Finn Diderichsen

Swedish population health-related quality of life results using the EQ-5D

Health-related quality of life (HRQoL) measured on population level may be useful to guide policies for health. This study aims to describe the HRQoL; in EQ-5D dimensions, mean rating scale (RS) scores and mean EQ-5D index values, in the general population, by certain disease and socio-economic groups, in Stockholm County 1998. The EQ-5D self-classifier and a RS were included in the 1998 cross-sectional postal Stockholm County public health survey to a representative sample (n = 4950, 20–88 years), 63% response rate. Mean RS score ranged from 0.90 (20–29 years) to 0.69 (80–88 years), mean EQ-5D index value ranged from 0.89 (20–29 years) to 0.74 (80–88 years). For different diseases mean RS scores ranged from 0.80 (asthma) to 0.69 (angina pectoris), mean EQ-5D index values ranged from 0.79 (asthma) to 0.66 (low back pain). The mean health state scores (RS and EQ-5D index) were 0.06 lower in the unskilled manual group than in the higher non-manual group after controlling for age and sex (p < 0.0001). This difference was 0.03 after controlling also for different diseases (p < 0.0001). In conclusion, our results show that the HRQoL varies greatly between socio-economic and disease groups. Furthermore, after controlling for age, sex and disease, HRQoL is lower in manual than in non-manual groups.

Physical, psychosocial, and organisational factors relative to sickness absence: a study based on Sweden Post

OBJECTIVE To analyse incidence of sickness for women and men relative to potential aetiological factors at work—physical, psychosocial, and organisational. METHODS The study group comprised 1557 female and 1913 male employees of Sweden Post. Sickness absence was measured by incidence of sickness (sick leave events and person-days at risk). Information on explanatory factors was obtained by a postal questionnaire, and incidence of sickness was based on administrative files of the company. RESULTS Complaints about heavy lifting and monotonous movements were associated with increased risk of high incidence of sickness among both women and men. For heavy lifting, an odds ratio (OR) of 1.70 (95% confidence interval (95% CI) 1.22 to 2.39) among women, and OR 1.70 (1.20 to 2.41) among men was found. For monotonous movements the risk estimates were OR 1.42 (1.03 to 1.97) and OR 1.45 (1.08 to 1.95) for women and men, respectively. Working instead of taking sick leave when ill, was more prevalent in the group with a high incidence of sickness (OR 1.74 (1.30 to 2.33) for women, OR 1.60 (1.22 to 2.10) for men). Overtime work of more than 50 hours a year was linked with low incidence of sickness for women and men. Among women, 16% reported bullying at the workplace, which was linked with a doubled risk of high incidence of sickness (OR 1.91 (1.31 to 2.77)). For men, the strongest association was found for those reporting anxiety about reorganisation of the workplace (OR 1.93 (1.34 to 2.77)). CONCLUSIONS Certain physical, psychosocial, and organisational factors were important determinants of incidence of sickness, independently of each other. Some of the associations were sex specific.

Health-related quality of life by disease and socio-economic group in the general population in Sweden

Measuring health-related quality of life (HRQoL) on population level, is becoming increasingly important for priority setting in health policy. In the health economics field, it is common to measure HRQoL in terms of health-state utilities or QoL weights. This study investigates the feasibility of obtaining mean QoL weights by mapping survey data to the generic HRQoL measure EQ-5D and to describe the HRQoL in terms of mean QoL weights in certain disease and socio-economic groups. Data from the 1996-1997 Survey of Living Conditions, interviews with a representative sample (16-84 years) of the Swedish population (n=11 698) were used. The mean QoL weight decreased from 0.91 among the youngest to 0.61 among the oldest, and was lower for women than for men. The QoL weight was 0.88 in the highest socio-economic group and 0.78 in the lowest socio-economic group. The QoL weight was lowest (0.38) among persons with depression and highest among persons with hypertension (0.71). The QoL weight decreased from 0.95 for persons with very good global self-rated health to 0.20 for persons with very poor global self-rated health. The results support the feasibility and validity of the mapping approach. HRQoL varies greatly between socio-economic groups and different disease groups.

Social policies and the pathways to inequalities in health: a comparative analysis of lone mothers in Britain and Sweden.

The aim of this study is to contribute to the emerging field of health inequalities impact assessment. It develops further a conceptual framework that encompasses the policy context as well as the pathways leading from social position to inequalities in health. It then uses this framework for a comparative analysis of social policies and their points of potential impact on the pathways leading from lone motherhood to ill health in Britain and Sweden. The British General Household Survey and the Swedish Survey of Living Conditions are analysed for the 17 years from 1979 to 1995/96. First, the results show that the health of lone mothers is poor in Sweden as well as in Britain and, most notably, that the magnitude of the differential between lone and couple mothers is of a similar order in Sweden as in Britain. This is despite the more favourable social policies in Sweden, which our results indicate have protected lone mothers from poverty and insecurity in the labour market to a much greater degree than the equivalent British policies over the 1980s and 1990s. Second, the pathways leading to the observed health disadvantage of lone mothers appear to be very different in the two countries in relation to the identified policy entry points. Overall, in Britain, around 50% of the health disadvantage of lone mothers is accounted for by the mediating factors of poverty and joblessness, whereas in Sweden these factors only account for between 3% and 13% of the health gap. The final section discusses the implications of the findings for future policy intervention and research in the two countries.

Social differences in traffic injury risks in childhood and youth—a literature review and a research agenda

Objectives—The paper reviews the scientific literature concerning social differences in traffic injuries in childhood in order to highlight the current state of knowledge and to draw the main lines of a research agenda. Method—A conceptual framework is used that identifies the mechanisms through which social context, social position, and various exposures may interact in the determination of health inequalities. It is used as a frame for presenting the evidence accumulated so far concerning social differences in traffic injury in childhood, including pedestrian, cyclist, and vehicle passenger injuries. Results—For most types of traffic injuries, mortality and morbidity are often higher among children from lower social positions and in more deprived socioeconomic areas. Whether the greater occurrence of injuries in deprived areas is a phenomenon attributable to the areas themselves, or merely a reflection of a wider pattern of injuries affecting lower socioeconomic groups, is unclear. There is evidence of an interaction effect between age and gender, and also between socioeconomic status and gender. Conclusions—The mechanisms leading to social inequalities in traffic injuries in childhood deserve greater scrutiny in future research. Further theoretical developments and empirical investigation will help define intervention needs and enable more effective targeted, long term prevention.

Higher relative, but lower absolute risks of myocardial infarction in women than in men: analysis of some major risk factors in the S heep study

Abstract. Reuterwall C, Hallqvist J, Ahlbom A, de Faire U, Diderichsen F, Hogstedt C, Pershagen G, Theorell T, Wiman B, Wolk A, the S heep Study Group (National Institute for Working Life; Karolinska Institute; Karolinska Hospital; and National Institute for Psychosocial Factors and Health, Solna; and the Stockholm County Council, Stockholm, Sweden). Higher relative, but lower absolute risks of myocardial infarction in women than in men: analysis of some major risk factors in the S heep study. J Intern Med 1999; 246: 161–174.

Unemployment and Early Cause-Specific Mortality: A Study Based on the Swedish Twin Registry

OBJECTIVES We investigated the association between unemployment and early cause-specific mortality to determine whether the relationship was modified by other risk indicators. METHODS Female and male twins (n=20632) were followed with regard to mortality from 1973 through 1996. Questionnaire data from 1973 were used to obtain information on experience of unemployment and on social, behavioral, health, and personality characteristics. RESULTS Unemployment was associated with an increased risk of suicide and death from undetermined causes. Low education, personality characteristics, use of sleeping pills or tranquilizers, and serious or long-lasting illness tended to strengthen the association between unemployment and early mortality. CONCLUSIONS An increased risk of death from external causes implies a need for support for those experiencing unemployment, particularly susceptible individuals.

Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? Results from Stockholm Heart Epidemiology Program (SHEEP).

The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45-64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8-30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25-50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.

How to evaluate interaction between causes : a review of practices in cardiovascular epidemiology

Hallqvist J et al. (Institute of Environmental Medicine and Department of International Health and Social Medicine, Karolinska Institute, Stockholm, Sweden). How to evaluate interaction between causes: a review of practices in cardiovascular epidemiology (Review). J Intern Med 1996; 239: 377–82.

Sexual activity as a trigger of myocardial infarction. A case-crossover analysis in the Stockholm Heart Epidemiology Programme (SHEEP)

OBJECTIVE To investigate sexual activity as a trigger of myocardial infarction and the potential effect modification of physical fitness. DESIGN A case-crossover study nested in the Stockholm Heart Epidemiology Programme (SHEEP). SETTING Stockholm County from April 1993 to December 1994. PATIENTS All patients with a first episode of non-fatal acute myocardial infarction admitted to coronary care units were eligible, and 699 patients participated in an interview. MAIN OUTCOME MEASURES Relative risks with 95% confidence intervals. RESULTS Only 1.3% of the patients without premonitory symptoms had sexual activity during two hours before the onset of myocardial infarction. The relative risk of myocardial infarction was 2.1 (95% confidence interval (CI) 0.7 to 6.5) during one hour after sexual activity, and the risk among patients with a sedentary life was 4.4 (95% CI 1.5 to 12.9). CONCLUSIONS The increased risk of myocardial infarction after sexual activity and the further increase in risk among the less physically fit support the hypothesis of causal triggering by sexual activity. However, the absolute risk per hour is very low, and exposure is relatively infrequent. Thus having sex once a week only increases the annual risk of myocardial infarction slightly. Counselling should focus on encouraging patients to live a physically active life and not on abstaining from sexual activity.