Anton Lager

Young people’s health : Health in Sweden: The National Public Health Report 2012. Chapter 3

Summary Over 18 per cent of Sweden’s population – approximately 1.8 million people – are 65 years of age or older. The proportion of elderly people in the population has been growing for more than a century and is expected to continue to rise given the gains in average life expec tancy and the fact that large age cohorts are reaching retirement age. The average remaining life expectancy among those who had reached the age of 65 in 2011 was 21 years for women and 18 years for men. The most common causes of death among elderly people are cardiovascular diseases and cancer. The risk of suffering a stroke or heart attack has declined and morbidity has shifted to the upper age groups. On the other hand, the cancer incidence has increased, while cancer mortality has declined, owing to earlier detection and more effective treatment. The most common forms of cancer among elderly people are prostate cancer, breast cancer, colorectal cancer, and lung cancer. There has been a rise in the proportion of elderly people who perceive their general state of health as good. In the case of women, however, the increase is mainly noticeable among younger pensioners, while in men, it is spread across all age groups, according to the Statistics Sweden’s Survey of Living Conditions (ULF). The percentage of elderly people reporting long-term illness has risen, while the proportion with illnesses or complaints that interfere with daily life activities has declined. The percentage of people suffering from impaired mobility has fallen since the 1980s, while pain issues have remained at about the same level. Reports of nervousness, anxiety and sleeping

The association of early IQ and education with mortality: 65 year longitudinal study in Malmö, Sweden

Objectives To establish whether differences in early IQ explain why people with longer education live longer, or whether differences in father’s or own educational attainment explain why people with higher early IQ live longer. Design Population based longitudinal study. Mortality risks were estimated with Cox proportional hazards regressions. Setting Malmö, Sweden. Participants 1530 children who took IQ tests at age 10 and were followed up until age 75. Results Own educational attainment was negatively associated with all cause mortality in both sexes, even when early IQ and father’s education were adjusted for (hazard ratio (HR) for each additional year in school 0.91 (95% CI 0.85 to 0.97) for men and HR 0.88 (95 % CI 0.78 to 0.98) for women). Higher early IQ was linked with a reduced mortality risk in men, even when own educational attainment and father’s education were adjusted for (HR for one standard deviation increase in IQ 0.85 (95 % CI 0.75 to 0.96)). In contrast, there was no crude effect of early IQ for women, and women with above average IQ had an increased mortality risk when own educational attainment was adjusted for, but only after the age of 60 (HR 1.60 (95 % CI 1.06 to 2.42)). Adding measures of social career over and above educational attainment to the model (for example, occupational status at age 36 and number of children) only marginally affected the hazard ratio for women with above average IQ (<5%). Conclusions Mortality differences by own educational attainment were not explained by early IQ. Childhood IQ was independently linked, albeit differently, to male adult mortality and to female adult mortality even when father’s education and own educational attainment was adjusted for, thus social background and own social career seem unlikely to be responsible for mortality differences by childhood IQ. The clear difference in the effect of IQ between men and women suggests that the link between IQ and mortality involves the social and physical environment rather than simply being a marker of a healthy body to begin with. Cognitive skills should, therefore, be addressed in our efforts to create childhood environments that promote health.

Children's overweight and obesity : local and national monitoring using electronic health records

Aim: To test the feasibility of a system for monitoring childrens obesity and overweight based on data from electronic health records in the school health services. Methods: Data on weight and height from electronic health records at school health services were collected for 10-year-olds in 2003—2004, 2004—2005 and 2005—2006. School health personnel extracted group-level data with a simple program installed on the computer containing the health records. Four Swedish municipalities were included in the study: Karlstad, Umeå, Västerås, and Ystad. Results: The system achieved coverage of 92—96% of all children in 2005—2006. The overall prevalence rates were 4.2% (3.8—4.7%) obese and 22.0% (21.1—23.0%) overweight, including obesity. Conclusions: A system based on electronic health records from the school health services can successfully provide data. The system has practical, economical and ethical strengths.

Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes : Results from five pooled cohorts

Smoking and nicotine exposure increase insulin resistance and the risk of type 2 diabetes. Swedish smokeless tobacco (snus) is high in nicotine, and its use is prevalent in Scandinavian countries, but few studies have investigated snus use in relation to diabetes risk.

Cognitive and emotional outcomes after prolonged education: a quasi-experiment on 320 182 Swedish boys

Abstract Background: Cognitive and socio-emotional abilities are powerful predictors of death and disease as well as of social and economic outcomes. Education is societies’ main way of promoting these abilities, ideally so that inequalities by socioeconomic background are reduced. However, the extent to which education serves these cognitive, social-emotional and equality objectives is relatively unknown and intensively debated. Drawing on a Swedish school reform that was explicitly designed as a massive quasi-experiment, we assessed differential impact of education on intelligence and emotional control across childhood socioeconomic position. We also assessed initial differences in abilities by childhood socioeconomic position and how well childhood socioeconomic position and abilities predict all-cause mortality. Methods: The Swedish comprehensive school reform, rolled out during the 1950s, extended compulsory education from 8 to 9 years in some municipalities whereas others were kept as controls for the sake of evaluation. We followed eight full cohorts of Swedish boys born between 1951 and 1958, who lived in 1017 municipalities with known experimental status (344 336 boys) and whose childhood socioeconomic position was known (320 182 boys). At conscription, intelligence was measured by four subtests and emotional control (calm and efficient responses in various situations) was rated by a military psychologist. Both measures were standardized to have a mean of 100 and standard deviation of 15. All-cause mortality was recorded until 49–56 years of age. Results: The reform had an average positive impact on intelligence of 0.75 IQ units (95% confidence interval (CI): 0.54, 0.97; P < 0.0005). The impact on emotional control was negative; −0.50 units (95% CI: −0.72, −0.28; P < 0.0005). Both effects differed by socioeconomic background so that the average IQ difference between sons of high non-manual and unqualified manual workers was reduced from 16.32 to 15.57 units and the difference in emotional control was reduced from 6.50 to 5.63 units. All-cause mortality was predicted by low childhood socioeconomic position [hazard ratio (HR) = 1.15 [95% CI: 1.11, 1.20], P < 0.0005], low intelligence [HR = 1.39 (95% CI: 1.34, 1.44), P < 0.0005] as well as low emotional control [HR = 1.61 (95% CI: 1.55, 1.67), P < 0.0005] in mutually adjusted models. Conclusions: Extending compulsory education promoted intelligence but lowered emotional control, and reduced disparities over social background in both. Emotional control was the strongest predictor of all-cause mortality. Our results are in line with the idea that education is important in our efforts to achieve healthy, competent and fair societies, but much more work is needed to understand the links between education and non-cognitive skills.

Intelligence and mortality. Only ignorance stops progress.

In their editorial Batty and colleagues discussed our work on intelligence and mortality, concluding that “efforts to reduce inequalities should continue to be broadly based, including educational opportunities and interventions initiated in early life.”1 2 We fully agree, but we wonder whether this conclusion is consistent with their reasoning, particularly …

Diabetes mellitus and hyperlipidaemia as risk factors for frequent pain in the back, neck and/or shoulders/arms among adults in Stockholm 2006 to 2010 – Results from the Stockholm Public Health Cohort

Abstract Background and aims Frequent back, neck and/or shoulder pain (BNSP) are common conditions which pose high burden for the society. Results from previous studies suggest that diabetes and hyperlipidaemia may be associated with a higher risk of getting such conditions, but there is in general, few studies based on longitudinal designs. The aim of this study was therefore to compare the risk of developing frequent BNSP in men and women with and without diabetes and/or hyperlipidaemia. Methods A longitudinal study based on the Stockholm Public Health Cohort was conducted based on subjects aged 45–84, who were free from pain at the mentioned sites in 2006 and followed up until 2010. The data in the current study is based on questionnaires, except socioeconomic status which was derived from Statistics Sweden. The exposure diabetes and hyperlipidaemia was self-reported and, a categorical variable was created; without any of the conditions, with hyperlipidaemia only, with diabetes only and with both conditions. The outcome frequent BNSP was defined using the following questions in the questionnaire in 2010: “During the past 6 months, have you had pain in the neck or upper part of the back?”, “During the past 6 months, have you had pain in the lower back?”, and “During the past 6 months, have you had pain in the shoulders/arms?”. All questions had three possible response options: no; yes, a couple of days per month or less often and; yes, a couple of days per week or more often. Those who reported weekly pain to at least one of these questions were considered to having frequent BNSP. Binomial regressions were run to calculate the crude and adjusted risk ratio (RR) in men and women separately. Additional analysis was performed in order to control for potential bias derived from individuals lost to follow-up. Results A total of 10,044 subjects fulfilled the criteria to be included in the study. The mean age of the sample was 60 years and evenly distributed by sex. After adjusting for age, body mass index, physical activity, high blood pressure and socioeconomic status, the RR for frequent BNSP among men with diabetes was 1.64 (95% CI: 1.23–2.18) and 1.19 (95% CI: 0.98–1.44) for hyperlipidaemia compared to men with neither diabetes nor hyperlipidaemia. Among women the corresponding RRs were 0.92 (95% CI: 0.60–1.14) and 1.23 (95% CI: 1.03–1.46). Having both diabetes and hyperlipidaemia at baseline was not associated with increased risk of frequent BNSP. Diabetes and hyperlipidaemia seems to be associated with an increased risk for frequent BNSP and the risk may differ between men and women. Behaviours and/or biological underlying mechanisms may explain the results. Conclusions This study suggests that metabolic diseases such as diabetes and hyperlipidaemia may have an impact on the pathophysiology of frequent BNSP and thus, contributes to the knowledge in musculoskeletal health. Furthermore, it confirms that men and women may differ in terms of risk factors for BNSP. Implications Health professionals should contemplate the results from this study when planning primary prevention strategies.

Use of moist oral snuff (snus) and pancreatic cancer : Pooled analysis of nine prospective observational studies

While smoking is a well‐established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between Swedish snus use and the risk of pancreatic cancer. A total of 424,152 male participants from nine cohort studies were followed up for risk of pancreatic cancer through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. During 9,276,054 person‐years of observation, 1,447 men developed pancreatic cancer. Compared to never‐snus use, current snus use was not associated with risk of pancreatic cancer (HR 0.96, 95% CI 0.83–1.11) after adjustment for smoking. Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer.

Suicide attempt predicted by academic performance and childhood IQ: a cohort study of 26 000 children

Academic performance in youth, measured by grade point average (GPA), predicts suicide attempt, but the mechanisms are not known. It has been suggested that general intelligence might underlie the association.

Moist smokeless tobacco (Snus) use and risk of Parkinson’s disease

Background Cigarette smoking is associated with a lower risk of Parkinsons disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinsons disease. Methods Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinsons disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking. Results During a mean follow-up time of 16.1 years, 1199 incident Parkinsons disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinsons disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinsons disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83). Conclusions Non-smoking men who used snus had a substantially lower risk of Parkinsons disease. Results also indicated an inverse dose-response relationship between snus use and Parkinsons disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinsons disease.