Masuma Novak

A life-course approach in explaining social inequity in obesity among young adult men and women.

Objective:To examine the cumulative influence of adverse behavioural, social, and psychosocial circumstances from adolescence to young adulthood in explaining social differences in overweight and obesity at age 30 years and if explanations differ by gender.Design:A 14-year longitudinal study with 96.4% response rate.Subject:Data from 547 men and 497 women from a town in north Sweden who were baseline examined at age 16 years and prospectively followed up to age 30 years.Measurements:Overweight and obesity were ascertained at ages 16 and 30 years. Occupation and education were used to measure socioeconomic status. The explanatory measurements were: age at menarche, smoking, physical activity, alcohol consumption, TV viewing, home and school environment, social support, social network, and work environment.Results:No gender or social difference in overweight was observed at age 16 years. At age 30 years, significantly more men than women (odds ratio (OR)=2.81, 95% confidence interval (CI) 2.14–3.68) were overweight or obese. Educational level was associated with overweight at age 30 years, but not occupational class. Both men (OR=1.55, 95% CI 1.10–2.19) and women (OR=1.78, 95% CI 1.16–2.73) with low education (⩽11 years) were at risk of overweight. The factors that explained the educational gradient in overweight among men were low parental support in education during adolescence, and physical inactivity, alcohol consumption, and nonparticipation in any association during young adulthood. The educational gradient in overweight in women was explained mostly by adolescence factors, which include early age at menarche, physical inactivity, parental divorce, not being popular in school, and low school control. Restricted financial resource during young adulthood was an additional explanatory factor for women. All these factors were significantly more common among men and women with low education than with high education.Conclusion:Social inequities in overweight reflect the cumulative influence of multiple adverse circumstances experienced from adolescence to young adulthood. Underlying pathways to social inequity in overweight differ between men and women. Policy implications to reduce social inequity in overweight include reduction of social differences in health behaviours and social circumstances that take place at different life stages, particularly psychosocial circumstances during adolescence.

Perceived stress and incidence of Type 2 diabetes: a 35-year follow-up study of middle-aged Swedish men

To explore incident cases of diagnosed diabetes over 35 years of follow‐up in relation to self‐perceived stress at baseline.

Parental perceptions of and concerns about child's body weight in eight European countries--the IDEFICS study.

What is already known about this subject Parents of children with overweight and obesity tend to underestimate their childrens weight. Most studies show no association between parental education level and accurate parental perception of a childs weight category. Studies show no consistent relationship between parental weight perception and the childs gender.

A longitudinal general population-based study of job strain and risk for coronary heart disease and stroke in Swedish men

Objectives The aim was to investigate whether psychosocial stress based on the job-demand-control (JDC) model increased the risk for coronary heart disease (CHD) and stroke. Setting Swedish men. Participants The Primary Prevention Study (PPS) comprises 6070 men born between 1915 and 1925 free from previous history of CHD and stroke at baseline (1974–1977). Psychosocial workplace exposure was assessed using a job-exposure matrix (JEM) for the JDC model based on occupation at baseline. The participants were followed from baseline examination, until death, until hospital discharge or until 75 years of age, whichever occurred first, using the Swedish national register on cause of death and the Swedish hospital discharge register for non-fatal and fatal stroke and CHD events. Cox regression models were used with stroke or CHD as the outcome, using JDC model and age as explanatory variables, as well as stratified models with regard to smoking, self-reported stress, socioeconomic status, obesity, hypertension and diabetes. Primary and secondary outcome measures Risk for stroke and CHD. Results There was an increased risk (HR) for CHD in relation to high strain (HR 1.31, 95% CI 1.01 to 1.70). The risk was further increased among ever-smokers and among blue-collar workers. There was a relation between low control and increased risk for CHD (HR 1.19, 95% CI 1.06 to 1.35). There was no increased risk for stroke in any of the JDC categories. Conclusions Exposure to occupational psychosocial stress defined as job strain or low control increased the risk for CHD, especially among smokers and blue-collar workers. There was no increased risk for stroke in any of the JDC categories.

Gender differences in the prevalence of metabolic syndrome in 50-year-old Swedish men and women with hypertension born in 1953

To investigate potential gender differences in the role of hypertension as a risk factor for metabolic syndrome (MetS) we used a random population sample of 50-year-old men (n=595) and women (n=667; all born in 1953) who were examined in 2003–2004. Systolic (SBP) and diastolic (DBP) blood pressure values were dichotomized at ⩾140 mm Hg and ⩾90 mm Hg, respectively. MetS was defined using NCEP (National Cholesterol Education Programme) and IDF (International Diabetes Federation) criteria. MetS was more prevalent in men than in women (NCEP 16% versus 10%, P=0.003; IDF 26% versus 16%, P=0.000) and systolic hypertension was more common in men than in women (high SBP 24% versus 18%, P=0.003; high DBP 29% versus 24%, P=0.074). Women with high SBP had about a seven-fold increased NCEP risk compared with normotensive women (odds ratio (OR) 6.91, confidence interval (CI) 2.90–16.42), whereas high SBP in men was associated with about a three-fold increased NCEP risk (OR 2.72, CI 1.69–4.38). A similar pattern was observed for the IDF criterion of MetS. All interaction terms (sex × hypertension) were significant at P<0.01. At middle age, despite that fewer women had hypertension or MetS than men, hypertension carries a relatively greater risk for MetS in women than in men.

Twenty-Year Trends in Long-term Mortality Risk in 17 149 Survivors of Ischemic Stroke Less Than 55 Years of Age

Background and Purpose— The purpose of the present study was to investigate the 4-year mortality risk among patients <55 years with a first ischemic stroke during 1987–2006. Methods— A total of 17 149 cases (37.4% women) aged 18 to 54 years who survived ≥28 days after a first ischemic stroke were identified in the Swedish Inpatient Register from 1987 to 2006. All patients were followed for 4 years or until death. The standardized mortality ratio was calculated by comparing the mortality rates with those of the general population of equivalent age, sex, and calendar year. Results— During the period, there were 1265 deaths. Long-term survival improved over time in both men and women. Among men, the mortality risk decreased by 32% (hazard ratio=0.68 [95% confidence interval, 0.56–0.82]) from the first 5-year period to the last 5-year period (1987–1991 versus 2002–2006), and among women, the mortality risk decreased by 45% (0.55 [0.41–0.75]). Despite an overall decrease in mortality, the standardized mortality ratios for the last 5-year period remained high: 5.88 (95% confidence interval, 5.10–6.71) for men and 5.91 (4.68–7.29) for women with an absolute excess risk of 1.60 and 0.97 per 100 person-years, respectively, with nearly half of all deaths related to cardiovascular disease. Conclusions— During the 20-year period, 4-year mortality decreased by one third but was still 6-fold higher than that of the general population in the most recent period, emphasizing the importance of secondary prevention in young persons who have had a stroke.

High-normal blood pressure and long-term risk of type 2 diabetes: 35-year prospective population based cohort study of men

BackgroundThe link between type 2 diabetes and hypertension is well established and the conditions often coexist. High normal blood pressure, defined by WHO-ISH as systolic blood pressure (SBP) 130–139 mm Hg or diastolic blood pressure (DBP) 85–89 mm Hg, has been found to be an independent predictor for type 2 diabetes in studies, although with relatively limited follow-up periods of approximately 10 years. The aim of this study was to investigate whether hypertension, including mildly elevated blood pressure within the normal range, predicted subsequent development of type 2 diabetes in men over an extended follow-up of 35 years.MethodsData were derived from the Gothenburg Primary Prevention Study where a random sample of 7 494 men aged 47–55 years underwent a baseline screening investigation in the period 1970–1973. A total of 7 333 men were free from previous history of diabetes at baseline. During a 35-year follow-up diabetes was identified through the Swedish hospital discharge and death registries. The cumulative risk of diabetes adjusted for age and competing risk of death was calculated. Using Cox proportional hazard models we calculated the multiple adjusted hazard ratios (HR) (95% confidence interval (CI)) for diabetes at different blood pressure levels.ResultsDuring a 35-year follow-up, 956 men (13%) were identified with diabetes. The 35-year cumulative risk of diabetes after adjusting for age and competing risk of death in men with SBP levels <130 mm Hg, 130–139 mm Hg, 140–159 mm Hg and ≥160 mm Hg were 19%, 30%, 31% and 49%, respectively. The HR for diabetes adjusted for age, body mass index (BMI), cholesterol, antihypertensive treatment, smoking, physical activity and occupation were 1.43 (95% CI 1.12-1.84), 1.43 (95% CI 1.14-1.79) and 1.95 (95% CI 1.55-2.46) for men with SBP 130–139 mm Hg, 140–159 mm Hg, and ≥ 160 mm Hg, respectively (reference; SBP<130 mm Hg).ConclusionIn this population, at mid-life, even high-normal SBP levels were shown to be a significant predictor of type 2 diabetes, independently of BMI and other conventional type 2 diabetes risk factors over an extended follow-up.

Stroke and coronary heart disease: predictive power of standard risk factors into old age—long-term cumulative risk study among men in Gothenburg, Sweden

Aims The aim of this study was to examine the short-term and long-term cumulative risk of coronary heart disease (CHD) and stroke separately based on age, sex, smoking status, systolic blood pressure, and total serum cholesterol. Methods and results The Primary Prevention Study comprising 7174 men aged between 47 and 55 free from a previous history of CHD, stroke, and diabetes at baseline examination (1970–73) was followed up for 35 years. To estimate the cumulative effect of CHD and stroke, all participants were stratified into one of five risk groups, defined by their number of risk factors. The estimated 10-year risk for high-risk individuals when adjusted for age and competing risk was 18.1% for CHD and 3.2% for stroke which increased to 47.8 and 19.6%, respectively, after 35 years. The estimates based on risk factors performed well throughout the period for CHD but less well for stroke. Conclusion The prediction of traditional risk factors (systolic blood pressure, total serum cholesterol, and smoking status) on short-term risk (0–10 years) and long-term risk (0–35 years) of CHD of stroke differs substantially. This indicates that the cumulative risk in middle-aged men based on these traditional risk factors can effectively be used to predict CHD but not stroke to the same extent.

Incidence of Type 2 diabetes among occupational classes in Sweden: a 35-year follow-up cohort study in middle-aged men

To assess if low occupational class was an independent predictor of Type 2 diabetes in men in Sweden over a 35‐year follow‐up, after adjustment for both conventional risk factors and psychological stress.

Social and health-related correlates of intergenerational and intragenerational social mobility among Swedish men and women

OBJECTIVE To explore the pattern and determinants of inter- and intragenerational occupational mobility among Swedish men and women. STUDY DESIGN A Swedish 14-year prospective longitudinal study (response rate 96.5%). METHODS Detailed information on 546 men and 495 women regarding their occupation, health status, health-related behaviour, psychosocial environment at home and school, material recourses and ethnicity prior to mobility were available at 16, 21 and 30 years of age. Odds ratios and 99% confidence intervals were calculated using logistic regression to determine social mobility. RESULTS The results indicated that being popular at school predicted upward mobility, and being less popular at school predicted downward mobility. Additionally, material deprivation, economic deprivation, shorter height (women) and poor health behavioural factors predicted downward mobility. Among this cohort, being less popular at school was more common among subjects whose parents had low socio-economic status. Occupational mobility was not influenced by ethnic background. CONCLUSIONS Apart from height (women), health status was not associated with mobility for men or women either inter- or intragenerationally. Unfavourable school environment was a consistent predictor of mobility for both genders. The results indicate that schools should be used as a setting for interventions aimed at reducing socio-economic health inequities. Targeted school interventions that are designed to assist higher educational attainment of socio-economically disadvantaged youth would help to break the social chain of risk experienced during this time, and thereby alter their life course in ways that would reduce subsequent social inequities in health and well-being.