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Inequalities in all-cause and cause-specific mortality across the life course by wealth and income in Sweden: a register-based cohort study.

https://arctichealth.org/en/permalink/ahliterature311278
Source
Int J Epidemiol. 2020 06 01; 49(3):917-925
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
06-01-2020
Author
S Vittal Katikireddi
Claire L Niedzwiedz
Ruth Dundas
Naoki Kondo
Alastair H Leyland
Mikael Rostila
Author Affiliation
MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, UK.
Source
Int J Epidemiol. 2020 06 01; 49(3):917-925
Date
06-01-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Aged, 80 and over
Cause of Death
Cohort Studies
Female
Health Status Disparities
Humans
Income - statistics & numerical data
Male
Middle Aged
Mortality - trends
Registries
Socioeconomic Factors
Sweden - epidemiology
Abstract
Wealth inequalities are increasing in many countries, but their relationship to health is little studied. We investigated the association between individual wealth and mortality across the adult life course in Sweden.
We studied the Swedish adult population using national registers. The amount of wealth tax paid in 1990 was the main exposure of interest and the cohort was followed up for 18?years. Relative indices of inequality (RII) summarize health inequalities across a population and were calculated for all-cause and cause-specific mortality for six different age groups, stratified by sex, using Poisson regression. Mortality inequalities by wealth were contrasted with those assessed by individual and household income. Attenuation by four other measures of socio-economic position and other covariates was investigated.
Large inequalities in mortality by wealth were observed and their association with mortality remained more stable across the adult life course than inequalities by income-based measures. Men experienced greater inequalities across all ages (e.g. the RII for wealth was 2.58 [95% confidence interval (CI) 2.54-2.63) in men aged 55-64?years compared with 2.29 (95% CI 2.24-2.34) for women aged 55-64?years), except among the over 85s. Adjustment for covariates, including four other measures of socio-economic position, led to only modest reductions in the association between wealth and mortality.
Wealth is strongly associated with mortality throughout the adult life course, including early adulthood. Income redistribution may be insufficient to narrow health inequalities-addressing the increasingly unequal distribution of wealth in high-income countries should be considered.
PubMed ID
32380544 View in PubMed
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Relative deprivation and mortality--a longitudinal study in a Swedish population of 4.7 million, 1990-2006.

https://arctichealth.org/en/permalink/ahliterature121585
Source
BMC Public Health. 2012;12:664
Publication Type
Article
Date
2012
Author
Monica Åberg Yngwe
Naoki Kondo
Sara Hägg
Ichiro Kawachi
Author Affiliation
Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-106 91, Stockholm, Sweden. monica.aberg-yngwe@chess.su.se
Source
BMC Public Health. 2012;12:664
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Confidence Intervals
Female
Humans
Income
Longitudinal Studies
Male
Middle Aged
Mortality - trends
Population Surveillance
Poverty
Proportional Hazards Models
Registries
Sweden - epidemiology
Abstract
Relative deprivation has previously been discussed as a possible mechanism underlying the income-health relation. The idea is that income matters to the individual's health, over and above the increased command over resources, as the basis of social comparisons between a person and his or her reference group. The following study aimed to analyze the role of individual-level relative deprivation for all-cause mortality in the Swedish population. The Swedish context, characterized by relatively small income inequalities and promoting values as egalitarianism and equality, together with a large data material provide unique possibilities for analyzing the hypothesized mechanism.
The data used are prospective longitudinal data from the Swedish population and based on a linkage of registers. Restricting selection to individuals 25-64?years, alive January 1st 1990, gave 4.7 million individuals, for whom a mortality follow-up was done over a 16-year period. The individual level relative deprivation was measured using the Yitzhaki index, calculating the accumulated shortfall between the individual's income and the income of all other's in the person's reference group. All-cause mortality was used as the outcome measure.
Relative deprivation, generated through social comparisons, is one possible mechanism within the income and health relation. The present study analyzed different types of objectively defined reference groups, all based on the idea that people compare themselves to similar others. Results show relative deprivation, when measured by the Yitzhaki index, to be significantly associated with mortality. Also, we found a stronger effect among men than among women. Analyzing the association within different income strata, the effect was shown to be weak among the poorest. Revealing the importance of relative deprivation for premature mortality, over and above the effect of absolute income, these results resemble previous findings.
Relative deprivation, based on social comparisons of income, is significantly associated with premature mortality in Sweden, over and above the effect of absolute income. Also, it was found to be more important among men, but weak among the poorest.
Notes
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PubMed ID
22894714 View in PubMed
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Rising inequality in mortality among working-age men and women in Sweden: a national registry-based repeated cohort study, 1990-2007.

https://arctichealth.org/en/permalink/ahliterature264279
Source
J Epidemiol Community Health. 2014 Dec;68(12):1145-50
Publication Type
Article
Date
Dec-2014
Author
Naoki Kondo
Mikael Rostila
Monica Åberg Yngwe
Source
J Epidemiol Community Health. 2014 Dec;68(12):1145-50
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Female
Health Status Disparities
Humans
Male
Middle Aged
Mortality - trends
Registries
Sweden - epidemiology
Abstract
In the past two decades, health inequality has persisted or increased in states with comprehensive welfare.
We conducted a national registry-based repeated cohort study with a 3-year follow-up between 1990 and 2007 in Sweden. Information on all-cause mortality in all working-age Swedish men and women aged between 30 and 64 years was collected. Data were subjected to temporal trend analysis using joinpoint regression to statistically confirm the trajectories observed.
Among men, age-standardised mortality rate decreased by 38.3% from 234.9 to 145 (per 100 000 population) over the whole period in the highest income quintile, whereas the reduction was only 18.3% (from 774.5 to 632.5) in the lowest quintile. Among women, mortality decreased by 40% (from 187.4 to 112.5) in the highest income group, but increased by 12.1% (from 280.2 to 314.2) in the poorest income group. Joinpoint regression identified that the differences in age-standardised mortality between the highest and the lowest income quintiles decreased among men by 18.85 annually between 1990 and 1994 (p trend=0.02), whereas it increased later, with a 2.88 point increase per year (p trend
Notes
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PubMed ID
25143429 View in PubMed
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Rural life and suicide: Does the effect of the community context vary by country of birth? A Swedish registry-based multilevel cohort study.

https://arctichealth.org/en/permalink/ahliterature312076
Source
Soc Sci Med. 2020 05; 253:112958
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
05-2020
Author
Mariko Kanamori
Naoki Kondo
Sol Juarez
Andrea Dunlavy
Agneta Cederström
Mikael Rostila
Author Affiliation
Department of Public Health Sciences, Stockholm University, SE-106 91, Stockholm, Sweden; Department of Health and Social Behavior and Department of Health Education and Health Sociology, the University of Tokyo, Tokyo, Japan. Electronic address: mariko.kanamori@su.se.
Source
Soc Sci Med. 2020 05; 253:112958
Date
05-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Cities
Cohort Studies
Europe
Female
Humans
Male
Pregnancy
Registries
Risk factors
Rural Population
Scandinavian and Nordic Countries
Suicide
Sweden - epidemiology
Urban Population
Abstract
Contextual factors varying by residence in rural or urban areas may have different effects on the suicide of residents by nativity, but evidence on the urban-rural gap in suicide according to nativity is lacking. This study aims to evaluate the effect of cross-level interaction between nativity and rurality of residence on suicide risk, at two levels of aggregation (municipalities/neighborhoods). Study design was nationwide register-based cohort study in Sweden, 2011-2016. Participants were all residents 20 years or older. We calculated Incidence Rate Ratios comparing suicide incidence by nativity using three-level (individuals, neighborhoods, and municipalities) Poisson regression, stratified by gender. Among men, suicide incidences were the highest among those born in other Nordic countries, followed by those born in Sweden, other European countries, Middle Eastern countries, and the rest of the world. Residing in rural areas was associated with high IRR of suicide regardless of nativity, compared to residing in urban areas. When evaluating rurality at municipality level, we observed an increased suicide risk from living in rural areas in men born in other European (rural-urban ratio of nativity-specific IRRs: 1.39) and other Nordic (1.37) countries, followed by native Swedes (1.22). When evaluating rurality at neighborhood level, rurality was associated with increased suicide risk in men for all nativities, with the foreign-born showing higher risk than the Swedish-born. Individual sociodemographic characteristics explained the excess suicide risk in rural municipalities, but not the excess risk in rural neighborhoods. Among women, urban residents showed higher suicide incidence than rural residents. We found no consistent patterning of interaction with nativities among women. Foreign-born individuals residing in rural municipalities may have less access to economic resources and employment opportunities. Furthermore, ethnic discrimination, stigma, and exclusion from social networks and community may be more common in rural neighborhood contexts, leading to an increased risk of suicide.
PubMed ID
32247941 View in PubMed
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