Linda Ernstsen
Norwegian University of Science and Technology
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Featured researches published by Linda Ernstsen.
BMC Public Health | 2012
Linda Ernstsen; Bjørn Heine Strand; Sara Marie Nilsen; Geir Arild Espnes; Steinar Krokstad
BackgroundThere has been an overall decrease in incident ischaemic heart disease (IHD), but the reduction in IHD risk factors has been greater among those with higher social position. Increased social inequalities in IHD mortality in Scandinavian countries is often referred to as the Scandinavian “public health puzzle”. The objective of this study was to examine trends in absolute and relative educational inequalities in four modifiable ischaemic heart disease risk factors (smoking, diabetes, hypertension and high total cholesterol) over the last three decades among Norwegian middle-aged women and men.MethodsPopulation-based, cross-sectional data from The Nord-Trøndelag Health Study (HUNT): HUNT 1 (1984–1986), HUNT 2 (1995–1997) and HUNT 3 (2006–2008), women and men 40–59 years old. Educational inequalities were assessed using the Slope Index of Inequality (SII) and The Relative Index of Inequality (RII).ResultsSmoking prevalence increased for all education groups among women and decreased in men. Relative and absolute educational inequalities in smoking widened in both genders, with significantly higher absolute inequalities among women than men in the two last surveys. Diabetes prevalence increased in all groups. Relative inequalities in diabetes were stable, while absolute inequalities increased both among women (p = 0.05) and among men (p = 0.01). Hypertension prevalence decreased in all groups. Relative inequalities in hypertension widened over time in both genders. However, absolute inequalities in hypertension decreased among women (p = 0.05) and were stable among men (p = 0.33). For high total cholesterol relative and absolute inequalities remained stable in both genders.ConclusionWidening absolute educational inequalities in smoking and diabetes over the last three decades gives rise to concern. The mechanisms behind these results are less clear, and future studies are needed to assess if educational inequalities in secondary prevention of IHD are larger compared to educational inequalities in primary prevention of IHD. Continued monitoring of IHD risk factors at the population level is therefore warranted. The results emphasise the need for public health efforts to prevent future burdens of life-style-related diseases and to avoid further widening in socioeconomic inequalities in IHD mortality in Norway, especially among women.
Age and Ageing | 2011
Linda Ernstsen; Sara Marie Nilsen; Geir Arild Espnes; Steinar Krokstad
BACKGROUND the aim of this study was to assess the predictive ability of self-rated health (SRH) on ischaemic heart disease (IHD) and all-cause mortality in elderly women and men. METHODS a total of 5,808 participants aged ≥ 70 years with no diagnosed atherosclerotic diseases at baseline in the Nord-Trøndelag Health Study (HUNT 2, 1995-97) were followed for 10 years. Participants provided data on psychosocial, behavioural and biomedical factors. The association between SRH and mortality was assessed using Cox proportional hazard model. RESULTS the SRH below good was reported by 50% of the women and 35% of the men. For SRH below good, the mortality from IHD was 1.62 (1.14-2.29) in women and 1.23 (0.91-6.67) in men. The corresponding adjusted hazard risk ratio for all-cause mortality was 1.59 (1.38-1.83) in women and 1.43 (1.26-1.63) in men. CONCLUSIONS poor SRH predicted mortality in elderly people. For older women, the predictive value of poor SRH was higher than that of men, and this was true independent of age, marital status, diabetes, any limiting long-standing illness and selected biomedical, behavioural and psychosocial factors. These results are in contrast to most studies on the SRH-mortality association in elderly people. Further theoretical and empirical studies are needed to identify the particular factors that should be taken into account when elderly women and men rate their own health.
Scandinavian Journal of Public Health | 2012
Sara Marie Nilsen; Linda Ernstsen; Steinar Krokstad; Steinar Westin
Aims: Socioeconomic inequalities in disability pensioning are well established, but we know little about the causes. The main aim of this study was to disentangle educational inequalities in disability pensioning in Norwegian women and men. Methods: The baseline data consisted of 32,948 participants in the Norwegian Nord-Trøndelag Health Study (1995–97), 25–66 years old, without disability pension, and in paid work. Additional analyses were made for housewives and unemployed/laid-off persons. Information on the occurrence of disability pension was obtained from the National Insurance Administration database up to 2008. Data analyses were performed using Cox regression. Results: We found considerable educational inequalities in disability pensioning, and the incidence proportion by 2008 was higher in women (25–49 years 11%, 50–66 years 30%) than men (25–49 years 6%, 50–66 years 24%). Long-standing limiting illness and occupational, psychosocial, and behavioural factors were not sufficient to explain the educational inequalities: young men with primary education had a hazard ratio of 3.1 (95% CI 2.3–4.3) compared to young men with tertiary education. The corresponding numbers for young women were 2.7 (2.1–3.1). We found small educational inequalities in the oldest women in paid work and no inequalities in the oldest unemployed/laid-off women and housewives. Conclusions: Illness and occupational, psychosocial, and behavioural factors explained some of the educational inequalities in disability pensioning. However, considerable inequalities remain after accounting for these factors. The higher incidence of disability pensioning in women than men and the small or non-existing educational inequalities in the oldest women calls for a gender perspective in future research.
Scandinavian Journal of Public Health | 2010
Linda Ernstsen; Ottar Bjerkeset; Steinar Krokstad
Aims: To investigate the influence of psychosocial and behavioural factors on educational inequalities in ischaemic heart disease (IHD) mortality. Methods: A population-based cohort study of 44,128 women and men free of IHD aged 30 years and older at baseline in 1995—97. Results: After adjustment for age and long-standing illness, both women (HR 3.22, 95% CI 1.31—7.90) and men (HR 1.57, 95% CI 1.03—2.40) who completed only primary education level (primary and lower secondary school) were at increased risk for IHD mortality compared to those who completed the tertiary education level (first and second stage of tertiary education). Behavioural factors explained 25% of the relative difference between primary and tertiary education level in IHD mortality among women and 53 % in men. Psychosocial factors had small influence on the relative difference in IHD mortality Conclusions: Findings from this study indicate that differences in behavioural factors contribute considerably more to inequalities in IHD mortality in educational levels than do psychosocial factors, and this effect seems to be stronger in men than women.
BMC Public Health | 2012
Sara Marie Nilsen; Johan Håkon Bjørngaard; Linda Ernstsen; Steinar Krokstad; Steinar Westin
BackgroundEducation-based inequalities in health are well established, but they are usually studied from an individual perspective. However, many individuals are part of a couple. We studied education-based health inequalities from the perspective of couples where indicators of health were measured by subjective health, anxiety and depression.MethodsA sample of 35,980 women and men (17,990 couples) was derived from the Norwegian Nord-Trøndelag Health Study 1995–97 (HUNT 2). Educational data and family identification numbers were obtained from Statistics Norway. The dependent variables were subjective health (four-integer scale), anxiety (21-integer scale) and depression (21-integer scale), which were captured using the Hospital Anxiety and Depression Scale. The dependent variables were rescaled from 0 to 100 where 100 was the worst score. Cross-sectional analyses were performed using two-level linear random effect regression models.ResultsThe variance attributable to the couple level was 42% for education, 16% for subjective health, 19% for anxiety and 25% for depression. A one-year increase in education relative to that of one’s partner was associated with an improvement of 0.6 scale points (95% confidence interval = 0.5–0.8) in the subjective health score (within-couple coefficient). A one-year increase in a couple’s average education was associated with an improvement of 1.7 scale points (95% confidence interval = 1.6–1.8) in the subjective health score (between-couple coefficient). There were no education-based differences in the anxiety or depression scores when partners were compared, whereas there were substantial education-based differences between couples in all three outcome measures.ConclusionsWe found considerable clustering of education and health within couples, which highlighted the importance of the family environment. Our results support previous studies that report the mutual effects of spouses on education-based inequalities in health, suggesting that couples develop their socioeconomic position together.
Mayo Clinic Proceedings | 2017
Xuemei Sui; John Ott; Katie Becofsky; Carl J. Lavie; Linda Ernstsen; Jiajia Zhang; Steven N. Blair
Objective: Mental health and emotional disorders are often associated with higher mortality risk. Whether higher cardiorespiratory fitness (CRF) reduces the risk for all‐cause mortality in individuals with emotional distress is not well known. Patients and Methods: Participants were 5240 men (mean age 46.5±9.5 years) with emotional distress (including depression, anxiety, thoughts of suicide, or a history of psychiatric or psychological counseling) who completed an extensive medical examination between 1987 and 2002, and were followed for all‐cause mortality through December 31, 2003. Cardiorespiratory fitness was quantified as maximal treadmill exercise test duration and was grouped for analysis as low, moderate, and high. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CIs. Results: During a median of 8.7 years (range, 1.0‐16.9 years) and 46,217 person‐years of follow‐up, there were 128 deaths from any cause. Age‐ and examination year–adjusted all‐cause mortality rates per 10,000 person‐years according to low, moderate, and high CRF groups were 64.7 (95% CI, 44.9‐89.3), 28.0 (95% CI, 23.8‐31.5), and 19.6 (95% CI, 17.1‐21.6) (trend P<.001) in men who reported any emotional distress. Overall, the multivariable‐adjusted HRs and 95% CIs across incremental CRF categories were 1.00 (referent), 0.54 (0.32‐0.90), and 0.47 (0.26‐0.85), linear trend P =.03. Conclusion: Among men with emotional distress, higher CRF is associated with lower risk of dying, independent of other clinical mortality predictors. Our findings underscore the importance of promoting physical activity to maintain a healthful level of CRF in individuals with emotional distress.
Mayo Clinic Proceedings: Innovations, Quality & Outcomes | 2017
Yanan Zhang; Jiajia Zhang; Jie Zhou; Linda Ernstsen; Carl J. Lavie; Steven P. Hooker; Xuemei Sui
Objective To investigate associations of estimated cardiorespiratory fitness (eCRF) and all-cause and cardiovascular disease (CVD) mortality in a representative US population. Participants and Methods A total of 12,834 participants, aged 20 to 86 years at baseline, were included in the Third National Health and Nutrition Examination Survey. They were followed up from October 18, 1988, through December 31, 2011, for all-cause and CVD death. Cardiorespiratory fitness was estimated from a nonexercise algorithm and further grouped into tertiles. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs. Results A total of 3439 deaths (999 due to CVD) occurred during median follow-up of 19.2 years. After adjusting for race/ethnicity, education, age, hypertension, diabetes, hypercholesterolemia, baseline CVD, and cancer status, each metabolic equivalent increase of eCRF was associated with an 18% (range, 15%-21%) lower risk of all-cause mortality and a 19% (range, 15%-24%) lower risk of CVD mortality in men and a 24% (range, 20%-28%) lower risk of all-cause mortality and a 24% (18%-30%) lower risk of CVD mortality in women. Compared with the lower eCRF group, the HRs (95% CIs) of the middle and upper groups were 0.72 (0.61-0.85) and 0.56 (0.47-0.67) for all-cause mortality and 0.76 (0.57-1.01) and 0.48 (0.34-0.66) for CVD mortality in men; and 0.80 (0.66-0.97) and 0.49 (0.40-0.60) for all-cause mortality and 0.84 (0.60-1.17) and 0.46 (0.33-0.66) for CVD mortality in women (trend P<.001 for all). Conclusion High eCRF was associated with lower risk of all-cause and CVD mortality in a national representative population. The eCRF method has great potential for initial clinical risk stratification and mortality prediction.
Tobacco Control | 2018
Chandrashekhar T Sreeramareddy; Sam Harper; Linda Ernstsen
Background Socioeconomic differentials of tobacco smoking in high-income countries are well described. However, studies to support health policies and place monitoring systems to tackle socioeconomic inequalities in smoking and smokeless tobacco use common in low-and-middle-income countries (LMICs) are seldom reported. We aimed to describe, sex-wise, educational and wealth-related inequalities in tobacco use in LMICs. Methods We analysed Demographic and Health Survey data on tobacco use collected from large nationally representative samples of men and women in 54 LMICs. We estimated the weighted prevalence of any current tobacco use (including smokeless tobacco) in each country for 4 educational groups and 4 wealth groups. We calculated absolute and relative measures of inequality, that is, the slope index of inequality (SII) and relative index of inequality (RII), which take into account the distribution of prevalence across all education and wealth groups and account for population size. We also calculated the aggregate SII and RII for low-income (LIC), lower-middle-income (lMIC) and upper-middle-income (uMIC) countries as per World Bank classification. Findings Male tobacco use was highest in Bangladesh (70.3%) and lowest in Sao Tome (7.4%), whereas female tobacco use was highest in Madagascar (21%) and lowest in Tajikistan (0.22%). Among men, educational inequalities varied widely between countries, but aggregate RII and SII showed an inverse trend by country wealth groups. RII was 3.61 (95% CI 2.83 to 4.61) in LICs, 1.99 (95% CI 1.66 to 2.38) in lMIC and 1.82 (95% CI 1.24 to 2.67) in uMIC. Wealth inequalities among men varied less between countries, but RII and SII showed an inverse pattern where RII was 2.43 (95% CI 2.05 to 2.88) in LICs, 1.84 (95% CI 1.54 to 2.21) in lMICs and 1.67 (95% CI 1.15 to 2.42) in uMICs. For educational inequalities among women, the RII varied much more than SII varied between the countries, and the aggregate RII was 14.49 (95% CI 8.87 to 23.68) in LICs, 3.05 (95% CI 1.44 to 6.47) in lMIC and 1.58 (95% CI 0.33 to 7.56) in uMIC. Wealth inequalities among women showed a pattern similar to that of men: the RII was 5.88 (95% CI 3.91 to 8.85) in LICs, 1.76 (95% CI 0.80 to 3.85) in lMIC and 0.39 (95% CI 0.09 to 1.64) in uMIC. In contrast to men, among women, the SII was pro-rich (higher smoking among the more advantaged) in 13 of the 52 countries (7 of 23 lMIC and 5 of 7 uMIC). Interpretation Our results confirm that socioeconomic inequalities tobacco use exist in LMIC, varied widely between the countries and were much wider in the lowest income countries. These findings are important for better understanding and tackling of socioeconomic inequalities in health in LMIC.
Frontiers in Aging Neuroscience | 2018
Ekaterina Zotcheva; Geir Selbæk; Espen Bjertness; Linda Ernstsen; Bjørn Heine Strand
Background: Leisure-time physical activity (PA) has been proposed as a protective factor against dementia, whereas psychological distress is associated with an increased risk of dementia. We investigated the associations of leisure-time PA and psychological distress with dementia-related mortality, and whether the association between leisure-time PA and dementia-related mortality differs according to level of psychological distress. Methods: 36,945 individuals from the Cohort of Norway aged 50-74 years at baseline (1994–2002) were included and followed up until January 1st 2015. Leisure-time PA and psychological distress were assessed through questionnaires, whereas dementia-related mortality was obtained through the Norwegian Cause of Death Registry. Adjusted Cox regression analyses were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). Results: Compared to inactivity, leisure-time PA was associated with a decreased risk of dementia-related mortality; low intensity leisure-time PA (HR = 0.73, 95% CI 0.59–0.89); high intensity leisure-time PA (HR = 0.61, 95%CI 0.49-0.77). A statistically significant difference in dementia-related mortality risk was observed between low and high intensity leisure-time PA (p < 0.05). Psychological distress was associated with an increased risk of dementia-related mortality (HR = 1.45, 95% CI 1.16–1.81). Among non-distressed, leisure-time PA was associated with a decreased dementia-related mortality risk; low intensity leisure-time PA (HR = 0.77, 95% CI 0.61–0.97); high intensity leisure-time PA (HR = 0.65, 95% CI 0.51–0.84). The same applied for those with psychological distress; low intensity leisure-time PA (HR = 0.57, 95% CI 0.35–0.94); high intensity leisure-time PA (HR = 0.42, 95% CI 0.22–0.82). The interaction between leisure-time PA and psychological distress on dementia-related mortality was not statistically significant (p = 0.38). Conclusions: Participating in leisure-time PA was associated with a reduced risk of dementia-related mortality, whereas psychological distress was associated with an increased risk of dementia-related mortality. Leisure-time PA appears to be equally strongly related with dementia-related mortality among those with and without psychological distress, underlining the importance of leisure-time PA for various groups of middle-aged and older adults.
Mayo Clinic Proceedings | 2018
Xuemei Sui; Virginia J. Howard; Michelle N. McDonnell; Linda Ernstsen; Matthew L. Flaherty; Steven P. Hooker; Carl J. Lavie
Objective: To examine the association between estimated cardiorespiratory fitness (eCRF) and incident stroke by black and white race. Participants and Methods: A total of 24,162 participants from the REasons for Geographic And Racial Differences in Stroke study (13,232 [54.8%] women; 9543 [39.5%] blacks; mean age, 64.6±9.3 years) without stroke at enrollment between January 15, 2003, and October 30, 2007, were followed for incident stroke through March 31, 2016. Baseline eCRF in maximal metabolic equivalents was determined using nonexercise sex‐specific algorithms and further grouped into age‐ and sex‐specific tertiles. Results: Over a mean of 8.3±3.2 years of follow‐up, 945 (3.9%) incident strokes occurred (377 in blacks and 568 in whites). The association between eCRF and stroke risk differed significantly by race (PInteraction<.001). In whites, after adjustment for stroke risk factors and physical functioning score, the hazard ratio of stroke was 0.82 (95% CI, 0.67‐1.00) times lower in the middle tertile of eCRF than in the lowest tertile and was 0.54 (95% CI, 0.43‐0.69) times lower in the highest tertile of eCRF. The protective effect of higher levels of eCRF on stroke incidence was more pronounced in those 60 years or older among whites. No association between eCRF and stroke risk was observed in blacks. Conclusion: Estimated cardiorespiratory fitness measured using nonexercise equations is a useful predictor of stroke in whites. The lack of an overall association between eCRF and stroke risk in blacks suggests that the assessment of eCRF in blacks may not be helpful in primary stroke prevention.