Hans Magne Gravseth

Suicide in young Norwegians in a life course perspective: population-based cohort study

Background Suicide is a leading cause of death in young adults. Several risk factors are well known, especially those related to adult mental health. However, some risk factors may have their origin in the very beginning of life. This study examines suicide in the general Norwegian population in a life course perspective, with a main focus on early life factors. Methods In this study, several national registers were linked, supplying personal data on biological and social variables from childhood to young adult age. Participants were all Norwegians live born during the period 1967–1976, followed up through 2004. Persons who died or emigrated before the year of their 19th birthday, at which age follow-up started, were excluded. Thus, the study population comprised 610 359 persons, and the study outcome was completed suicide. Results 1406 suicides (0.23%) were recorded, the risk being four times higher in men than in women. Suicide risk factors included not being firstborn (adjusted HR in men and women (95% CIs): 1.19 (1.05 to 1.36) and 1.42 (1.08 to 1.88)), instability of maternal marital status during childhood, parental suicide (mainly in women), low body mass index (only investigated in men), low education and indications of severe mental illness. Conclusions Suicide in young adults may be rooted in early childhood, and the effect is likely to act through several mechanisms, some of which may be linked to the composition and stability of the parental home. A life course perspective may add to our understanding of suicide.

Influence of physical, mental and intellectual development on disability in young Norwegian men.

BACKGROUND Few studies have examined the effects of educational level, intellectual performance, mental function, body mass index and height as well as their interrelationship on the risk of disability pension (DP), taking other life course factors into account. METHODS We linked several national registers, comprising the Medical Birth Registry, the Central Population Register, the Education Register, the Norwegian Labour and Welfare Organisation and the Norwegian Armed Forces Personnel Data Base, providing personal data on biological and social variables from childhood to young adult age. Participants were all males live born during the period 1967-76, followed up through 2003. Men were excluded who died, emigrated or were granted a DP until age 23 years (when follow-up started) and persons who did not become gainfully employed during the study period. Thus, the study population comprised 302 330 men, and the study outcome was being granted a DP after age 23 years. RESULTS 3651 men (1.2%) were granted a DP. The DP rate was inversely associated with both educational level and intellectual performance. The adjusted population attributable risks (PAR) values for these two variables were 47% and 35%, respectively. The effect of the other variables was modest. Over- and underweight and short stature were associated with DP, but the effect was largely reduced after adjusting for intellectual performance. Impaired mental function seemed to have an independent effect. CONCLUSION Receiving an early DP is dependent on several factors acting at different stages of life, above all educational level and intellectual performance. High education can modify some of the effects of low intellectual performance.

Risk factors for long-term absence due to psychiatric sickness: a register-based 5-year follow-up from the Oslo health study.

Objective: To identify individual and work-related predictors of long-term (>8 weeks) sickness absence with psychiatric diagnoses (LSP). Methods: Data from the Oslo Health Study (response rate 46%) were linked to public registers. A total of 8333 subjects were followed from 2001 through 2005. Cox regression was used to compute hazard ratios for LSP. Results: At least one LSP was present in 7.8% of women and 3.9% of men. Poor support from superior had an independent and moderate effect. Path and linear regression analyses indicated that the effect of support from superior was mediated through mental distress and not the other way around. Self-reported mental distress had a strong independent effect. Conclusions: Women had a higher risk of LSP than men. Low education and poor support from superior and mental distress were found to be determinants of LSP.

Trends in incidence of occupational asthma, contact dermatitis, noise-induced hearing loss, carpal tunnel syndrome and upper limb musculoskeletal disorders in European countries from 2000 to 2012

Objectives The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries. Methods OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of ‘centres’, requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules. Results Reports of contact dermatitis and asthma, conditions with shorter time between exposure to causal substances and OD, were consistently declining with only a few exceptions. For OD with physical causal exposures there was more variation between countries. Reported NIHL was increasing in Belgium, Spain, Switzerland and the Netherlands and decreasing elsewhere. Trends in CTS and upper limb musculoskeletal disorders varied widely within and between countries. Conclusions This is the first direct comparison of trends in OD within Europe and is consistent with a positive impact of European initiatives addressing exposures relevant to asthma and contact dermatitis. Taking a more flexible approach allowed comparisons of surveillance data between and within countries without harmonisation of data collection methods.

Epidemiology of trauma: a population-based study of geographical risk factors for injury deaths in the working-age population of Norway.

INTRODUCTION Trauma is a major global cause of morbidity and mortality. Population-based studies identifying high-risk populations and regions may facilitate primary prevention and the development of optimal trauma systems. This study describes the epidemiology of adult trauma deaths in Norway and identifies high-risk areas by assessing different geographical measures of rurality. METHODS All trauma-related deaths in Norway from 1998 to 2007 among individuals aged 16-66 years were identified by accessing national registries. Mortality data were analysed by linkage to population and geographical data at municipal, county and national levels. Three measures of rurality (centrality, population density and settlement density) were compared based on their association with trauma mortality rates. RESULTS The study included 8466 deaths, of which 78% were males. The national annual trauma mortality rate was 28.7 per 100,000. Population density was the best predictor of high-risk areas, and there was a consistent inverse relationship between mortality rates and population density. The most rural areas had 52% higher trauma mortality rates compared to the most urban areas. This difference was largely due to deaths following transport-related injury. Seventy-eight per cent of all deaths occurred in the prehospital phase. Rural areas and death following self-harm had higher proportion of prehospital deaths. CONCLUSION Rural areas, as defined by population density, are at a higher risk of deaths following traumatic injuries and have higher proportions of prehospital deaths and deaths following transport-related injuries. The heterogeneous characteristics of trauma populations with respect to geography and mode of injury should be recognised in the planning of preventive strategies and in the organisation of trauma care.

Influence of early life factors on social inequalities in psychiatric outcomes among young adult Norwegian men

Background: Social inequalities in health can to a substantial degree be explained by social causation. However, indirect selection by early life factors has been suggested. The main aim of this study was to estimate how much adult social gradients in selected psychiatric outcomes depended on parental and individual characteristics in early life. Methods: The population comprised all males born in Norway 1967–71 (n = 170 678). We compiled data on several social and biological variables from birth onwards from different national registers. Health outcomes were collected from the Cause of Death Register (suicide) and the Labour and Welfare Administration (psychiatric disability, psychiatric sickness absence). Indicator of socio-economic position was education level at the age of 28 years. Men were followed up between 4 and 9 years from the age of 29 years. Results: Crude rates per 100 000 person-years were 21.8 (suicide), 145.7 (disability) and 1164.7 (sickness absence). Social inequalities were strong and consistent for all outcomes. Parental and individual characteristics accounted for a substantial part of the social inequalities in neurosis or personality disorder disability (44.1%) and a moderate role for inequalities in psychiatric sickness absence (25.6%), schizophrenia disability (20.7%) and suicide (17.4%). General ability at the age of 18 years had strongest influence on the social health gradients. Suicide and schizophrenia disability were associated with a combination of high parental and low own education level. Conclusion: This study indicates that indirect selection explains a substantial part of social inequalities in certain psychiatric outcomes and that early life prevention is important to reduce health gradients.

Social inequalities in road traffic deaths at age 16–20 years among all 611 654 Norwegians born between 1967 and 1976: a multilevel analysis

Background Road traffic injury is a major cause of death among youths. Aims To estimate mortality differences in family socioeconomic position (SEP) and municipal disadvantage level. Methods Data on all Norwegians born in 1967–76, gathered from national registries, were linked by a unique national identification number. The 611 654 participants were followed-up for 5 years from age 16 years. Parental education level, fathers income level, and proportion of high-income earners in the municipality served as SEP indicators. Associations between SEP and road traffic deaths were analysed by multilevel Poisson regression. Results Road traffic deaths (n=676, rate 22.2 per 100 000 person-years) constituted a major cause of death, of which 91.9% were motor vehicle occupants. SEP distributions differed according to gender and type of motor vehicle crash (collision, non-collision). There was an inverse relationship between municipal proportions of high-income earners and mortality (population attributable fraction (PAF) 0.43, 95% CI 0.30 to 0.53) in all categories of gender-specific crash types. Family SEP gradients were not found except for male non-collision deaths, where increasing mortality was found in association with decreasing parental education level (PAF 0.94, 95% CI 0.59 to 0.99) and increasing paternal income (PAF 0.25, 95% CI 0.06 to 0.40). Conclusion The different SEP patterns for road traffic deaths across gender and motor vehicle crash type illustrate that heterogeneity of social inequalities in health can be found even within narrow age bands and for similar causes of death.

Educational attainment of Norwegian men: influence of parental and early individual characteristics.

The life course perspective in social inequalities in health research has resulted in an increased interest in status attainment processes. Adult status is commonly measured as occupational class, income level or educational attainment, and the latter was applied in this study. The study objective was to estimate the relative contribution of parental and early individual characteristics on educational attainment. The study population comprised all males born in Norway in 1967-1971, and alive at age 28 years (n=160,914). Data on social and biological variables were compiled from birth onwards in several national registers. Information on educational attainment at age 28 years was derived from Statistics Norway. Mean years of education was 12.62 years (SD 2.24). Educational attainment was strongly associated with general ability score at age 18 years and parental educational attainment. Parental income had more limited influence; all other early factors had only marginal effect. Path analysis results suggest that the direct effect of general ability was of the same size as the combined direct and indirect effect of parental education and income. The results suggest that status attainment in this young male population is mainly dependent on general ability and parental education level.

Paediatric trauma mortality in Norway: A population-based study of injury characteristics and urban–rural differences

INTRODUCTION Paediatric injury is a major global public health challenge. Epidemiological research is required for effective primary injury prevention and to develop trauma systems for optimal management of childhood injuries. This study aimed to describe the characteristics and geographical distribution of paediatric trauma deaths and to assess the relationship between rural locations and mortality rates. MATERIALS AND METHODS By accessing national registries, all trauma related deaths of persons aged 0-15 years in Norway from 1998 to 2007 were included. Paediatric trauma mortality rates and injury characteristic were analysed in relation to three different measures of municipal rurality: centrality, population density and settlement density. RESULTS There were 462 trauma related deaths during the study period and the national annual paediatric mortality rate was 4.81/100000. Rural areas had higher mortality rates, and this difference was best predicted by municipal centrality. Rural trauma was characterised by traffic accidents and deaths that occurred prior to reaching hospital. The rural and northernmost county, Finnmark, had a mortality rate three times the national average. CONCLUSION Mortality rates after childhood injury are high in rural areas. Substantiated measures of rurality are required for optimal allocation of primary and secondary preventive measures.

Work-related psychosocial risk factors for long-term sick leave: a prospective study of the general working population in Norway.

Objective: To examine the effect of work-related psychosocial exposures on long-term sick leave (LTSL) in the general working population. Methods: A prospective study of the general working population in Norway. Eligible respondents were interviewed in 2009 and registered with at least 100 working days in 2009 and 2010 (n = 6758). The outcome was medically confirmed LTSL of 40 days or more during 2010. Results: In the fully adjusted model, high exposure to role conflict (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.20 to 2.09), emotional demands (OR, 1.32; 95% CI, 1.03 to 1.69), and low supportive leadership (OR = 1.50; 95% CI, 1.15 to 1.96) predicted LTSL. A test for trend was statistically significant for all factors (P ⩽ 0.05). We estimated that 15% of LTSL cases were attributable to these factors. Conclusions: This study underlines the importance of taking into account psychosocial exposures as risk factors for LTSL.