Swedish-born Parents Research Articles

Epilepsy in second-generation immigrants: a cohort study of all children up to 18 years of age in Sweden.

Our purpose was to study the association between country of birth and incident epilepsy in second-generation immigrants in Sweden. The study population included all children (n=4023149) aged up to 18years in Sweden. Epilepsy was defined as at least one registered diagnosis of epilepsy in the National Patient Register. The incidence of epilepsy, using individuals with Swedish-born parents as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence interval (95% CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, neighbourhood socioeconomic status and comorbid conditions, also using data from the Total Population Register. A total of 26310 individuals had a registered epilepsy event, i.e. 6.5/1000 (6.6/1000 amongst boys and 6.3/1000 amongst girls). After adjustment, the risk of epilepsy was lower than in children of Swedish-born parents. Amongst girls the significant HR was 0.85 (95% CI 0.81-0.88), but in boys only when adjusting also for comorbidity (HR0.96, 95% CI 0.92-0.99). Amongst specific immigrant groups, a higher incidence of epilepsy was observed amongst boys with parents from Turkey and Africa, but not when adjusting for comorbidity, and a lower risk was observed in many other groups (boys with parents from Latvia, girls with parents from Finland, Iceland, Southern Europe, countries from the former Yugoslavia, and Asia). The risk of epilepsy was lower in second-generation immigrant children compared to children with Swedish-born parents, but with substantial differences between different immigrant groups.

Location choices of Swedish independent schools

This paper studies the location decisions of the Swedish privately provided independent schools. It makes use of the great expansion of such schools following the 1992 independent school reform, to study the local determinants of independent school entry. The analysis thus provides evidence on the location choices made by private agents in a mixed market setting. The modifiable areal unit problem is addressed by employing a set of alternative measures for local school markets, constructed from highly detailed geographical data on schools and students. The results suggest that independent schools were more likely to choose locations with a larger share of students with high-educated parents; a higher student population density; and a lower share of students with Swedish-born parents. There is also some evidence that independent schools were less likely to locate in municipalities with a left-wing political majority.

End-Stage Kidney Diseases in Immigrant Groups: A Nationwide Cohort Study in Sweden

Background: Our aim was to study the association between the country of birth and incident end-stage kidney disease (ESKD) in several immigrant groups in Sweden, using individuals born in Sweden or with Swedish-born parents as referents. Methods: A cohort study of first- and second-generation immigrants residing in Sweden between January 1, 1998 and December 31, 2012 was performed. Outcomes were defined as having at least one registered diagnosis of ESKD in the National Patient Register. The incidence of ESKD in different immigrant groups was used in the Cox regression models to estimate hazard ratios (HRs) and 95% CIs. All models were stratified by sex and adjusted for age, geographical residence, educational level, marital status, and neighbourhood socioeconomic status. Results: Compared to their referents, higher incidence rates and HRs of ESKD (HR; 95% CI) were observed in general among foreign-born men (1.10; 1.04–1.16) and women (1.12; 1.04–1.21) but not among second-generation immigrants (persons born in Sweden with foreign-born parents). A particularly high ­incidence was noted among men and women from ­East-European countries, as well as from non-European regions. A lower incidence of ESKD was noted among men from Finland. Conclusions: We observed substantial differences in incidence of ESKD between immigrant groups and the Swedish-born population, which may be clinically relevant when monitoring preventive measures in patient subgroups with a higher risk of deteriorating kidney disease, and suggest higher attention to hypertension and diabetes control in immigrants. Mechanisms attributable to the migration process or ethnic differences may lead to an increased risk of ESKD.

Urolithiasis in immigrant groups: a nationwide cohort study in Sweden

Objective: To study the association between country of birth and incident urolithiasis in immigrant groups in Sweden, using individuals born in Sweden (or with Swedish-born parents in the second-generation study) as referents.Methods: This nationwide follow-up study included first- and second-generation immigrants residing in Sweden between 1 January 1998 and 31 December 2012. Urolithiasis was defined as having at least one registered diagnosis of urolithiasis in the National Patient Register. Cox regression analysis was used to estimate the risk (hazard ratios (HR) with 95% confidence intervals (CI)) of incident urolithiasis. The models were stratified by sex and adjusted for age, sociodemographic status and co-morbidity.Results: Compared to referents, slightly higher incidence rates and HRs of urolithiasis (HR; 95% CI) were observed among first-generation men (1.06; 1.04–1.09) and women (1.12; 1.08–1.16) but not among second-generation immigrants (persons born in Sweden with foreign-born parents). Among first-generation immigrants, higher HRs were noted among men and women from Central and Eastern Europe, Russia, Latin America, Africa and Asia. Lower HRs were seen among men and women from the Nordic countries, most Western European countries and North America. Among second-generation immigrants, higher HRs were noted among men and women from Denmark, Germany and Hungary, in men from Austria, and in women from the Netherlands and Poland. Lower HRs were seen in second generation immigrants from Latin America, Africa and Asia (men and women).Conclusions: We observed substantial differences in incidence of urolithiasis between certain immigrant groups and the Swedish-born population, of importance in the clinical situation.

Policy constructions, immigrants’ social rights and gender: The case of Swedish childcare policies

This article explores how policy constructions shape policy outcomes for immigrant women and men, focusing on two Swedish childcare policies: (1) parental leave and (2) childcare services. It sheds light on the dynamics between policy constructions and (1) the gender differentiation in immigrants’ social entitlements, (2) the gender differentiation in social entitlements of the Swedish-born population and (3) differences and similarities between the two. Among the major findings is that the universal construction of childcare services and parental insurance promotes parity in immigrant and Swedish-born parents’ utilization. Immigrant families have high enrolment rates in childcare programmes and their rates approach or equal those of non-immigrant families. In the case of parental benefits, over 40 percent of immigrant mothers would be ineligible without the universal construction, and a huge immigrant/ethnic divide in entitlement would exist. Second, a gender differentiation characterizes the claiming of parental benefits, and the differentiation is sharper for immigrant parents. Third, the ethnicity benefit differential is much wider for mothers’ parental leave benefits than for fathers’ benefits. Fourth, despite universal policy constructions, immigrants’ weaker attachment to the labour market affects their social rights, and the effect is greater for immigrant women.

“It Happens All the Time”: Women’s Experiences and Normalization of Sexual Harassment in Public Space

This study explored the prevalence of sexual harassment, consequences of harassment, and reasons for not reporting these experiences through a survey among Swedish female university students (N = 1941). One fourth reported one or more incidents of sexual harassment during the 12 months period prior to the survey. Victims were more often younger and with Swedish-born parents compared with nonvictims. Victimization most frequently occurred at clubs or restaurants and the most frequently reported consequences were anger and worry about being victimized again. Few reported the incidents to the police making this, in part, an invisible problem.

Refugee migration and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden

Objective To determine whether refugees are at elevated risk of schizophrenia and other non-affective psychotic disorders, relative to non-refugee migrants from similar regions of origin and the Swedish-born population. Design...

Over-Education Amongst the Children of Immigrants in Sweden

The main focus of the article is whether immigrants’ descendants have the same occupational mismatch as immigrants, or whether their experiences reflect those of the population with Swedish-born parents. Register data for the entire population of Sweden for the year 2007 is used for a multivariate analysis. All employed individuals aged between 25 and 64 have been selected. The main results show that the descendant generation has lower levels of mismatch compared to the immigrant generation: the male descendant population shows higher odds of being over-educated, whereas the female descendant population does not significantly differ in this from Swedish-born individuals with two Swedish-born parents.

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.

Preterm and postterm birth in immigrant- and Swedish-born parents: a population register-based study.

Ethnic minorities/immigrant groups tend to have increased risk for preterm birth. Less is known about this risk in diverse immigrant groups, couples of mixed ethnic-origin and in relation to duration of residence. Data from the Swedish Medical Birth Register on 1,028,303 mothers who gave birth to 1,766,026 singleton live born infants (1982-2002), was linked to the Education and Total Population Registers. Immigrant parents were identified by country of birth. Risk of early preterm, late preterm and postterm birth was analyzed using multinomial logistic regression. Polish, Yugoslavian, Iranian, South Asian, East Asian and Sub-Saharan African parents, Swedish mothers who had children with non-Swedish fathers, and parents from two different immigrant groups had higher risk of early preterm birth [adjusted relative risk (RR) (95% CI) 1.76 (1.24-2.50), 1.57 (1.31-1.87), 1.67 (1.30-2.14), 1.52 (1.07-2.16), 1.51 (1.08-2.10), 2.03 (1.32-3.12), 1.56 (1.45-1.67), and 1.55 (1.35-1.77) respectively] compared to Swedish-born parents. South Asian, Sub-Saharan African, and East Asian immigrants had a higher risk of late preterm birth compared to Swedish-born parents. North African and Middle Eastern, Somali, and Ethiopian/Eritrean groups had increased risk of postterm birth [adjusted RR 1.31 (1.16-1.47), 2.57 (2.31-2.86), 1.85 (1.67-2.04) respectively]. Adjustment for covariates did not substantially change associations. Immigrant mothers resident <3 years had higher risk for early preterm and postterm birth compared to residents >10 years [adjusted RR 1.46 (1.24-1.71) and 1.16 (1.11-1.23) respectively]. In addition to higher risk of preterm birth in select immigrant groups, some immigrant groups are also at higher risk of postterm birth. Shorter duration of residence is associated with higher risk of non-term deliveries.

Birth Outcomes of Foreign‐Born, Native‐Born, and Mixed Couples in Sweden

Many births in industrialised countries are to immigrant parents, or to one immigrant and one domestically born parent. Their newborn outcomes have not been well studied. We conducted a study of 1,690,423 singleton infants born in Sweden between 1987 and 2008, including those of immigrants from East Asia, South Asia, Sub-Saharan Africa, and East Africa. Preterm delivery and small for gestational age (SGA) were assessed among infants of (i) immigrant parents from the same world region, (ii) an immigrant mother and a Swedish-born father, and (iii) a Swedish-born mother and an immigrant father; each compared to (iv) two Swedish-born parents. Log binomial regression analysis generated adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) for preterm delivery and SGA. Compared with infants of two Swedish-born parents, infants born to immigrant mothers from East Asia, South Asia, and Sub-Saharan African were at higher risk of preterm delivery (ARR ranging from 1.2 to 1.9), irrespective of whether the father was from the same world region or Swedish-born, with the only exception of East African women, who had lower risk. Infants born to two foreign-born parents had the highest risks of SGA, particularly South Asians (ARR 4.69; 95% CI 4.29, 5.12). Mixed couples exhibited intermediate risks of SGA. Adverse birth outcomes differ according to a couple's ethnic composition. Having a Swedish-born partner is associated with lower risk of SGA among immigrant mothers and fathers, and with lower risk of preterm delivery among immigrant fathers but not mothers.

Testing the anniversary reaction: causal effects of bereavement in a nationwide follow-up study from Sweden.

Lingering grief associated with the death of a loved one has been hypothesized to precipitate acute health events among survivors on anniversary dates. We sought to study excess mortality risk in parents around the death date and birth date of a deceased child as an indication of a "bereavement effect". We conducted a population based follow-up study using Swedish registries including links between children and parents. All biological and Swedish-born parents who experienced the death of a minor child born were observed during the period 1973-2008 (n = 48,666). An increased mortality risk was found during the week of a child's death among mothers who lost a child aged 0-17 years (SMRR = 1.46, 95% CI 0.98-2.17). The association was stronger among mothers who lost a child aged 1-17 years (SMRR = 1.89, 95% CI 0.97-3.67) as compared to those who lost an infant (SMRR = 1.29, 95% CI 0.78-2.12). Cardiovascular diseases and suicides were overrepresented as causes of death in mothers who died around the anniversary. We found no significant increase in the mortality risk around the date of child's birth, nor any suggestion of excess mortality risk among fathers, but rather a depression of paternal death (SMRR = 0.60, 95% CI 0.34-1.03). Our study indicates an anniversary reaction among mothers who lost a young child. These results suggest that bereavement per se could have an effect on health and mortality which should be acknowledged by public health professionals working with bereaved people.

Impaired metabolic control and socio-demographic status in immigrant children at onset of Type1 diabetes.

The aim of the present study was to compare clinical and socio-demographic conditions at the onset of Type1 diabetes in children born to immigrant families and children born to Swedish families, and to assess whether those conditions had an impact on metabolic status. This was an observational nationwide population-based matched cohort study on prospectively recorded registry data of all children with diabetes in Sweden and their families during 2000-2010. Out of a total of 13415 children from the Swedish Childhood Diabetes Registry (SWEDIABKIDS), 879 children born to immigrant parents were collected. To these we added 2627 children with Swedish-born parents, matched for gender, age and year of onset of Type1 diabetes. The proportion of low capillary pH (<7.30) at onset was higher in the immigrant cohort [25.8% vs. 16.4% in the Swedish cohort (P<0.001)]. HbA1c was also higher [95mmol/mol (10.8%) vs. 88mmol/mol (10.2%), respectively (P<0.001)]. In a logistic regression model with low pH as the dependent variable, we were unable to reveal any significant association to socio-demographic factors, but the odds ratio for HbA1c was 0.983 (95%CI 0.976-0.991) and for plasma glucose was 0.953 (95%CI 0.933-0.973). Children born to immigrant parents have lower capillary pH and higher HbA1c at diabetes onset. Immigrant families harbour lower socio-demographic living conditions, but this fact does not seem to influence the inferior metabolic condition at diabetes onset.

Birth by vacuum extraction delivery and school performance at 16 years of age

The aim of the present study was to investigate cognitive competence, as indicated by school performance, at 16 years of age, in children delivered by vacuum extraction. This was a register study of a national cohort of 126,032 16 year olds born as singletons, with a vertex presentation, at a gestational age of 34 weeks or older, with Swedish-born parents, delivered between 1990 and 1993 without major congenital malformations. Linear regression was used to analyze mode of delivery in relation to mean scores from national tests in mathematics (40.2; scale, 10-75; SD, 14.9) and mean average grades (223.8; scale, 10-320; SD, 52.3), with adjustment for perinatal and sociodemographic confounders. Children delivered by vacuum extraction (-0.51; 95% confidence interval [CI], -0.76 to 0.26) as well as by nonplanned cesarean section (-0.51; 95% CI, -0.82 to -0.20) had slightly lower mean mathematics test scores than children born vaginally without instruments, after adjustment for major confounders. Mean average grades in children delivered by vacuum extraction were -1.05 (95% CI, -1.87 to -0.23) and -1.20 (95% CI,-2.24 to -0.16) in children delivered by nonplanned cesarean section compared with children born vaginally. Children delivered by vacuum extraction had slightly lower grades at age 16 years compared with those born by noninstrumental vaginal delivery but very similar to those delivered by nonplanned cesarean. This suggests that vacuum extraction and nonplanned cesarean are equivalent alternatives for terminating deliveries with respect to cognitive outcomes.

Are Children of Immigrants Born in Sweden More Law-Abiding Than Immigrants? A Reconsideration

Previous Swedish studies have found that second-generation immigrants participate in offending less than first-generation immigrants, which is a striking finding from an international perspective. The aim of this study is to critically investigate the idea that second-generation immigrants have lower rates of registered offending than first-generation immigrants. The population of the present study consists of all 4.4 million persons who were registered as living in Sweden at the end of 1996. These people were followed for 5 years. During this time, 280,000 persons were registered for 1.5 million offenses. As far as the participation in overall offending is concerned the previous results were reproduced. However, when focusing on the offending rates in different offense types, the first-generation immigrants have the highest risks of being registered for violent crimes and second-generation immigrants with no Swedish-born parents have the highest risks for property crimes. The pattern found is further discussed in relation to the risk of second-generation immigrants with no Swedish-born parent to develop a criminal career and thereby frames the problem of criminality in culture differences, immigration policy, and so on.

Being born in Sweden increases the risk for type 1 diabetes – a study of migration of children to Sweden as a natural experiment

To investigate whether the age of first exposure to a high-incidence country like Sweden determines the risk of T1DM in children with an origin in a low incidence region of the world. Register study in a Swedish study population in the age 6-25 years in three categories of residents with an origin in low incidence regions of T1DM (Eastern Europe, East Asia, South Asia and Latin America); 24,252 international adoptees; 47,986 immigrants and 40,971 Swedish-born with two foreign-born parents and a comparison group of 1,770,092 children with Swedish-born parents. Retrieval of a prescription of insulin during 2006 was used as an indicator of T1DM and analysed with logistic regression. The odds ratios (OR) for T1DM were lower than the Swedish majority population for residents with an origin in the four low incidence regions. Being Swedish-born implied a higher risk for T1DM in the four low incidence study groups compared with the internationally adopted with an OR of 1.68 (CI 1.03-2.73). Being born in Sweden increases the risk for T1DM in children with an origin in low incidence countries. This may imply that exposures in utero or very early infancy are important risk factors for T1DM.

Do migrant studies help to identify causes of asthma?

Do migrant studies help to identify causes of asthma?

Migration and asthma medication in international adoptees and immigrant families in Sweden

Studies of asthma in migrant populations illustrate the effects of environmental changes. In this register study we investigated the importance of exposure to a western lifestyle in different phases of development in Swedish residents with an origin in regions in the world where asthma usually is less prevalent. The study population comprised 24,252 international adoptees, 47,986 foreign-born and 40,971 Swedish-born with foreign-born parents and 1,770,092 Swedish-born residents with Swedish-born parents (age 6-25 years). Purchased prescribed inhaled corticosteroids (ICS) during 2006 were used as an indicator of asthma. International adoptees and children born in Sweden by foreign-born parents had three- to fourfold higher rates of asthma medication compared with foreign-born children. The odds ratios (ORs) of asthma medication declined persistently with age at immigration. For adoptees the ORs compared with infant adoptees were 0.78 [95% confidence interval (CI) 0.71-0.85] for those adopted at 1-2 years, 0.51 (0.42-0.61) at 3-4 years and 0.35 (0.27-0.44) after 5 or more years of age. Corresponding ORs for foreign-born children with foreign-born parents immigrating at 0-4 years, at 5-9 years, at 10-14 years and at 15 years or more were 0.73 (0.63-0.86), 0.56 (CI 0.46-0.68) and 0.35 (CI 0.28-0.43), respectively. The ORs were only marginally affected by adjustment for region of birth and socio-economic indicators. Age at immigration is a more important determinant of purchased ICS than population of origin. This indicates the importance of environmental factors for asthma in schoolchildren and young adults.

Creating Egalitarian Families among the Adult Children of Turkish- and Polish-Origin Immigrants in Sweden

This article analyzes the factors shaping egalitarian family relationships among those with two Swedish-born parents and those with at least one parent born in Poland or Turkey. We ask: (1) What factors affect sharing domestic tasks and do they also shape the division of child care responsibilities? (2) Do these effects differ, depending on the extent of exposure to Swedish life? We analyze data from a longitudinal survey conducted between 1999 and 2003. Holding egalitarian work–family attitudes affects actual sharing of housework, but much more for those growing up in more socially integrated than in less integrated families.

Migration background: a risk factor for caries development during adolescence

The influence of child and parental migration background on the risk of approximal caries increment in Swedish adolescents was investigated. This retrospective longitudinal register-based cohort study included all 13-yr-old adolescents (n = 18,142) who were resident in the County of Stockholm, Sweden, in 2000, and followed them up to 19 yr of age. At follow-up, 15,538 subjects were examined. Caries data [decayed, missing, and filled teeth/surfaces (DMFT/S)], were collected from a dental database. Socio-demographic determinants were collected from Swedish National Registers. After adjustments for socio-demographic confounders, logistic regression analysis revealed that adolescents with foreign-born parents, irrespective of whether the child was born in Sweden or abroad, exhibited a significantly elevated risk for approximal caries increment (DMFSa > 0), and developed, on average, 0.53 and 1.14 more approximal caries lesions, respectively, compared with their counterparts with Swedish-born parents. Furthermore, adolescents born in eastern Europe exhibited an increased risk for approximal caries increment (DMFSa > 0) and developed, on average, 1.06 more approximal caries lesions compared with Swedish-born adolescents. In conclusion, parental migration background must be considered as a risk factor for caries development during adolescence, irrespective of whether or not the adolescent was born in Sweden.