Tomas Hemmingsson

Childhood Socioeconomic Position and Objectively Measured Physical Capability Levels in Adulthood: A Systematic Review and Meta-Analysis

Background Grip strength, walking speed, chair rising and standing balance time are objective measures of physical capability that characterise current health and predict survival in older populations. Socioeconomic position (SEP) in childhood may influence the peak level of physical capability achieved in early adulthood, thereby affecting levels in later adulthood. We have undertaken a systematic review with meta-analyses to test the hypothesis that adverse childhood SEP is associated with lower levels of objectively measured physical capability in adulthood. Methods and Findings Relevant studies published by May 2010 were identified through literature searches using EMBASE and MEDLINE. Unpublished results were obtained from study investigators. Results were provided by all study investigators in a standard format and pooled using random-effects meta-analyses. 19 studies were included in the review. Total sample sizes in meta-analyses ranged from N = 17,215 for chair rise time to N = 1,061,855 for grip strength. Although heterogeneity was detected, there was consistent evidence in age adjusted models that lower childhood SEP was associated with modest reductions in physical capability levels in adulthood: comparing the lowest with the highest childhood SEP there was a reduction in grip strength of 0.13 standard deviations (95% CI: 0.06, 0.21), a reduction in mean walking speed of 0.07 m/s (0.05, 0.10), an increase in mean chair rise time of 6% (4%, 8%) and an odds ratio of an inability to balance for 5s of 1.26 (1.02, 1.55). Adjustment for the potential mediating factors, adult SEP and body size attenuated associations greatly. However, despite this attenuation, for walking speed and chair rise time, there was still evidence of moderate associations. Conclusions Policies targeting socioeconomic inequalities in childhood may have additional benefits in promoting the maintenance of independence in later life.

Early-Onset Depression, Anxiety, and Risk of Subsequent Coronary Heart Disease: 37-Year Follow-Up of 49,321 Young Swedish Men

OBJECTIVES The purpose of this study was to investigate the long-term cardiac effects of depression and anxiety assessed at a young age, when reverse causation is not feasible. BACKGROUND Most prospective studies found a relatively strong association between depression and subsequent coronary heart disease (CHD). However, almost exclusively, only middle-age or older participants were examined, and subclinical atherosclerosis might contribute to the observed association. The prospective association between anxiety and CHD was less evident in previous studies and has been subjected to similar methodological concerns on the possibility for a reverse causation. METHODS In a nationwide survey, 49,321 young Swedish men, 18 to 20 years of age, were medically examined for military service in 1969 and 1970. All the conscripts were seen by a psychologist for a structured interview. Conscripts reporting or presenting any psychiatric symptoms were seen by psychiatrists. Depression and anxiety was diagnosed according to International Classification of Diseases-8th Revision (ICD-8). Data on well-established CHD risk factors and potential confounders were also collected (i.e., anthropometrics, diabetes, blood pressure, smoking, alcohol consumption, physical activity, socioeconomic position, family history of CHD, and geographic area). Participants were followed for CHD and for acute myocardial infarction for 37 years. RESULTS Multiadjusted hazard ratios associated with depression were 1.04 (95% confidence interval [CI]: 0.70 to 1.54), 1.03 (95% CI: 0.65 to 1.65), for CHD and for acute myocardial infarction, respectively. The corresponding multiadjusted hazard ratios for anxiety were 2.17 (95% CI: 1.28 to 3.67) and 2.51 (95% CI: 1.38 to 4.55). CONCLUSIONS In men, aged 18 to 20 years, anxiety as diagnosed by experts according to ICD-8 criteria independently predicted subsequent CHD events. In contrast, we found no support for such an effect concerning early-onset depression in men.

Self-rated health and mortality among young men: what is the relation and how may it be explained?

Aims: This study examined the relation between self-rated health (SRH) and mortality among young men, and factors in youth and adolescence that could explain the relation. Methods: Using logistic regression relative risks of mortality between various levels of self-rated health were compared in a longitudinal study of 49,321 men born in 1949-51, participating in a nationwide military conscription survey in 1969-70. Results: Poor self-rated health at conscription was associated with increased mortality during 27 years of follow up for those stating Rather poor or Very poor compared with those stating Very good SRH. SRH was most strongly related to alcohol- and drug-related mortality. Three psychological factors ( low emotional control, psychiatric diagnosis at conscription, and self-reported medication for nervous problems) were found to account for 84% of the increased mortality in the group stating Rather poor or Very poor SRH (remaining RR=1.1). However, the explanatory power of the psychologicalfactors was widely different for different diagnoses of death. Conclusions: Poor self-rated health among young men is a predictor of future mortality. Psychological factors seem to be important explanatory variables.

Unemployment and mortality—a longitudinal prospective study on selection and causation in 49321 Swedish middle-aged men

Background: Unemployment is associated with increased risk of mortality. It is, however, not clear to what extent this is causal, or whether other risk factors remain uncontrolled for. The aim of this study was to investigate the association between unemployment and all-cause and cause-specific mortality, adjusting for indicators of mental disorder, behavioural risk factors and social factors over the life course. Methods: This study was based on a cohort of 49321 Swedish males, born 1949/51, tested for compulsory military conscription in 1969/70. Data on employment/unemployment 1990–4 was based on information from the Longitudinal Register of Education and Labour Market Statistics. Information on childhood circumstances was drawn from National Population and Housing Census 1960. Information on psychiatric diagnosis and behavioral risk factors was collected at conscription testing in 1969/70. Data on mortality and hospitalisation 1973–2004 were collected in national registers. Results: An increased risk of mortality 1995–2003 was found among individuals who experienced 90 days or more of unemployment during 1992–4 compared with those still employed (all-cause mortality HR 1.91, 95% CI 1.58 to 2.31. Adjustment for risk factors measured along the life course considerably lowered the relative risk (all cause mortality HR 1.30, 95% CI 1.06 to 1.58). Statistically significant increased relative risk was found during the first 4 years of follow up (all-cause mortality, adjusted HR 1.57, 95% CI 1.13 to 2.18, but not the following 4 years (all cause mortality, adjusted HR 1.17, 95% CI 0.91 to 1.50). Conclusion: The results suggest that a substantial part of the increased relative risk of mortality associated with unemployment may be attributable to confounding by individual risk factors.

Unemployment and suicide

270 www.thelancet.com Vol 374 July 25, 2009 DNA-positive for some HPV types, since the vaccine will provide protection from infection with the other HPV types. Hopefully, additional vaccines will be developed against a broader spectrum of high-risk HPV types than those currently covered. This increase in scope of coverage will be of particular importance to HPV immunisation in the developing world, where the prevalence of HPV types diff ers from that in developed countries. Women have shouldered responsibility for contraception since its inception. The goal to eradicate sexually transmitted carcinogenic viruses can be jointly carried by women and men, and could be accomplished within a few decades.

Cannabis, schizophrenia and other non-affective psychoses: 35 years of follow-up of a population-based cohort.

BACKGROUND There is now strong evidence that cannabis use increases the risk of psychoses including schizophrenia, but the relationship between cannabis and different psychotic disorders, as well as the mechanisms, are poorly known. We aimed to assess types of psychotic outcomes after use of cannabis in adolescence and variation in risk over time. METHOD A cohort of 50 087 military conscripts with data on cannabis use in late adolescence was followed up during 35 years with regard to in-patient care for psychotic diagnoses. RESULTS Odds ratios for psychotic outcomes among frequent cannabis users compared with non-users were 3.7 [95% confidence interval (CI) 2.3-5.8] for schizophrenia, 2.2 (95% CI 1.0-4.7) for brief psychosis and 2.0 (95% CI 0.8-4.7) for other non-affective psychoses. Risk of schizophrenia declined over the decades in moderate users but much less so in frequent users. The presence of a brief psychosis did not increase risk of later schizophrenia more in cannabis users compared with non-users. CONCLUSIONS Our results confirm an increased risk of schizophrenia in a long-term perspective, although the risk declined over time in moderate users.

To what extent may the association between immigrant status and mental illness be explained by socioeconomic factors

BackgroundImmigrants in Sweden have a higher rate of mental illness than the native Swedes. This study investigated to what extent the association between immigrant status and mental illness can be explained by a different distribution of known risk factors for impaired mental health between groups of immigrants and persons born in Sweden.MethodsThe study is based on data from the Swedish PART-study, designed to identify risk factors for, and social consequences of, mental illness. The study population consists of a random sample of 10,423 Swedish citizens, whereof 1,109 were immigrants. The data was collected in the year 2000. The immigrants were divided into three groups based on country of origin (Scandinavians born outside Sweden, Europeans born outside Scandinavia, non-Europeans). The occurrence of mental illness among immigrants and native Swedes were compared not adjusting and adjusting for indicators of socioeconomic advantage/disadvantage (education, income, labour market position, etc). Mental illness was approximated with the WHO (ten) wellbeing index scale and depressive symptoms were measured with the major depression inventory scale (MDI).ResultsImmigrants’ excess risk for low subjective wellbeing was completely accounted for by adjustment for known risk factors in all the immigrant groups. However, social-economic disadvantages could not account for the non-European immigrants’ higher prevalence of depression (MDI), although the increased relative risk found in univariate analyses was substantially reduced.ConclusionsThe findings in this study suggest that the association between immigrant status and mental illness appears above all to be an effect of a higher prevalence of social and economic disadvantage.

Obesity and Attained Education: Cohort Study of More Than 700,000 Swedish Men

Objective: To study the relationship between BMI at age 18 years and later attained education, with control for intelligence and parental social position.

Body mass index in late adolescence and its association with coronary heart disease and stroke in middle age among Swedish men

Background and objectives:Body mass index (BMI) in adolescence may be of particular importance as a predictor of future risk of coronary heart disease (CHD). Associations measured either in childhood or in middle age have appeared to be weaker or non-existent. We investigated the association between BMI measured in adolescence and CHD, and also stroke, among middle aged Swedish men and controlled for potential confounders not included in previous studies.Methods:Data on BMI, smoking and blood pressure (diastolic and systolic) was collected from 49 321 Swedish males, born during 1949–1951, at conscription for military service in 1969/70. Census data on socioeconomic indicators in childhood and adulthood was linked to the cohort. The men were followed from 1991 through 2004 in national registers with regard to mortality and hospitalization from CHD and stroke.Results:A graded increase of CHD was seen in over six levels of BMI (BMI<18.5, hazard ratio (HR)=1.0, BMI=18.5–20.99 (reference category), BMI=21–22.99, HR=1.2; BMI=23–24.99, HR=1.5; BMI=25–29.99, HR=2.5; BMI ⩾30, HR=4.3). A graded association between BMI and stroke was also found, although weaker. Adjustments for cardiovascular risk factors (smoking, diastolic and systolic blood pressure, and early cardiovascular mortality in parents) attenuated the relative risks to some extent, whereas adjustments for socioeconomic indicators in childhood and adulthood had minor effects.Conclusion:The results strongly suggest that BMI in late adolescence is an important predictor of both CHD and stroke among men before age 55 years, independent of smoking, hypertension and early cardiovascular mortality in parents.

Explanations of social class differences in alcoholism among young men

The aim of this study was to analyse the role of differences in alcohol consumption and other risk factors for alcoholism established in late adolescence, for later differences in the distribution of alcoholism between social classes among young men. Data on risk factors in childhood and adolescence, e.g. risk use of alcohol, was collected among 49,323 men, born 1949-1951, at conscription for compulsory military training 1969/1970. Data on socio-economic group was obtained from the 1975 census and data on alcoholism diagnoses from the national in-patient care register 1976-1983. Several risk factors for alcoholism, such as risk use of alcohol, psychiatric diagnosis at conscription, parental divorce, low emotional control and contact with police and child care authorities, seemed to be more common among those who were recruited to blue-collar occupations compared to those who were recruited to non-manual occupations. In multivariate analyses, taking the background variables into consideration, the increased relative risks among manual workers for alcoholism diagnoses, found in univariate analyses, diminished considerably. Several risk factors had a stronger effect on the outcome among unskilled workers compared with non-manual employees at medium or higher degree. It is concluded that risk factors for poor health established in late adolescence could explain much of the increased relative risk of alcoholism among young unskilled and skilled male workers in this study.