The incidence of major depression among adults has been shown to be socially differentiated, and there are reasons to seek explanations for this before adulthood. In this cohort study, we examined whether academic performance in adolescence predicts depression in adulthood, and the extent to which externalizing disorders explain this association.
We followed 26,766 Swedish women and men born 1967-1982 from the last year of compulsory school, at age about 16, up to 48 years of age. We investigated the association between grade point average (GPA, standardized by gender) and first diagnosis of depression in national registers of in- or out-patient psychiatric care. We used Cox proportional hazards models, adjusting for lifetime externalizing diagnoses and potential confounders including childhood socioeconomic position and IQ.
During follow-up, 7.0% of the women and 4.4% of the men were diagnosed with depression. A GPA in the lowest quartile, compared with the highest, was associated with an increased risk in both women (hazard ratio 95% confidence interval 1.7, 1.3-2.1) and men (2.9, 2.2-3.9) in models controlling for potential confounders. Additional control for externalizing disorders attenuated the associations, particularly in women.
The findings suggest that poor academic performance is associated with depression in young adulthood and that the association is partly explained by externalizing disorders. Our results indicate the importance of early detection and management of externalizing disorders among children and adolescents.
We investigate (a) alcohol consumption in association with type 2 diabetes, taking heavy episodic drinking (HED), socioeconomic, health and lifestyle, and psychosocial factors into account, and (b) whether a seemingly protective effect of moderate alcohol consumption on type 2 diabetes persists when stratified by occupational position.
This population-based longitudinal cohort study comprises 16,223 Swedes aged 18-84 years who answered questionnaires about lifestyle, including alcohol consumption in 2002, and who were followed-up for self-reported or register-based diabetes in 2003-2011. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated in a multivariable-adjusted logistic regression model for all participants and stratified by high and low occupational position. We adjusted for HED, socioeconomic (occupational position, cohabiting status and unemployment), health and lifestyle (body mass index (BMI), blood pressure, smoking, physical inactivity, poor general health, anxiety/depression and psychosocial (low job control and poor social support) characteristics one by one, and the sets of these factors.
Moderate consumption was inversely associated with type 2 diabetes after controlling for health and lifestyle (OR=0.47; 95% CI: 0.29-0.79) and psychosocial factors (OR=0.40; 95% CI: 0.22-0.79) when compared to non-drinkers. When adjusting for socioeconomic factors, there was still an inverse but non-significant association (OR=0.59; 95% CI: 0.35-1.00). In those with high occupational position, there was no significant association between moderate consumption and type 2 diabetes after adjusting for socioeconomic (OR=0.67; 95% CI: 0.3-1.52), health and lifestyle (OR=0.70; 95% CI: 0.32-1.5), and psychosocial factors (OR=0.75; 95% CI: 0.23-2.46). On the contrary, in those with low occupational position, ORs decreased from 0.55 (95% CI: 0.28-1.1) to 0.35 (95% CI: 0.15-0.82) when adjusting for psychosocial factors, a decrease that was solely due to low job control. HED did not influence any of these associations.
Moderate alcohol consumption is associated with a lower risk of type 2 diabetes, after adjusting for HED, health and lifestyle, and psychosocial characteristics. The association was inverse but non-significant after adjusting for socioeconomic factors. When stratified by occupational position, there was an inverse association only in those with low occupational position and after adjusting for low job control.
Moderate drinking has small effects on health. Alcohol-related risks are greatest for young people, and decrease with age. Women are more sensitive than men to the effects of alcohol. Protective effects of moderate drinking are reported for cardiovascular disease, diabetes type 2 and cognitive functioning. However, moderate drinking also involves risks, especially of injuries, violence, foetal damage, certain forms of cancer, liver disease and hypertension. Alcohol consumption should not be recommended for health reasons. Binge drinking, regardless of age, is a medical risk. Health professionals should discuss the pattern of drinking with patients, especially binge drinking, to a larger extent than is usually the case today.
We aimed to assess alcohol consumption and alcohol-attributed disease burden by DALYs (disability adjusted life years) in the BRICS countries (Brazil, Russia, India, China and South Africa) between 1990 and 2013, and explore to what extent these countries have implemented evidence-based alcohol policies during the same time period.
A comparative risk assessment approach and literature review, within a setting of the BRICS countries. Participants were the total populations (males and females combined) of each country. Levels of alcohol consumption, age-standardized alcohol-attributable DALYs per 100?000 and alcohol policy documents were measured.
The alcohol-attributed disease burden mirrors level of consumption in Brazil, Russia and India, to some extent in China, but not in South Africa. Between the years 1990-2013 DALYs per 100 000 decreased in Brazil (from 2124 to 1902), China (from 1719 to 1250) and South Africa (from 2926 to 2662). An increase was observed in Russia (from 4015 to 4719) and India (from 1574 to 1722). Policies were implemented in all of the BRICS countries and the most common were tax increases, drink-driving measures and restrictions on advertisement.
There was an overall decrease in alcohol-related DALYs in Brazil, China and South Africa, while an overall increase was observed in Russia and India. Most notably is the change in DALYs in Russia, where a distinct increase from 1990-2005 was followed by a steady decrease from 2005-2013. Even if assessment of causality cannot be done, policy changes were generally followed by changes in alcohol-attributed disease burden. This highlights the importance of more detailed research on this topic.
Cites: Lancet. 2015 Nov 28;386(10009):2145-91 PMID 26321261
Various attempts have been made to measure the burden of alcohol, drugs and tobacco smoking on population health, and mortality is an often used measure. As part of the governmental strategy to prevent use of alcohol, drugs, doping and tobacco (ANDT) in Sweden, we assessed disease burden measured by DALY (Disability Adjusted Life Years), attributed to alcohol, drugs and tobacco over time, as an overall indicator of problem level. DALY was developed within the Global Burden of Disease study (GBD), and combines life lost to premature death (YLL) and years lived with disability (YLD) in one measure. In 2010 tobacco contributed to 7.7% of the total disease burden in Sweden, followed by alcohol (3.4%) and drugs (1.3%). The disease burden caused by tobacco has decreased substantially since 1990, while small changes are observed for alcohol and drugs. Much of the disease burden specially related to drugs and alcohol was related to YLD, which can be captured with the DALY measure.
AIMS: The risk of alcohol-related disorders in first- and second-generation immigrants in Sweden were investigated and compared with the Swedish majority population to assess how alcohol habits are modified over generations in a new society. DESIGN: Register study based on multivariate analyses of demographic data, including information on country of birth, from the Swedish Population and Housing Census of 1985 linked to data on hospital admissions for alcohol-related disorders during 1990-99 in the National Hospital Discharge Register. PARTICIPANTS: The study population consisted of a national cohort of 1.25 million youth born 1968-79 and 1.47 million adults born 1929-65. RESULTS: First- and second-generation immigrants from Finland had higher relative risks (RRs) for hospital admission because of an alcohol-related disorder compared to the Swedish majority population (socio-economic adjusted RRs 2.1 and 1.9, respectively), while first-generation immigrants born in southern Europe, the Middle East and other non-European countries had lower risks. Second-generation immigrants with heritage in southern Europe, the Middle East and other non-European countries had socio-economic adjusted RRs that were higher relative to the first generation immigrants but lower relative to the Swedish majority population. Intercountry adoptees had the highest adjusted RR (2.5). CONCLUSIONS: Patterns of alcohol abuse in the country of origin are strong determinants of alcohol-related disorders in first-generation immigrants. The patterns in second-generation immigrants are influenced by parental countries of origin as well as patterns in the majority population. The Finnish minority and intercountry adoptees are of particular concern in prevention.
Alcohol has been suggested to be either protective of, or not associated with Parkinson's disease (PD). However, experimental animal studies indicate that chronic heavy alcohol consumption may have dopamine neurotoxic effects relevant for PD. We studied the association between diagnosed alcohol use disorders and PD.
All individuals in Sweden admitted with a diagnosis of an alcohol use disorder or appendicitis (reference group) between January 1, 1972 and December 31, 2008 were identified through the Swedish National Inpatient Register, and followed for up to 37 years for a diagnosis of PD. We estimated hazard ratios (HR) with 95% confidence intervals (CI) and adjusted for age and sex.
We found 1,741 (0.3%) cases of PD in the cohort of 602,930 individuals, 1,083 (0.4%) among those admitted with an alcohol use disorder and 658 (0.2%) of the individuals admitted with appendicitis. The mean follow-up time was 13.6 and 17.1 years, respectively. The HR for PD associated with an alcohol use disorder was 1.38 (CI 1.25-1.53) adjusted for age and sex. When the risk was estimated in age groups for first hospital admission with PD the highest risk was observed in the lowest age group, =44, HR 2.39 (0.96-5.93), adjusted for age at exposure and sex.
A history of an alcohol use disorder conferred an increased risk of admission with a diagnosis of Parkinson's disease in both women and men. In particular, the risk seemed higher at lower ages of first admission with Parkinson's disease.
Cites: Mov Disord. 2010 Oct 30;25(14):2333-920737543
To test the hypothesis that manual workers are at higher risk of death than are non-manual employees when living in municipalities with higher income inequality.
Hierarchical regression was used for the analysis were individuals were nested within municipalities according to the 1990 Swedish census. The outcome was all-cause mortality 1992-1998. The income measure at the individual level was disposable family income weighted against composition of family; the income inequality measure used at the municipality level was the Gini coefficient.
The study population consisted of 1 578 186 people aged 40-64 years in the 1990 Swedish census, who were being reported as unskilled or skilled manual workers, lower-, intermediate-, or high-level non-manual employees.
There was no significant association between income inequality at the municipality level and risk of death, but an expected gradient with unskilled manual workers having the highest risk and high-level non-manual employees having the lowest. However, in the interaction models the relative risk (RR) of death for high-level non-manual employees was decreasing with increasing income inequality (RR = 0.77; 95% CI, 0.63-0.93), whereas the corresponding risk for unskilled manual workers increased with increasing income inequality (RR = 1.24; 95% CI, 1.06-1.46). The RRs for skilled manual, low- and medium- level non-manual employees were not significant. Controlling for income at the individual level did not substantially alter these findings, neither did potential confounders at the municipality level.
The findings suggest that there could be a differential impact from income inequality on risk of death, dependent on individuals' social position.
This study investigates whether a) income inequality in Swedish municipalities increases the risk of myocardial infarction (AMI); b) the association between income inequality and AMI is mediated by level of residential segregation, measured as homogeneity in parishes (as a proxy for neighbourhoods) within municipalities; and c) there is an interaction between parish homogeneity and individual level social position. The study population consisted of all individuals aged 40-64 years in 1990 who lived in municipalities with >50,000 inhabitants (n = 1,284,955). Data on socioeconomic, demographic information and diagnosis data on AMI were obtained by linkage between authority-administered registers and the National Patient Register. All individuals were followed from 1991 onwards until the first relevant discharge, death or end of observation period (1998). We used a multilevel Poisson model where individuals were nested within 729 parishes which in turn were nested in 41 municipalities. We found that the risk for AMI was lower in the municipalities with higher degree of income inequality. Segregation of households in the highest income quintile diluted, but did not eliminate, the association between income inequality and risk of AMI - the degree of parish affluence seemed to be more important as a mediator than other parish characteristics, even when individual level characteristics were added to the model. Interaction analyses showed that the divide between manual workers and non-manual employees became more apparent in parishes with a higher degree of parish affluence. This was more apparent in municipalities with higher income inequality and was due to a decreasing risk among high level non-manual employees and an unchanged risk among manual workers. The results give some support to the idea that income inequality might serve as a proxy for social stratification even in a comparatively egalitarian context.
AIMS: The aim of this study was to investigate attitudes towards androgenic anabolic steroids among male adolescents who have used anabolics compared to those who have not. DESIGN AND SETTING: A cross-sectional survey was performed in the year 2000 in all secondary schools in the county of Halland on the west coast of Sweden. PARTICIPANTS AND MEASUREMENTS: An anonymous multiple-choice questionnaire was distributed to all classes with 14-, 16-, and 18-year-old male adolescents. The response rate was 92.7% (n=4049). FINDINGS: Those who admitted having used androgenic anabolic steroids differed in several ways from those who had not. Fewer believed androgenic anabolic steroids to be harmful [odds ratio (OR) = 0.15, 95% CI 0.08-0.30] and more believed that girls preferred boys with large muscles (OR = 6.1, 95% CI 3.4-11.0). They trained more often at gyms (OR = 5.6, 95% CI 3.0-10.6), drank more alcohol (OR = 4.2, 95% CI 2.0-9.1), and had used narcotic drugs more often (OR = 15.3, 95% CI 8.5-27.5) than the other male adolescents. More immigrants than native-born adolescents had used anabolics (OR = 4.2, 95% CI 2.2-7.9). CONCLUSION: Attitudes towards anabolics differ between users and nonusers. These aspects may be beneficial to focus on as one part of a more complex intervention program in order to change these attitudes and decrease the misuse of androgenic anabolic steroids.