little is known on the relation between socioeconomic factors and worsening of pain, including progression from non-chronic pain to chronic pain. MethodsTo assess the relation between socioeconomic status and pain worsening, we used the Stockholm Public Health Cohort Study from 2006 to 2014 and analysed data of 9721 participants who completed follow-up. The adjusted incidence rate ratios (IRRs) of moderate and severe pain worsening episodes were computed, using a pain amplification model, which encompasses spreading, somatisation, and psychological distress components. Multiple imputation analysis was performed subsequently to adjust for cohort attrition. ResultsCompared with non-skilled workers, self-employed subjects (IRR=1.18; 95% confidence interval [CI], 1.01–1.39) and non-manual employees were at higher risk of moderate worsening (lower non-manual employees: IRR=1.21; 95% CI, 1.03–1.41; intermediate non-manual employees: IRR=1.26; 95% CI, 1.10–1.44; higher non-manual employees: IRR=1.25; 95% CI, 1.08–1.45). This risk increase was limited to worsening starting at stage 0 (non-chronic pain). No association was found between socioeconomic status and severe pain worsening. ConclusionOur results support a moderate association between intermediate and high socioeconomic status, and moderate pain worsening. This association could be explained by the heterogeneous composition of the socioeconomic variable used in this cohort, and by changes in exposure and other time-varying covariables' status during follow-up.

Geriatric syndromes and subsequent health-care utilization among older community dwellers in Stockholm

Little is known about the long-term effect of geriatric syndromes on health-care utilization. This study aims to determine the association between geriatric syndromes and health-care utilization during a four-year period among older community dwellers. Based on the Stockholm Public Health Cohort study, a total number of 6700 community dwellers aged ≥65 years were included. From a baseline survey in 2006, geriatric syndromes were defined as having at least one of the following: insomnia, functional decline, urinary incontinence, depressive symptoms and vision impairment. Health-care utilization was identified by linkages at individual level with register data with a four-year follow-up. Cox regression was performed to estimate the associations. Compared to those without geriatric syndromes, participants with any geriatric syndromes had a higher prevalence of frequent hospitalizations, long hospital stays, frequent outpatient visits and polypharmacy in each of the follow-up years. After controlling for covariates, having any geriatric syndromes was associated with higher levels of utilization of inpatient and outpatient care as well as polypharmacy. The association was stable over time, and the fully adjusted hazard ratio (95% confidence interval) remained stable in frequent hospitalizations (from 1.89 [1.31, 2.73] in year 1 to 1.70 [1.23, 2.35] in year 4), long hospital stay (from 1.75 [1.41, 2.16] to 1.49 [1.24, 1.78]), frequent outpatient visits (from 1.40 [1.26, 1.54] to 1.33 [1.22, 1.46]) and polypharmacy (from 1.63 [1.46, 1.83] to 1.53 [1.37, 1.71]). Having any geriatric syndromes is associated with higher levels of health-care utilization among older community dwellers, and the impact of geriatric syndromes is stable over a four-year period.

Physical workload and increased frequency of musculoskeletal pain: a cohort study of employed men and women with baseline occasional pain

ObjectivesMusculoskeletal pain (MSP) is prevalent among the workforce. This study investigates the long-term association between physical workload (PWL) and increased frequency of MSP among male and female employees with pre-existing...

Body image perception, smoking, alcohol use, indoor tanning, and disordered eating in young and middle-aged adults: findings from a large population-based Swedish study

BackgroundBody image concerns may give rise to a multitude of risk behaviors, such as unhealthy weight control practices, disordered eating behaviors (e.g., compensatory purging or preoccupation with food), smoking, excessive alcohol intake, or sunbed use. However, the distribution of these risk behaviors across adulthood has rarely been studied.MethodsThe aim of this study was to explore health risk behaviors as correlates of body image perception in a randomly selected study population of 30,245 individuals aged 30–66 in Stockholm, Sweden, utilizing data from the Stockholm Public Health Cohort. Bivariate correlations were explored and a hierarchic binary logistic regression analysis was performed.ResultsThe prevalence of body image discrepancy was higher among smokers and respondents displaying disordered eating behaviors. In contrast, alcohol and sunbed use were inversely correlated to body image discrepancy. Body mass index was the substantially strongest explanatory factor behind the observed variance in body image discrepancy, followed by loss-of-control eating. Notably, no major gender differences in body image perception were detected. Some unexpected patterns of association between variables other than body image perception, such as those between smoking, alcohol use, and sunbed use, were seen.ConclusionsOverall, the patterns differ substantially from what has previously been found in adolescent and young adult samples, indicating that the synergy and aggregation of risk behaviors observed among younger individuals may not apply to adults aged 30–66.

Distribution of sickness absence risk across different levels and patterns of drinking: findings from the Stockholm Public Health Cohort.

Aim:This study estimated (i) the risk function between different indicators of alcohol use and long-term sickness absence, adjusting for possible confounding factors, (ii) whether the risk function between average volume of consumption and sickness absence is modified by heavy episodic drinking (HED), and (iii) to what extent the risk for sickness absence among abstainers is due to health selection bias.Data and methods:The study was based on data from the Stockholm Public Health Cohort 2006, with an analytical sample of 16,477 respondents aged 18–64 years. The outcome included register-based long-term (> 14 days) sickness absence. Negative binominal regression was used to estimate the association between sickness absence and average weekly volume of consumption, frequency of HED, and both in interaction.Results:Abstainers, chronic heavy drinkers and respondents with the highest frequency of HED had approximately two-fold higher rates of sickness absence relative to the reference groups, i.e., moderate drinkers and those with HED one to 6 times per year. Adjustment for confounding factors did not materially affect the shape of the risk function. After exclusion of abstainers with alcohol-related problems, or poor health, the estimates for abstainers became non-significant. Moderate drinkers with HED did not have significantly higher rates of sickness absence than moderate drinkers without HED.Conclusions:Our results suggest a significant association between alcohol use and sickness absence. There were indications that the U-shaped risk function may largely be due to health selection bias among abstainers. We found no indication of effect modification of HED on moderate drinking.

Understanding the differential effect of alcohol consumption on the relation between socio-economic position and alcohol-related health problems: results from the Stockholm Public Health Cohort.

AimTo test (i) whether the harmful effects of average volume of alcohol consumption (AC) and heavy episodic drinking (HED) differ by socio‐economic position (SEP), and (ii) if so, to what extent such differential effects can be attributed to an unequal distribution of harmful levels and patterns of drinking, health, life‐style and social factors.DesignA longitudinal cohort study with baseline in 2002 or 2006, with record‐linkage to national registers.SettingStockholm County, Sweden.ParticipantsA total of 37 484 individuals, aged 25–70 years, responding to the survey in 2002 or 2006.MeasurementsThe outcome of alcohol‐related health problems was obtained from the National Patient Register and Cause of Death Register using the Swedish index diagnoses related to alcohol use. Self‐reported information on occupational class (measure of SEP), AC, HED as well as other health‐related factors were extracted from the surveys. Average follow‐up time was 13.3 years.FindingsDuring follow‐up, a total of 1237 first‐time events of alcohol‐related health problems occurred. After initial adjustments, heavy drinking appeared to be more harmful to individuals with low SEP compared with high SEP (P = 0.001). Differences in HED frequency explained the largest part of the differential effect of AC. Engaging in weekly HED was more harmful to individuals with low SEP (P = 0.031) than high SEP. Differences in AC, together with other factors, explained a large part of the differential effect of HED.ConclusionsThe greater adverse impact of alcohol consumption on health in Sweden on people with lower socio‐economic position may be largely attributable to higher prevalence of heavy episodic drinking, as well as other behavioral and social risk factors.

Consumption of fruit and vegetables and the risk of type 2 diabetes: a 4-year longitudinal study among Swedish adults.

A low intake of fruit and vegetables is a significant contributor to the global burden of disease. The aim of this study was to estimate the size of the risk of type 2 diabetes (T2D) of a low intake and to investigate possible sex differences. In this regard, this study used a longitudinal data from the Stockholm Public Health Cohort located in Sweden, collected in 2010 and 2014. The analysis included 14 718 men and 20 589 women aged 25 to 84 years. Fruit and vegetable intake, separately <2 servings/d or combined <4 servings/d (one serving corresponding to 100 g) was set as a cut-point for low intake. The sex difference at baseline was examined. Sex-stratified logistic regression was performed with onset of T2D as the outcome and fruit and vegetable intake at baseline as the exposure with adjustment for other known risk factors. Results indicate that men consumed significantly (P < 0⋅001) less fruit and vegetables compared with women. A 62 % higher risk to develop T2D over the 4-year period was observed in men who had low vegetable intake compared with high intake after adjusting for age, education, BMI, smoking, alcohol and physical activity (OR 1⋅62; 95 % CI 1⋅00, 2⋅63). In women, a significantly higher risk of T2D was also observed with a low intake of vegetables, but not after adjustment. The present study suggests that higher consumption of vegetables seems to be protective for the onset of T2D in men. Thus, increasing the intake of vegetables in men should be a public health priority.