Kozma Ahacic

Mobility limitations in the Swedish population from 1968 to 1992: Age, gender and social class differences

Mobility limitations are closely related to disability in old age. The study of mobility limitations in the population may improve the understanding of the development of disability, as well as gender and class patterns in disability in old age. Representative samples of the Swedish population between the ages of 18 and 75 years were interviewed in 1968, 1974, 1981, and 1991. A further sample of people aged 76+ years was interviewed in 1992. The questionnaire included the ability to walk 100 meters, to walk up and down stairs, and to run 100 meters. Mobility limitations begin to appear around age 40 years, and increase with age. In 1992 nearly none in the oldest age group (85+) could run 100 meters, and less than half could walk 100 meters, or go up and down stairs without difficulty. Between 1968 and 1991, the proportion of people with mobility limitations was reduced by one third, with the most prominent reduction among the oldest age groups. Women were more likely to report mobility limitations compared to men at all waves; however, the gender difference decreased between 1968 and 1991. Blue-collar workers had more mobility limitations than white-collar workers, and this discrepancy did not decrease over time. Mobility limitations often begin early in life, and differences between cohorts, men and women, and social classes can be seen well before the age of 50. The results suggest that gender differences in functional limitations among elderly people may decrease in the future, while social class inequalities are likely to persist.

Changes in dental status and dental care utilization in the Swedish population over three decades: age, period, or cohort effects?

OBJECTIVES In cross-sectional data, cohort effects give a false impression of changes in edentulousness over age and time. This study, therefore, corroborated cross-sectional data with corresponding longitudinal analyses. Complete or partial edentulousness and yearly dental care utilization were studied from 1968 to 2002. METHODS A nationally representative Swedish panel study allowed repeated cross-sectional comparisons of ages 18-75 (5 waves n approximately 5000), and ages 77+ at later waves (2 waves n approximately 500). Cross-sectional 10-year age group differences in 5 waves, time-lag differences between waves for age groups, and within-cohort differences between waves for 10-year birth cohorts were examined. RESULTS Regular over time analysis revealed large decreases in edentulousness between waves. While cross-sectional differences indicated an exponential curve-linear age-dependency, longitudinal differences revealed little decline, contradicting cross-sectional results. Following the cohorts showed little change within cohorts but large differences between cohorts. Care utilization increased between 1968 and 2002 in older age groups but decreased somewhat in younger ones. In 1968, utilization was highly age-related with lower utilization rates among older age groups. By 2000/2002, this had almost reversed. However, all cohorts had aged with little change in their rates of care utilization, while at the same time great between-cohort differences were demonstrated. CONCLUSIONS For both edentulousness and dental care utilization, almost all variation originated before 1968. These cohort effects are probably the consequences of changes in dentistry going back several decades and they demonstrate the early socialization of health behavior.

Mobility limitations 1974–1991: period changes explaining improvement in the population

The proportion of people with mobility limitations (difficulties with running, walking and stairs) decreased between 1968 and 1991 in the Swedish population aged 18-75. The distribution of predictors of late life morbidity, e.g., social class, health behaviour and childhood conditions, also changed during this period. This study explored whether the changes in these predictors over time were related to the decrease in the proportion of the population with mobility limitations. In two nationally representative interview samples (n=4468) from 1974 and 1991 of persons aged 45-71 the odds for limitations were cross-sectionally compared in ordered logistic regression models. In addition, predictors for the mobility outcome in 1974 were collected from an earlier 1968 survey and predictors for the 1991 outcome were collected from 1981. In 1974 the odds for limitations in the population was 50% higher than in 1991. Had the population composition regarding social class and housewives in 1991 been identical to 1974, the odds for limitations would have been similar in 1974 and 1991. Period improvement in social classes with poorer mobility also contributed to the overall period improvement. Health behaviours were examined as possible mediating factors. The increase of physically active people between 1968 and 1974 was related to the period improvement in mobility between 1974 and 1991. Smoking showed an increased association with mobility limitations during the period, indicating that mobility improvement would have been greater if everyone had been a non-smoker. Results indicate how sensitive disability rates may be for cohort or period effects.

Income and education as predictors of return to working life among younger stroke patients.

BackgroundSocioeconomic conditions are not only related to poor health outcomes, they also contribute to the chances of recovery from stroke. This study examines whether income and education were predictors of return to work after a first stroke among persons aged 40-59.MethodsAll first-stroke survivors aged 40-59 who were discharged from a hospital in 1996-2000 and who had received income from work during the year prior to the stroke were sampled from the Swedish national register of in-patient care (n = 7,081). Income and education variables were included in hazard regressions, modelling the probability of returning to work from one to four years after discharge. Adjustments for age, sex, stroke subtype, and length of in-patient care were included in the models.ResultsBoth higher income and higher education were associated with higher probability of returning to work. While the association between education and return to work was attenuated by income, individuals with university education were 13 percent more likely to return than those who had completed only compulsory education, and individuals in the highest income quartile were about twice as likely to return as those in the lowest. The association between socioeconomic position and return to work was similar for different stroke subtypes. Income differences between men and women also accounted for womens lower probability of returning to work.ConclusionsThe study demonstrates that education and income were independent predictors of returning to work among stroke patients during the first post-stroke years. Taking the relative risk of return to work among those in the higher socioeconomic positions as the benchmark, there may be considerable room for improvement among patients in lower socioeconomic strata.

Prevalence of Musculoskeletal pain in the general Swedish population from 1968 to 2002: Age, period, and cohort patterns

&NA; We examined age, period, and cohort patterns in musculoskeletal pain prevalence between 1968 and 2002 in the Swedish population. A repeated nationally representative survey allowed cross‐sectional comparisons of ages 18–75 (5 waves n ≈ 5000), and ages 77+ at later waves (2 waves n ≈ 500). Cross‐sectional 10‐year age group differences in 5 waves, time‐lag differences between waves (shifts across time) for age groups, and within‐cohort differences between waves for 10‐year birth cohorts followed over time were analyzed using graphs and ordered logistic regressions. The outcome scale was based on the three items measuring slight or severe pain in back, shoulder, and joints during the past 12 months. Age–period–cohort models showed that pain prevalence increased with age – mild or severe at all locations. Adjusted for the age‐related increase, the cohorts followed over time did not show significant period change, except for cohorts born during 1940s. Beginning with the 1940s’ cohorts pain prevalence increased over the period, and after baseline later cohorts also entered adulthood and the study with a higher pain prevalence. The prevalence of pain in the adult population thus increased with the passage through age and time of the 1940s cohorts. While there were no pronounced cohort differences at baseline in 1968, results demonstrated strong age effects in pain. The results indicate that the prevalence of musculoskeletal pain among the oldest age groups may increase in the future, when more baby‐boomers are entering their oldest ages.

Relationships between symptoms, physical capacity and activity limitations in 1992 and 2002

Background and aims: Studies of health trends suggest that various components of health and disability follow different trends over time. This in turn suggests that the relations between different health outcomes may change. This study explores associations between three kinds of outcomes (symptoms, physical capacity, activity limitations) in order to evaluate whether relationships between them had changed over the past decade. Methods: Ordered logistic regressions evaluated the relationships between variables in two collapsed representative samples of the Swedish oldest old (77+) in 1992 and 2002, living at home and in institutions (n=1115, non-response 15%, proxy interviews 13%). Interviews included symptoms (fatigue, pain and dizziness), physical capacity (tests of lung function + physical performance, and mobility, i.e., walking, running, and climbing stairs) and activity limitations (IADL, ADL). Results: Prevalence of symptoms and poor capacity was higher in 2002 than in 1992, whereas the prevalence of activity limitations did not change. All symptoms were related to physical capacity. Fatigue and pain were related to activity limitations with adjustments for physical capacity, as well as independently. All capacity measures had independent relationships with activity limitations. The relationship of fatigue with ADL was weaker in 2002 than in 1992. Adjusted for performance and lung function, the relationship of mobility with ADL was also weaker. Otherwise, relationships were not significantly different (p>0.05). Conclusions: Among old people, symptoms are closely associated with activity limitations. Identifying the role of symptoms may enhance development of early interventions. The weakened relationship between ADL and functional limitations indicate that they follow different trends.

Income and education as predictors of stroke mortality after the survival of a first stroke

Background. It is well known that socioeconomic indicators, such as income and education, predict both stroke incidence and stroke mortality. This means that persons in lower socioeconomic positions are less likely to survive their stroke, and there will be a selective survival in the group discharged from hospital after their first stroke. Question. Does socioeconomic position continue to predict mortality, stroke specific, or from other causes, among patients surviving their first stroke in spite of this selective survival? Methods. All persons in Sweden aged 40–59 years who were discharged after a first hospitalization for stroke in 1996–2000 were included (n = 10,487), then followed up until the end of the fourth calendar year after discharge. Data were analysed with Cox regressions controlling for age, sex, and stroke type. Results. Persons with high socioeconomic position, measured by education and income, have lower mortality than those of low position. Education was not significant when adjusted for income, however. The risk of dying was similar for stroke-specific mortality and all-cause mortality, for those with cerebral infarction as well as for all patients. Conclusions. Socioeconomic position predicted stroke-specific mortality also in the selective group of persons who survived their first stroke.

Being questioned and receiving advice about alcohol and smoking in health care: Associations with patients' characteristics, health behavior, and reported stage of change

BackgroundAlcohol habits are more rarely addressed than other health behavior topics in Swedish health care. This study examined whether differences between topics could be explained by their different associations with patient characteristics or by the differences in the prevalence of the disadvantageous health behavior, i.e., excessive alcohol use and smoking. The study moreover examined whether simply being asked questions about behavior, i.e., alcohol use or smoking, was associated with reported change.MethodsThe study was based on a cross-sectional postal survey (n = 4 238, response rate 56.5 percent) representative of the adult population in Stockholm County in 2003. Retrospective self-reports were used to assess health care visits during the past 12 months, the questions and advice received there, patients characteristics, health behavior, and the present stage of change. Logistic regression analysis was used to estimate the associations among the 68 percent who had visited health care.ResultsAmong the health care visitors, 23 percent reported being asked about their alcohol habits, and 3 percent reported receiving advice or/and support to modify their alcohol use - fewer than for smoking, physical exercise, or diet. When regression models adjusted for patient characteristics, the differences between health behaviors in the extent of questioning and advice remained. However, when the models also adjusted for smoking and alcohol consumption there was no difference between smoking and alcohol-related advice. In fact one-third of the present smokers and two-fifths of the persons dependent on alcohol reported having receiving advice the previous 12 months. Those who reported being asked questions or receiving advice more often reported a decreased alcohol use and similarly intended to cease smoking within 6 months. Questions about alcohol use were moreover related to a later stage of stage of change independently of advice among women but not among men.ConclusionsWhile most patients are never addressed, many in the target groups seem to be reached anyway. Besides advice, already addressing alcohol habits appears to be associated with change. The results also indicate that gender possibly plays a role in the relationship between advice and the stage of change.

Non-response bias and hazardous alcohol use in relation to previous alcohol-related hospitalization: comparing survey responses with population data

BackgroundThis study examines whether alcohol-related hospitalization predicts survey non-response, and evaluates whether this missing data result in biased estimates of the prevalence of hazardous alcohol use and abstinence.MethodsRegistry data on alcohol-related hospitalizations during the preceding ten years were linked to two representative surveys. Population data corresponding to the surveys were derived from the Stockholm County registry. The alcohol-related hospitalization rates for survey responders were compared with the population data, and corresponding rates for non-responders were based on the differences between the two estimates. The proportions with hazardous alcohol use and abstinence were calculated separately for previously hospitalized and non-hospitalized responders, and non-responders were assumed to be similar to responders in this respect.ResultsPersons with previous alcohol-related admissions were more likely currently to abstain from alcohol (RR=1.58, p<.001) or to have hazardous alcohol use (RR=2.06, p<.001). Alternatively, they were more than twice as likely to have become non-responders. Adjusting for this skewed non-response, i.e., the underrepresentation of hazardous users and abstainers among the hospitalized, made little difference to the estimated rates of hazardous use and abstinence in total. During the ten-year period 1.7% of the population were hospitalized.ConclusionsFew people receive alcohol-related hospital care and it remains unclear whether this group’s underrepresentation in surveys is generalizable to other groups, such as hazardous users. While people with severe alcohol problems – i.e. a history of alcohol-related hospitalizations – are less likely to respond to population surveys, this particular bias is not likely to alter prevalence estimates of hazardous use.

Changes in sobriety in the Swedish population over three decades: age, period or cohort effects?

Aims This study aimed to examine age, cohort and period trends in alcohol abstinence. Design Two surveys, the Level of Living Survey collected in 1968, 1974, 1981, 1990 and 2000, and the Swedish Panel Study of the Oldest Old (SWEOLD) collected in 1992 and 2002, were studied with graphical depictions of cross-sectional and longitudinal data presented over time and over age. Cross-sectional 10-year age group differences, time-lag differences between waves and within-cohort differences between waves for 10-year birth cohorts were examined. Logistic regression models were applied to confirm the observed patterns. Setting The samples were representative of the Swedish population. Participants Participants ranged in age from 18 to 75 (n = 5000 per wave), and 77+ at later waves (n = 500). Measurements Alcohol abstinence was determined by asking ‘Do you ever drink wine, beer, or spirits?’, where a ‘no’ response indicated abstinence. Findings Decreases in abstinence rates were observed from 1968 to 2000/02. While cross-sectional analysis indicated increased abstinence with advancing age, the longitudinal analysis suggested otherwise. Inspection of cohort differences revealed little change within cohorts and large differences between cohorts; abstinence rates declined in later-born cohorts up to the 1940s birth cohorts; stability was observed in cohorts born since the 1940s. Logistic regression models indicated that neither age nor period were significant (P > 0.05) predictors of abstinence when cohort (P < 0.001) was included. Conclusion Decreasing proportions of total alcohol abstainers in Sweden from 1968 to 2000 appear to be attributable primarily to decreases in successive cohorts rather than drinkers becoming abstainers.