Models for all-cause mortality among 45,000 men and women with cancer in 12 different sites were estimated, using register and census data for complete Norwegian birth cohorts. This observed-survival method appeared to be an adequate approach. The results support the idea that women who were pregnant shortly before a breast cancer diagnosis may have a poorer prognosis than others. In principle, such an effect may also reflect that these women have a young child during the follow-up period and are burdened by that. However, this social explanation can hardly be very important, given the absence of a corresponding significant effect in men and for other cancer sites in women. Breast cancer is different from other malignancies also with respect to the effect of parenthood more generally, regardless of the timing of the pregnancies. On the whole, male and female cancer patients with children experience lower mortality than the childless, though without a special advantage associated with adult children. This suggests a social effect, perhaps operating through a link between parenthood, lifestyle and general health. No parity effect was seen for breast cancer, however, which may signal that the social effect is set off against an adverse physiologic effect of motherhood for this particular cancer. Among men, both marriage and parenthood were associated with a good prognosis. Married male cancer patients with children had mortality one-third lower than that among the childless and never-married. Women who had never married did not have the same disadvantage.
We estimated the degree to which the relationship between socio-economic position (SEP) and alcohol-related disorders is attenuated after adjustment for levels and patterns of drinking, behavioural, material and social factors.
A longitudinal cohort study with baseline in 2002, with linkage to register data on patient care and deaths in 2002-11 to yield the outcome measures.
Stockholm County, Sweden.
Respondents to baseline survey aged 25-64 (n = 17?440) with information on all studied covariates.
Occupational class was the studied SEP indicator and a combined measure of volume of weekly alcohol consumption and frequency of heavy episodic drinking, smoking, employment status, income, social support, marital status and education, all at baseline, were the studied covariates. Alcohol-related disorders (n = 388) were indicated by first register entries on alcohol-related medical care or death during the follow-up.
Unskilled workers had an approximately four times greater risk of alcohol-related disorders than higher non-manual employees, hazard ratio (HR) = 4.08 (2.78, 5.98). After adjustment for alcohol use, the SEP difference in risk for alcohol-related harm fell by a fourth for the same group, HR = 2.91 (1.96, 4.33). The difference was reduced further when behavioural factors and material factors were taken into account, HR = 2.09 (1.34, 3.26), whereas adjusting for social factors and attained education resulted in smaller reductions.
Socio-economic differences in alcohol use explain one fourth of the socio-economic position differences in alcohol-related disorders in Stockholm, Sweden. Hazardous alcohol use and other behavioural, material and social factors together explain nearly 60% of the socio-economic position differences in alcohol-related disorders.
To study whether there is an association between dyadic consensus, depressive symptoms, and parental stress during early parenthood and marital separation 6-8 years after childbirth, among couples in Sweden.
At baseline, 393 couples were included. The couples answered three questionnaires, including: Dyadic consensus at 1 week post-partum, depressive symptoms at 3 months post-partum and parental stress at 18 months post-partum. The parents' addresses were followed up after 6-8 years, to study the marital separation rate.
We found, 6-8 years after childbirth, that 20% of study couples were separated. Separation was associated with less dyadic consensus (mothers p
Marital differentials in survival from 12 common types of cancer are assessed by estimating a mixed additive multiplicative hazard regression model on the basis of individual register and census data for the whole Norwegian population. These data cover the period 1960-91 and include more than 100,000 cancer deaths. The data and method make it possible to take into account the marital mortality differentialsin the absence of cancer. The excess all-cause mortality among cancer patients compared with similar persons without a cancer diagnosis is, on the whole, more than 15% higher for never-married men, never-married women and divorced men, than for the married of the same sex. Other previously married have an excess mortality elevated by about 7%. This protective effect of marriage is not due to stage, which is controlled for. The possible importance of treatment and host factors is discussed.
PURPOSE: The aim of this study was to investigate the effects of the accumulated number of job losses and broken partnerships (defined as the end of cohabitation) on the risk of fatal and nonfatal events of ischemic heart disease (IHD). METHODS: Prospective birth cohort study with follow-up of events of IHD from 1993 to 2004. Participants were 8365 men born in the metropolitan area of Copenhagen, Denmark, in 1953. Events of IHD were retrieved from the Danish National Patient Register and the Cause of Death Registry. Job losses and broken partnerships were identified in the Social Registers. We included mother's marital status and father's occupation at birth, body mass index at 18 years, and own educational attainment as covariates. RESULTS: We found that only broken partnerships were associated with IHD (1.28 95% confidence interval 1.02-1.58) and the subdiagnoses of other IHD (1.37 95% confidence interval 1.02-1.85). We found no indication of dose-response relationship between number of events and risk of IHD. CONCLUSION: In this study of middle-aged men, we found only weak support for the effect of psychosocial stress on IHD measured with register based life events; we found that IHD was associated with broken partnerships but not with job loss. We did not find that the risk of incident IHD varied with the number of these stressful life events.
Living with a spouse is associated with a reduced risk of coronary heart disease mortality in middle age, but it remains unclear whether marriage and other living arrangements are important both for the development of the disease and the survival following incidence. Cohabitation and living alone have also become more common in many Western societies and thus warrant further study. We explored the association between living arrangements and myocardial infarction (MI) incidence and fatality. We used a population-based register sample of adults aged 40-60 in Finland in 1995 (n?=?302,885) followed up until the end of 2007. MI incidence and mortality were identified from hospital discharge records and cause of death register (5917 incident cases in men and 1632 in women). Living with a marital partner was contrasted to three alternatives: cohabiting with non-marital partner, co-residence with persons other than a partner and living alone. MI incidence and long-term fatality were analysed with Cox proportional hazards regression with time-varying covariates and first-day fatality with logistic regression. Men who were married had a lower risk of MI incidence even after adjusting for socioeconomic factors - i.e. education, occupation, income, wealth and employment status - with small differences between the other living arrangement groups. For women the effects of living arrangements on incidence were fully explained by the same socioeconomic factors. However, our findings revealed that living arrangements were strong determinants for survival after MI independent of other socio-demographic factors. The results demonstrate greater fatality associated with living alone in men and suggest that cohabitation in midlife may be associated with a greater fatality risk in women. The social support and control offered by a marital relationship may protect from MI fatality in particular.
PURPOSE: To examine HRQoL measured by EORTC QLQ-C30 with respect to an increasing number of self-reported chronic health problems in the general Swedish population and to study the association between HRQoL, chronic health problems and age, gender, income, marital status and employment status. METHOD: A postal survey among a large random sample of 4000 adults aged 18-79 years. The study material contained EORTC QLQ-C30 core questionnaire supplemented by a sociodemographic questionnaire including questions about 13 chronic health problems of which four categories, 'No', 'Few', 'Some' or 'A lot of chronic health problems were constructed. RESULTS: Multiple chronic health problems were significantly associated with reduced HRQoL. The increased number of chronic health problems was also associated with age. When the number of chronic health problems was accounted for, the influence of age diminished. Low income and unemployment were associated with greater decline in HRQoL with respect to increasing number of problems among the respondents in working age. CONCLUSION: The impact of increased number of chronic health problems had varying consequences in different age groups. Moreover, sociodemographic and economic factors showed to interact differently with chronic health problems and HRQoL in various age groups. It appears from our results that an assessment and a careful consideration of these factors will be valuable in order to facilitate the interpretation of the effects of cancer and treatment on long-term HRQoL of cancer patients.
The hospice philosophy with focus on the patient's autonomy and the ideal of a good death are the overall objectives of palliative care. Often-raised questions, when discussing hospice, are for which of the incurable ill inpatient hospice is the most optimal care alternative together with who are making use of hospice. The aim of the present study was to describe patient characteristics such as age, marital status, diagnosis, referral source and length of stay (LoS) in relation to gender, during the first decade at an inpatient hospice ward (1992-2001). Data, obtained from medical register, were analysed by using descriptive statistics and the chi-square test. The number of patients was 666 women and 555 men, and most of them were elderly. In some respects significant differences were observed between women and men. More women than men were single, had cancer with relatively rapid trajectory and were referred from the oncology department. Men, more often than women, were diagnosed with cancers with a somewhat longer trajectory. Despite the longer trajectory, the LoS was shorter for men (median =13 days) than for women (median = 17 days). The most frequent referral source was hospital, though men, younger men in particular, were more often referred from home-based hospice care than women. During the last 3 years self-referrals were documented. Self-referrals can be seen as one distinct expression from a standpoint of one's own active choice compared with other referrals. Altogether, self-referrals were less frequent among women than men but in relation to age, self-referrals were more common among the youngest (85 years) than men in the same age groups. Further studies illuminating a gender perspective can broaden the understanding of what these differences may imply for women and men.
Studies from Norway and other countries have shown that the unmarried have poorer cancer survival than the married, given age, tumor site and stage at diagnosis. The objective of this investigation was to assess the importance of comorbidities for this difference, using disease indicators derived from the Norwegian Prescription Database (NorPD) and information on cancer and sociodemographic characteristics from various other registers, all of which cover the entire Norwegian population. Discrete-time hazard models for cancer mortality up to 2007 were estimated for all 22,925 men and 21,694 women diagnosed with 13 common types of cancer in 2005-7. There were 4898 cancer deaths among men and 4187 among women. Controlling for sociodemographic factors and tumor characteristics, the odds of dying from cancer among never-married men relative to the married was 1.56 (CI 1.41-1.74). The corresponding estimates for widowed and divorced were 1.16 (CI 1.05-1.28) and 1.27 (CI 1.15-1.40). For women, the odds ratios for these three groups were 1.47 (CI 1.29-1.67), 1.10 (CI 1.01-1.20) and 1.14 (CI 1.02-1.27). Several of the 24 indicators of diseases in the year before diagnosis were associated with cancer survival, but their inclusion reduced the excess mortality of the unmarried by only 1-5 percentage points, or about 10% as an overall relative figure. Similar results were found when the four most common cancers were analyzed separately, though there were some differences between them in the role played by the comorbidities. It is possible that important comorbidities are inadequately captured by the included indicators, and perhaps especially for the unmarried. Such concerns aside, the results suggest that the marital status differences in cancer survival to little extent are due to comorbidities (and the few disease risk factors that are also captured), but rather to various other "host factors" or to treatment or care.
Section of Vascular Surgery, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
A population-based screening programme for abdominal aortic aneurysm (AAA) started in 2010 in Stockholm County, Sweden. This present study used individual data from Sweden's extensive healthcare registries to identify the reasons for non-participation in the AAA screening programme.
All 65-year-old men in Stockholm are invited to screening for AAA; this study included all men invited from July 2010 to July 2012. Participants and non-participants were compared for socioeconomic factors, travel distance to the examination centre and healthcare use. The influence of these factors on participation was analysed using univariable and multivariable logistic regression models.
The participation rate for AAA screening was 77·6 per cent (18?876 of 24?319 men invited). The prevalence of AAA (aortic diameter more than 2·9?cm) among participants was 1·4 per cent. The most important reasons for non-participation in the multivariable regression analyses were: recent immigration (within 5?years) (odds ratio (OR) 3·25, 95 per cent confidence interval 1·94 to 5·47), low income (OR 2·76, 2·46 to 3·10), marital status single or divorced (OR 2·23, 2·08 to 2·39), low level of education (OR 1·28, 1·16 to 1·40) and long travel distance (OR 1·23, 1·10 to 1·37). Non-participants had a higher incidence of stroke (4·5 versus 2·8 per cent; P?