Else-Karin Grøholt

Recurrent pain in children, socio-economic factors and accumulation in families.

The aim of this study was to estimate the prevalence of parent-reported pain among children in the Nordic countries in 1996, and to describe the association between recurrent pain in children and parental socio-economic factors. We also wanted to estimate the association between parental pain and childhood pain and co-occurrence of different pain patterns in the same child. Data were obtained from a cross-sectional survey on childrens health and well-being in the Nordic countries in 1996. About 10, 000 children aged 2–17 years of age were selected from population registries. Mean response rate was 68%. We selected the cases ≥7 years where the respondent was the childs biological mother or father, yielding a total of 6230 subjects. The adjusted analyses were performed using logistic regression in SPSS. The total prevalence of headache, abdominal pain and back pain among children 7–17 years of age was 14.9, 8.3 and 4.7%, respectively. The most common pain combination was headache and abdominal pain. Pain was most frequent among girls. The prevalence was slightly higher in low educated or low-income families compared to those of high status. Children living in low educated, low-income, worker families had approximately a 1.4-fold odds of having pain. There was a strong association between the different pain conditions, and between pain and other forms of distress in the same child. A site-specific association between parental and child pain was also shown, but we assume that this might have been mediated through subjective (information) bias.

Educational inequalities in mortality over four decades in Norway: prospective study of middle aged men and women followed for cause specific mortality, 1960-2000.

Objectives To determine the extent to which educational inequalities in relation to mortality widened in Norway during 1960-2000 and which causes of death were the main drivers of this disparity. Design Nationally representative prospective study. Setting Four cohorts of the Norwegian population aged 45-64 years in 1960, 1970, 1980, and 1990 and followed up for mortality over 10 years. Participants 359 547 deaths and 32 904 589 person years. Main outcome measures All cause mortality and deaths due to cancer of lung, trachea, or bronchus; other cancer; cardiovascular diseases; suicide; external causes; chronic lower respiratory tract diseases; or other causes. Absolute and relative indices of inequality were used to present differences in mortality by educational level (basic, secondary, and tertiary). Results Mortality fell from the 1960s to the 1990s in all educational groups. At the same time the proportion of adults in the basic education group, with the highest mortality, decreased substantially. As mortality dropped more among those with the highest level of education, inequalities widened. Absolute inequalities in mortality denoting deaths among the basic education groups minus deaths among the high education groups doubled in men and increased by a third in women. This is equivalent to an increase in the slope index of inequality of 105% in men and 32% in women. Inequalities on a relative scale widened more, from 1.33 to 2.24 among men (P=0.01) and from 1.52 to 2.19 among women (P=0.05). Among men, absolute inequalities mainly increased as a result of cardiovascular diseases, lung cancer, and chronic lower respiratory tract diseases. Among women this was mainly due to lung cancer and chronic lower respiratory tract diseases. Unlike the situation in men, absolute inequalities in deaths due to cardiovascular causes narrowed among women. Chronic lower respiratory tract diseases contributed more to the disparities in inequalities among women than among men. Conclusion All educational groups showed a decline in mortality. Nevertheless, and despite the fact that the Norwegian welfare model is based on an egalitarian ideology, educational inequalities in mortality among middle aged people in Norway are substantial and increased during 1960-2000.

Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study

Objectives To assess the association of Apgar score 5 minutes after birth with cerebral palsy in both normal weight and low birthweight children, and also the association with the cerebral palsy subdiagnoses of quadriplegia, diplegia, and hemiplegia. Design Population based cohort study. Setting The Medical Birth Registry of Norway was used to identify all babies born between 1986 and 1995. These data were linked to the Norwegian Registry of Cerebral Palsy in Children born 1986-95, which was established on the basis of discharge diagnoses at all paediatric departments in Norway. Population All singletons without malformations born in Norway during 1986-95 and who survived the first year of life (n=543 064). Main outcome measure Cerebral palsy diagnosed before the age of 5 years. Results 988 children (1.8 in 1000) were diagnosed with cerebral palsy before the age of 5 years. In total, 11% (39/369) of the children with Apgar score of less than 3 at birth were diagnosed with cerebral palsy, compared with only 0.1% (162/179 515) of the children with Apgar score of 10 (odds ratio (OR) 53, 95% CI 35 to 80 after adjustment for birth weight). In children with a birth weight of 2500 g or more, those with an Apgar score of less than 4 were much more likely to have cerebral palsy than those who had an Apgar score of more than 8 (OR 125, 95% confidence interval 91 to 170). The corresponding OR in children weighing less than 1500 g was 5 (95% CI 2 to 9). Among children with Apgar score of less than 4, 10-17% in all birthweight groups developed cerebral palsy. Low Apgar score was strongly associated with each of the three subgroups of spastic cerebral palsy, although the association was strongest for quadriplegia (adjusted OR 137 for Apgar score <4 v Apgar score >8, 95% CI 77 to 244). Conclusions Low Apgar score was strongly associated with cerebral palsy. This association was high in children with normal birth weight and modest in children with low birth weight. The strength of the association differed between subgroups of spastic cerebral palsy. Given that Apgar score is a measure of vitality shortly after birth, our findings suggest that the causes of cerebral palsy are closely linked to factors that reduce infant vitality.

Overweight and obesity among adolescents in Norway: cultural and socio-economic differences

BACKGROUND The aim of this study was to investigate overweight and obesity among a representative population of 15,966 Norwegian 15-16 year olds and the associations with different socio-economic and cultural risk factors. METHODS Self-reported data were obtained from school-based surveys in six counties during 2000-04. Overweight and obesity were calculated using Coles index. RESULTS The prevalence of overweight and obesity were 11.8% and 2.4%, respectively, higher among boys. Logistic regression analyses revealed that adolescents in Nordland, Troms and Finnmark (the northernmost counties) were 70-90% more likely to be overweight and obese compared with adolescents in Oslo (the capital and southernmost county) (OR for overweight in Finnmark = 1.7, CI = 1.3, 2.3). Lower educational plans and poor family economy were both significantly associated with overweight and obesity. So was physical inactivity (OR = 1.2, CI = 1.1, 1.3 and OR = 1.6, CI = 1.2, 2.1, respectively). Eating breakfast was positively associated with not being overweight/obese. CONCLUSION Overweight and obesity is associated with socio-economic factors and with factors related to food habits and nutrition, suggesting important areas for prevention.

Trends in educational inequalities in cause specific mortality in Norway from 1960 to 2010: a turning point for educational inequalities in cause specific mortality of Norwegian men after the millennium?

BackgroundEducational inequalities in total mortality in Norway have widened during 1960–2000. We wanted to investigate if inequalities have continued to increase in the post millennium decade, and which causes of deaths were the main drivers.MethodsAll deaths (total and cause specific) in the adult Norwegian population aged 45–74 years over five decades, until 2010 were included; in all 708,449 deaths and over 62 million person years. Two indices of inequalities were used to measure inequality and changes in inequalities over time, on the relative scale (Relative Index of Inequality, RII) and on the absolute scale (Slope Index of Inequality, SII).ResultsRelative inequalities in total mortality increased over the five decades in both genders. Among men absolute inequalities stabilized during 2000–2010, after steady, significant increases each decade back to the 1960s, while in women, absolute inequalities continued to increase significantly during the last decade. The stabilization in absolute inequalities among men in the last decade was mostly due to a fall in inequalities in cardiovascular disease (CVD) mortality and lung cancer and respiratory disease mortality. Still, in this last decade, the absolute inequalities in cause-specific mortality among men were mostly due to cardiovascular diseases (CVD) (34% of total mortality inequality), lung cancer and respiratory diseases (21%). Among women the absolute inequalities in mortality were mostly due to lung cancer and chronic lower respiratory tract diseases (30%) and CVD (27%).ConclusionsIn men, absolute inequalities in mortality have stopped increasing, seemingly due to reduction in inequalities in CVD mortality. Absolute inequality in mortality continues to widen among women, mostly due to death from lung cancer and chronic lung disease. Relative educational inequalities in mortality are still on the rise for Norwegian men and women.

Adiposity among children in Norway by urbanity and maternal education: a nationally representative study

BackgroundInternational research has demonstrated that rural residency is a risk factor for childhood adiposity. The main aim of this study was to investigate the urban-rural gradient in overweight and obesity and whether the association differed by maternal education.MethodsHeight, weight and waist circumference (WC) were measured in a nationally representative sample of 3166 Norwegian eight-year-olds in 2010. Anthropometric measures were stratified by area of residence (urbanity) and maternal education. Risk estimates for overweight (including obesity) and waist-to-height ratio ≥0.5 were calculated by log-binomial regression.ResultsMean BMI and WC and risk estimates of overweight (including obesity) and waist-to-height ratio ≥0.5 were associated with both urbanity and maternal education. These associations were robust after mutual adjustment for each other. Furthermore, there was an indication of interaction between urbanity and maternal education, as trends of mean BMI and WC increased from urban to rural residence among children of low-educated mothers (p = 0.01 for both BMI and WC), whereas corresponding trends for children from higher educational background were non-significant (p > 0.30). However, formal tests of the interaction term urbanity by maternal education were non-significant (p-value for interaction was 0.29 for BMI and 0.31 for WC).ConclusionsIn this nationally representative study, children living rurally and children of low-educated mothers had higher mean BMI and waist circumference than children living in more urban areas and children of higher educated mothers.

Parental marital status and childhood overweight and obesity in Norway: a nationally representative cross-sectional study

Objective Sociodemographic changes in Norway and other western industrialised countries, including family structure and an increasing proportion of cohabiting and divorced parents, might affect the prevalence of childhood overweight and obesity issues. We aimed to examine whether parental marital status was associated with general and abdominal obesity among children. We also sought to explore whether the associations differed by gender. Design Cross-sectional. Setting 127 primary schools across Norway. Participant 3166 third graders (mean age 8.3 years) participating in the nationally representative Norwegian Child Growth Study in 2010. Measurements Height, weight and waist circumference were objectively measured. The main outcome measures were general overweight (including obesity; body mass index ≥25 kg/m2) using International Obesity Task Force (IOTF) cut-offs and abdominal obesity (waist-to-height ratio ≥0.5) by gender and parental marital status. Prevalence ratios, adjusted for possible confounders, were calculated by log-binomial regression. Results General overweight (including obesity) was 1.54 (95% CI 1.21 to 1.95) times more prevalent among children of divorced parents compared with children of married parents, and the corresponding prevalence ratio for abdominal obesity was 1.89 (95% CI 1.35 to 2.65). Formal tests of the interaction term parental marital status by gender were not statistically significant. However, in gender-specific analyses the association between parental marital status and adiposity measures was only statistically significant in boys (p=0.04 for general overweight (including obesity) and p=0.01 for abdominal obesity). The estimates were robust against adjustment for maternal education, family country background and current area of residence. Conclusions General and abdominal obesities were more prevalent among children of divorced parents. This study provides valuable information by focusing on societal changes in order to identify vulnerable groups.

Impact of instrument error on the estimated prevalence of overweight and obesity in population-based surveys

BackgroundThe basis for this study is the fact that instrument error increases the variance of the distribution of body mass index (BMI). Combined with a defined cut-off value this may impact upon the estimated proportion of overweight and obesity. It is important to ensure high quality surveillance data in order to follow trends of estimated prevalence of overweight and obesity. The purpose of the study was to assess the impact of instrument error, due to uncalibrated scales and stadiometers, on prevalence estimates of overweight and obesity.MethodsAnthropometric measurements from a nationally representative sample were used; the Norwegian Child Growth study (NCG) of 3474 children. Each of the 127 participating schools received a reference weight and a reference length to determine the correction value. Correction value corresponds to instrument error and is the difference between the true value and the measured, uncorrected weight and height at local scales and stadiometers. Simulations were used to determine the expected implications of instrument errors. To systematically investigate this, the coefficient of variation (CV) of instrument error was used in the simulations and was increased successively.ResultsSimulations showed that the estimated prevalence of overweight and obesity increased systematically with the size of instrument error when the mean instrument error was zero. The estimated prevalence was 16.4% with no instrument error and was, on average, overestimated by 0.5 percentage points based on observed variance of instrument error from the NCG-study. Further, the estimated prevalence was 16.7% with 1% CV of instrument error, and increased to 17.8%, 19.5% and 21.6% with 2%, 3% and 4% CV of instrument error, respectively.ConclusionsFailure to calibrate measuring instruments is likely to lead to overestimation of the prevalence of overweight and obesity in population-based surveys.

Trends in educational inequalities in old age mortality in Norway 1961−2009: a prospective register based population study

BackgroundThe vast majority of deaths occur in older adults. Paradoxically, knowledge on long-term trends in mortality inequalities among the aged, and particularly for those aged 80 years and over, is sparse. The historical trends in size and impact of socioeconomic inequalities on old age mortality are important to monitor because they may give an indication on future burden of inequalities. We investigated trends in absolute and relative educational inequalities in old age mortality in Norway between 1961 and 2009.MethodsWe did a register-based population study covering the entire Norwegian population aged 65-94 in the years 1961−2009 (1,534,513 deaths and 29,312,351 person years at risk). By examining 1-year mortality rates by gender, age and educational level we estimated trends in mortality rate ratios and rate differences.ResultsOn average, age-standardised absolute inequalities increased by 0.17 deaths per 1000 person-years per year in men (P<0.001), and declined by 0.07 deaths per 1000 person-years per year in women (P<0.001). Trends in rate differences were largest in men aged 75−84 years, but differed in direction by age group in women. The corresponding mean increase in age-standardised relative inequalities was 0.4% and 0.1% per year in men and women, respectively (P<0.001). Trends in rate ratios were largest in the youngest age groups for both genders and negligible among women aged 85−94 years.ConclusionsWhile relative educational inequalities in old age mortality increased for both genders, absolute educational inequalities increased only temporarily in men and changed little among women. Our study show the importance of including absolute measures in inequality research in order to present a more complete picture of the burden of inequalities to policy makers. As even in older ages, inequalities represent an unexploited potential to public health, old age inequalities will become increasingly important as many countries are facing aging populations.

Norhealth: Norwegian health information system.

Norhealth (www.norgeshelsa.no) is a web-based health information system that monitors health and health related conditions, including risk- and protective factors, over time. Norhealth was developed to create a knowledge base for health promotion and prevention strategies in Norway and is targeted at politicians, decision makers, media, students and health professionals. Norhealth has a Norwegian and English version. Users of Norhealth can create their own tables, graphs, time series, maps and radar diagrams. Most Norhealth elements can be exported to PDF and tables can also be exported to Excel. Norhealth elements can also be pasted into Word or PowerPoint. Norhealth has 40 health indicators, but aims to reach 70. The indicator list corresponds roughly to the European Community Health Indicators (ECHI) short list. Data is presented at the national and regional level and by age group and gender. Around 50 fact sheets are written in Norwegian. Future developments include linking fact sheets to figures in Norhealth, writing annual health reports, translating fact sheets to English, improving user friendliness, adding more health indicators and monitoring social inequalities in health. Conclusions: Norhealth is an interactive web-based health information system that was developed to create a knowledge base for health promotion and prevention strategies in Norway.