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Are there inequities in treatment of end-stage renal disease in Sweden? A longitudinal register-based study on socioeconomic status-related access to kidney transplantation.

https://arctichealth.org/en/permalink/ahliterature283530
Source
Int J Environ Res Public Health. 2017 Jan 27;14(2)
Publication Type
Article
Date
Jan-27-2017
Author
Ye Zhang
Johan Jarl
Ulf-G Gerdtham
Source
Int J Environ Res Public Health. 2017 Jan 27;14(2)
Date
Jan-27-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Health Services Accessibility - standards
Healthcare Disparities - standards - statistics & numerical data
Humans
Kidney Failure, Chronic - surgery
Kidney Transplantation - standards - statistics & numerical data
Logistic Models
Longitudinal Studies
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Proportional Hazards Models
Registries - standards
Social Class
Socioeconomic Factors
Sweden
Young Adult
Abstract
Socioeconomic status-related factors have been associated with access to kidney transplantation, yet few studies have investigated both individual income and education as determinates of access to kidney transplantation. Therefore, this study aims to explore the effects of both individual income and education on access to kidney transplantation, controlling for both medical and non-medical factors. We linked the Swedish Renal Register to national registers for a sample of adult patients who started Renal Replacement Therapy (RRT) in Sweden between 1 January 1995, and 31 December 2013. Using uni- and multivariate logistic models, we studied the association between pre-RRT income and education and likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, we also used multivariate Cox proportional hazards regression analysis to assess the association between treatment and socioeconomic factors. Among the 16,215 patients in the sample, 27% had received kidney transplantation by the end of 2013. After adjusting for covariates, the highest income group had more than three times the chance of accessing kidney transplantation compared with patients in the lowest income group (odds ratio (OR): 3.22; 95% confidence interval (CI): 2.73-3.80). Patients with college education had more than three times higher chance of access to kidney transplantation compared with patients with mandatory education (OR: 3.18; 95% CI: 2.77-3.66). Neither living in the county of the transplantation center nor gender was shown to have any effect on the likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, the results from Cox models were similar with what we got from logistic models. Sensitive analyses showed that results were not sensitive to different conditions. Overall, socioeconomic status-related inequities exist in access to kidney transplantation in Sweden. Additional studies are needed to explore the possible mechanisms and strategies to mitigate these inequities.
Notes
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PubMed ID
28134798 View in PubMed
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Breaking bad habits by education - smoking dynamics among Swedish women.

https://arctichealth.org/en/permalink/ahliterature101919
Source
Health Econ. 2011 Jul;20(7):876-81
Publication Type
Article
Date
Jul-2011
Author
Gustav Kjellsson
Ulf-G Gerdtham
Carl Hampus Lyttkens
Author Affiliation
Department of Economics, Lund University, Lund, Sweden. gustav.kjellsson@nek.lu.se
Source
Health Econ. 2011 Jul;20(7):876-81
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Female
Humans
Models, Educational
Models, Psychological
Smoking - prevention & control - psychology
Smoking Cessation - methods - psychology
Sweden
Women - education - psychology
Abstract
In a dynamic Two-Part Model (2 PM), we find the effect of previous smoking on the participation decision to be decreasing with education among Swedish women, i.e. more educated are less state dependent. However, we do not find an analogous effect of education on the conditional intensity of consumption.
PubMed ID
20882575 View in PubMed
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Business cycles and mortality: results from Swedish microdata.

https://arctichealth.org/en/permalink/ahliterature177952
Source
Soc Sci Med. 2005 Jan;60(1):205-18
Publication Type
Article
Date
Jan-2005
Author
Ulf-G Gerdtham
Magnus Johannesson
Author Affiliation
Department of Community Medicine, Lund University, Malmö University Hospital, SE-205 02 Malmö, Sweden. ulf.gerdtham@smi.mas.lu.se
Source
Soc Sci Med. 2005 Jan;60(1):205-18
Date
Jan-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death - trends
Commerce - trends
Economics - trends
Female
Humans
Male
Middle Aged
Mortality - trends
Probability
Regression Analysis
Risk
Statistics as Topic
Survival Analysis
Sweden - epidemiology
Unemployment - statistics & numerical data
Abstract
We assess the relationship between business cycles and mortality risk using a large individual level data set on over 40,000 individuals in Sweden who were followed for 10-16 years (leading to over 500,000 person-year observations). We test the effect of six alternative business cycle indicators on the mortality risk: the unemployment rate, the notification rate, the deviation from the GDP trend, the GDP change, the industry capacity utilization, and the industry confidence indicator. For men we find a significant countercyclical relationship between the business cycle and the mortality risk for four of the indicators and a non-significant effect for the other two indicators. For women we cannot reject the null hypothesis of no effect for any of the business cycle indicators.
PubMed ID
15482879 View in PubMed
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The Danish effect on Swedish alcohol costs An analysis based on hospitalization data from southern Sweden.

https://arctichealth.org/en/permalink/ahliterature9054
Source
Eur J Health Econ. 2006 Mar;7(1):46-54
Publication Type
Article
Date
Mar-2006
Author
Johan Jarl
Ulf-G Gerdtham
Carl Hampus Lyttkens
Thor Lithman
Juan Merlo
Author Affiliation
Department of Clinical Science, Malmö, Lund University, Sweden.
Source
Eur J Health Econ. 2006 Mar;7(1):46-54
Date
Mar-2006
Language
English
Publication Type
Article
Abstract
This study investigated: (a) the cost and change in hospitalizations related to alcohol misuse for the healthcare sector and (b) the effect of distance to the border on alcohol-related hospitalization costs. The first objective was analyzed using descriptive statistics and the second using ordinary least squares regression on aggregated municipality data. The total cost decreased marginally during the study period while the number of patient-cases decreased substantially, presenting evidence of a substitution towards outpatient care. The increase in average treatment cost and the almost constant total cost provide evidence for a societal increase in the burden of alcohol-related diseases. We found a negative effect for distance to Denmark on alcohol-related hospitalization cost for the year 2003. The effect was smaller for 1998, suggesting that the increase in private import quotas during the study period has affected individuals' consumption level and/or consumption pattern. We also found indications that the increase in import quotas lead to a higher cost increase for heavy consumers than for low consumers.
PubMed ID
16341738 View in PubMed
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Does income-related health inequality change as the population ages? Evidence from Swedish panel data.

https://arctichealth.org/en/permalink/ahliterature99025
Source
Health Econ. 2010 Mar;19(3):334-49
Publication Type
Article
Date
Mar-2010
Author
M Kamrul Islam
Ulf-G Gerdtham
Philip Clarke
Kristina Burström
Author Affiliation
Department of Economics, University of Bergen, Bergen, Norway. Kamrul.Islam@econ.uib.no
Source
Health Econ. 2010 Mar;19(3):334-49
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Health Status Disparities
Humans
Income - statistics & numerical data
Middle Aged
Models, Theoretical
Socioeconomic Factors
Sweden
Young Adult
Abstract
This paper explains and empirically assesses the channels through which population aging may impact on income-related health inequality. Long panel data of Swedish individuals is used to estimate the observed trend in income-related health inequality, measured by the concentration index (CI). A decomposition procedure based on a fixed effects model is used to clarify the channels by which population aging affects health inequality. Based on current income rankings, we find that conventional unstandardized and age-gender-standardized CIs increase over time. This trend in CIs is, however, found to remain stable when people are instead ranked according to lifetime (mean) income. Decomposition analyses show that two channels are responsible for the upward trend in unstandardized CIs - retired people dropped in relative income ranking and the coefficient of variation of health increases as the population ages.
PubMed ID
19370697 View in PubMed
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Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data.

https://arctichealth.org/en/permalink/ahliterature71257
Source
Soc Sci Med. 2003 Nov;57(9):1621-9
Publication Type
Article
Date
Nov-2003
Author
Eddy van Doorslaer
Ulf G Gerdtham
Author Affiliation
Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, Netherlands. vandoorslaer@bmg.eur.nl
Source
Soc Sci Med. 2003 Nov;57(9):1621-9
Date
Nov-2003
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Educational Status
Empirical Research
Female
Health Surveys
Humans
Income - classification - statistics & numerical data
Male
Middle Aged
Mortality
Proportional Hazards Models
Research Support, Non-U.S. Gov't
Risk factors
Self Concept
Socioeconomic Factors
Survival Analysis
Sweden - epidemiology
Abstract
This paper empirically addresses two questions using a large, individual-level Swedish data set which links mortality data to health survey data. The first question is whether there is an effect of an individual's self-assessed health (SAH) on his subsequent survival probability and if this effect differs by socioeconomic factors. Our results indicate that the effect of SAH on mortality risk declines with age-probably because of adjustment towards 'milder' overall health evaluations at higher ages-but does not seem to differ by indicators of socioeconomic status (SES) like income or education. This finding suggests that there is no systematic adjustment of SAH by SES and therefore that any measured income-related inequality in SAH is unlikely to be biased by reporting error. The second question is: how much of the income-related inequality in mortality can be explained by income-related inequality in SAH? Using a decomposition method, we find that inequality in SAH accounts for only about 10% of mortality inequality if interactions are not allowed for, but its contribution is increased to about 28% if account is taken of the reporting tendencies by age. In other words, omitting the interaction between age and SAH leads to a substantial underestimation of the partial contribution of SAH inequality by income. These results suggest that the often observed inequalities in SAH by income do have predictive power for the-less often observed-inequalities in survival by income.
PubMed ID
12948571 View in PubMed
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Does the choice of EQ-5D tariff matter? A comparison of the Swedish EQ-5D-3L index score with UK, US, Germany and Denmark among type 2 diabetes patients.

https://arctichealth.org/en/permalink/ahliterature270760
Source
Health Qual Life Outcomes. 2015;13:145
Publication Type
Article
Date
2015
Author
Aliasghar A Kiadaliri
Björn Eliasson
Ulf-G Gerdtham
Source
Health Qual Life Outcomes. 2015;13:145
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Denmark
Diabetes Mellitus, Type 2 - psychology
Female
Germany
Humans
Life expectancy
Male
Middle Aged
Quality of Life - psychology
Quality-Adjusted Life Years
Socioeconomic Factors
Surveys and Questionnaires - standards
Sweden
Abstract
To compare the performance of the recently developed Swedish experience-based time trade-off (TTO) valuation of the EuroQol-5D-3L (EQ-5D-3L) against the hypothetical-based TTO valuations from UK, US, Germany and Denmark.
Type 2 diabetes patients from the Swedish National Diabetes Register (N = 1,757) responded to EQ-5D-3L questionnaire in 2008. Health utilities were compared using a range of parametric and nonparametric tests. Absolute agreement and consistency were investigated using intra-class correlations coefficients (ICCs) and Bland-Altman plots. Differences in health utilities between known-groups were evaluated. Transition scores for pairs of observed EQ-5D-3L health states were calculated and compared.
The Swedish tariff (SWT) resulted in substantially higher health utilities and differences were more profound for more severe health problems. ICC ranged 0.6 to 0.8 and Bland-Altman plots showed wide limits of agreement. While all tariffs discriminate between known-groups, the effect sizes were generally small. The SWT had higher (lower) known-group validity for macrovascular (microvascular) complications. The SWT and UK tariff were associated with the lowest and the highest mean absolute transition scores, respectively, for 2775 observed pairs of the EQ-5D-3L health states.
There were systematic differences between the SWT and tariffs from other countries meaning that the choice of tariff might have substantial impact on funding decisions. The Swedish experienced-based TTO valuation will give higher priority to life-extending interventions than those which improve quality of life. We suggest that economic evaluations in Sweden include both Swedish experience-based and non-Swedish hypothetical-based valuations through a sensitivity analysis.
Notes
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PubMed ID
26374709 View in PubMed
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Effects of macroeconomic trends on social security spending due to sickness and disability.

https://arctichealth.org/en/permalink/ahliterature177658
Source
Am J Public Health. 2004 Nov;94(11):2004-9
Publication Type
Article
Date
Nov-2004
Author
Jahangir Khan
Ulf-G Gerdtham
Bjarne Jansson
Author Affiliation
Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Norrbacka, 2nd floor, 171 76 Stockholm, Sweden. jahangir.khan@phs.ki.se
Source
Am J Public Health. 2004 Nov;94(11):2004-9
Date
Nov-2004
Language
English
Publication Type
Article
Keywords
Accidents, Occupational - economics
Canada
Disabled Persons
Economics - trends
Europe
Humans
Pensions
Regression Analysis
Social Security - economics
Unemployment - statistics & numerical data
United States
Abstract
We analyzed the relationship between macroeconomic conditions, measured as unemployment rate and social security spending, from 4 social security schemes and total spending due to sickness and disability.
We obtained aggregated panel data from 13 Organization for Economic Cooperation and Development member countries for 1980-1996. We used regression analysis and fixed effect models to examine spending on sickness benefits, disability pensions, occupational-injury benefits, survivor's pensions, and total spending.
A decline in unemployment increased sickness benefits spending and reduced disability pension spending. These effects reversed direction after 4 years of unemployment. Inclusion of mortality rate as an additional variable in the analysis did not affect the findings.
Macroeconomic conditions influence some reimbursements from social security schemes but not total spending.
Notes
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PubMed ID
15514244 View in PubMed
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[Equally good care of myocardial infarction in Sweden today. Geographic differences in mortality are without significance for the individual patient]

https://arctichealth.org/en/permalink/ahliterature53204
Source
Lakartidningen. 2005 Jan 3-16;102(1-2):20-3
Publication Type
Article
Author
Juan Merlo
Anders Håkansson
Anders Beckman
Ulf Lindblad
Martin Lindström
Ulf-G Gerdtham
Lennart Råstam
Author Affiliation
Samhällsmedicinska institutionen, Universitetssjukhuset MAS, Malmö. juan.merlo@smi.mas.lu.se
Source
Lakartidningen. 2005 Jan 3-16;102(1-2):20-3
Language
Swedish
Publication Type
Article
Keywords
Aged
Comparative Study
English Abstract
Female
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction - mortality - therapy
Odds Ratio
Quality of Health Care
Regression Analysis
Sweden - epidemiology
Abstract
It is a known fact that the 1990s brought a decrease in mortality after myocardial infarction in Sweden but that differences in mortality rates following myocardial infarction still remain between the Swedish counties. Unresolved, however, are questions as to what these inter-county differences mean for the individual patient and what role hospital care plays in this context. We analysed all patients aged 64-85 years who were hospitalised following diagnosis of myocardial infarction in Sweden during the period 1993-1996. To gain an understanding of the relevance of geographical differences in mortality after myocardial infarction for the individual patient we applied multi-level regression analysis and calculated county and hospital median odds ratios (MORs) in relation to 28-day mortality. For hospitalised patients with myocardial infarction, being cared for in another hospital with higher mortality would increase the risk of dying by 9% (MOR = l.09) in men and 12% in women. If these patients moved to another county with higher mortality the risk would increase by 7% and 3%, respectively. The small geographical differences in 28-day mortality after myocardial infarction found in Sweden suggest a high degree of equality across the country; however, further improvement could be achieved in hospital care, especially for women--an issue that deserves further analysis.
Notes
Comment In: Lakartidningen. 2005 Jan 3-16;102(1-2):9-1015707101
PubMed ID
15707102 View in PubMed
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Frequency and intensity of alcohol consumption: new evidence from Sweden.

https://arctichealth.org/en/permalink/ahliterature287388
Source
Eur J Health Econ. 2017 May;18(4):495-517
Publication Type
Article
Date
May-2017
Author
Gawain Heckley
Johan Jarl
Ulf-G Gerdtham
Source
Eur J Health Econ. 2017 May;18(4):495-517
Date
May-2017
Language
English
Publication Type
Article
Keywords
Adult
Alcohol Drinking - economics - epidemiology
Alcoholic Beverages - economics
Cross-Sectional Studies
Drinking Behavior
Female
Humans
Male
Middle Aged
Regression Analysis
Sex Distribution
Socioeconomic Factors
Sweden - epidemiology
Taxes - economics
Abstract
There is an increasing body of evidence that the intensity in which alcohol is drunk is of greater concern than the frequency or overall quantity consumed. This paper provides an extensive analysis of the demand for alcohol as measured by total quantity, frequency, and intensity. A unique large sample of cross-sectional data from Sweden 2004-2011 allows reduced-form alcohol demand equations to be estimated for beer, wine, and spirits, split by alcohol drinking pattern (average vs. binge drinkers) and gender. Results find a negative beer excise rate effect for participation and frequency, and positive effect for intensity. The effect was stronger for binge drinkers. Generally, the results also show a positive socioeconomic (income and education) gradient in frequency demand and a negative gradient in the intensity demand. Female wine drinkers show a positive socioeconomic gradient in both frequency and intensity. The findings highlight the complexity of this policy space. Tax increases appear to reduce frequency but raise intensity consumed. The more educated and higher earners drink more in total, but less intensely when they do and this is likely to explain in part why poor health is concentrated amongst lower socioeconomic status individuals.
Notes
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PubMed ID
27282872 View in PubMed
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32 records – page 1 of 4.