Between 1992 and 1996 more than one million refugees, mostly women, received asylum in the USA, Canada and Germany and about 47,000 of them sought refuge in Sweden. Little is known about their cardiovascular health. Using data from a cross-sectional study of a simple random sample of non-patients, female Bosnian refugees (n = 98) aged 18-59 and Swedish-born controls (n = 95) we examined six primary diet cardiovascular risk factors: S-triglycerides, S-cholesterol, high-density lipoprotein cholesterol, body mass index (BMI), waist circumference, and sagittal diameter of the abdomen. Bosnian women aged 42-59 y had substantially higher levels of BMI, larger waist and sagittal diameter of the abdomen measurements, higher levels of S-triglycerides, and lower HDL cholesterol indicating a more disadvantaged diet (CVD risk profile) than Swedish women. Younger Bosnian women aged 18-41 y had a higher sagittal diameter of the abdomen and lower high-density lipoprotein cholesterol than Swedish women. In conclusion this is the first study to report large differences in blood lipids, obesity and abdominal obesity after adjustment for socioeconomic status between Bosnian and Swedish women. These findings underscore the critical need to improve early detection obesity-related conditions in Bosnian women in exile.
BACKGROUND: The purpose of this study was to analyse both cross-sectional associations and how longitudinal changes in lifestyle factors from one state in 1980-1981 to another in 1988-1989 influence self-reported health status. Another aim was to estimate the hazard ratios for all-cause mortality for the changes in lifestyle factors and self-reported hypertension during the same period of time. METHOD: The cross-sectional and the longitudinal analyses are based on the same simple random sample of 3,843 adults, aged 25-74, interviewed in 1980-1981 and 1988-1989 and is part of the Swedish Annual Level-of-Living Survey. About 85% of the respondents in the first interview participated in a second interview in 1988-1989. Cross-sectional odds ratios, based on a marginal model, were estimated using the generalized estimating equations. The transitional models were analysed using unconditional logistic regression. A proportional hazard model was applied to investigate the influence of lifestyle transitions on mortality. RESULTS: Physical inactivity, being a current or former smoker and obesity (women only) were strong risk factors for poor health either as main effects and/or combined (interactions). There was a strong interaction between physical activity and smoking, and for women, also between body mass index (BMI) and physical activity. Smoking, physically inactive and obese women had about a ten times higher risk of poor health status than non-smoking, physically active, and normal-weight women. The corresponding risk for men was about five times higher. Physically active, but smoking and obese individuals showed only moderately increased risks for poor health status. The transitional model showed that those who were physically inactive in 1980-1981, but did exercise in 1988-1989, improved their health after adjustments for sociodemographic and other lifestyle factors. Continuing to smoke or being physically inactive or having hypertension at both points in time were all associated with higher hazard ratios for all-cause mortality (1.6, 1.9 and 1.8, respectively) than those who reported that they were in good status at both points in time. CONCLUSIONS: We found that physical activity protects against poor health irrespective of an increased BMI and smoking. The major clinical implications are the long-standing benefits of physical activity and not smoking.
The aim of this follow-up study, based on individual data, was to analyse the influence of ethnicity and other demographic and social factors on suicide rates between 1986 and 1989 for the Swedish population according to the 1985 census. The data were analysed by sex and age using a Poisson regression model. During the study period there were 8,310 cases of suicide and undetermined death. The main finding in this study was that ethnicity, defined as being foreign-born, was a significant risk factor for suicide in both sexes and in all age groups except for males aged 30 to 49 years. Not being married was a significant risk factor in all age groups for both males and females. Form of tenure, i.e. living in rented flats, was a significant risk factor for suicide in middle-aged males and females, while over-crowding was a risk factor for middle-aged males and for the over 50's of both sexes. As ethnicity, defined as foreign-born, was an important variable related to suicide, the association between different ethnic groups and suicide will be evaluated in forthcoming studies.
The purpose of this study was to examine the importance of social deprivation for psychiatric admissions and its correlation with two different deprivation scores. Care Need Index (CNI) and Townsend scores were calculated at the small area level in Malm?, a city in southern Sweden. Admission rates for all psychiatric inpatients from Malm? aged 20-79 years, admitted to the psychiatric and alcohol clinics from 1 January 1991 to 31 December 1994, were calculated. The relationship between the CNI and psychiatric admissions was analysed by applying a Poisson regression model. The results are shown as incidence density ratios (IDR) with 95% confidence intervals (CI). From the most deprived areas, the first psychiatric admission rate was more than four times higher than in the most affluent areas. The rates of second and third admission were even higher. Admissions to the alcohol clinic were similar to psychiatric admissions, but the most deprived areas had first admission rates about ten times higher than in the most affluent areas. About 27% of first admissions, including patients from both psychiatric and alcohol clinics, had a diagnosis of psychosis, and 43% were substance abusers. There were differences between the patients' diagnoses in different areas. The correlation between the CNI and Townsend scores was very high. The most important finding of this study is the strong correlation between social deprivation, based on different deprivation indices, and first admissions to psychiatric and alcohol clinics.
Three hundred thirty eight Latinamerican refugees living in Lund, Sweden, 51 that lived in Lund and were repatriated to Chile and 1132 Swedish subjects were interviewed using the survey of the Swedish National Statistics Institute. Data were analyzed using an unconditional logistic regression model, controlling possible confounders. Refugees living in Lund and repatriated to Chile considered their health as bad in a higher proportion than their Swedish counterparts, with an odds ratio of 3.48 (2.03-5.66) and 4.78 (2.1-10.25) respectively. Refugees and repatriated subjects had a higher risk of suffering long lasting illnesses with odds ratio of 2.84 and 2.64 respectively. It is concluded that there are great differences in life standards, housing and social relationships between Swedish people, Latinamerican refugees and repatriated individuals.
BACKGROUND: Although it is well known that analgesics contribute to suicide, there is little knowledge about how much of the mortality and suicide can be explained by socioeconomic deprivation or by sales of analgesics. METHODS: This ecological study analyses the relationships between the sales (defined daily doses per 1000 inhabitants per day) of dextropropoxyphene, dextropropoxyphene combinations, paracetamol, codeine and paracetamol combinations, and other codeine combinations and the Swedish UPA (underprivileged area) score, mortality and suicide rates in 33 municipalities in Sk?ne in 1987 and 1994 for people aged 20-64 years. The association of each of the subgroups of analgesics with all-cause mortality, and with standardised mortality rates for suicide, adjusted for UPA score, was investigated by using weighted (by population size) regression analysis. RESULTS: In 1994 there was a moderate to strong significant correlation between sales of analgesics and UPA scores, mortality and suicide (r = 0.49-0.78). Although UPA score explained 68.9% and 67.4% respectively of the variance between the analgesics and all-cause mortality and suicide, codeine and paracetamol combinations explained a further 10.1% of the variance in suicide. Dextropropoxyphene and codeine and paracetamol combinations explained an additional 3.8% and 2.9% respectively of the variance in mortality. CONCLUSIONS: Local prescription rates for analgesics were associated with mortality and suicide, when adjusted for socioeconomic deprivation defined as UPA score.
OBJECTIVE: To analyse the association between the Swedish underprivileged area (UPA) score and the standardized mortality ratio in Swedish municipalities. SETTING: All 284 municipalities in Sweden. DESIGN: The UPA-score was calculated for municipalities using the proportion of persons in the following groups: elderly persons living alone, children under five, persons in one-parent families, unskilled (SEI 1), unemployed, persons living in crowded households, those who have moved house in the last year, and persons of minority ethnic origin. After transformation (arc sin square root of) and standardization, each of the eight variables was weighted by the UK general practitioners' average weighting and added to give a composite index of socioeconomic deprivation--the UPA-score. The strength of the relationship between the UPA-score and premature mortality in Sweden was investigated by regression analysis using SMR, for people aged 20-64 years, 1989-93, as the dependent variable. RESULTS: The mean UPA-score (standard deviation) of the 284 municipalities was 0 (10.0) and the range -43 to 28. The mean SMR for all persons was 1 and the range 0.46 to 1.81. The association between UPA-score and SMR was statistically significant and the UPA-score explained 20% of the variation between municipalities in SMR. CONCLUSION: The range of social deprivation at the municipality level in Sweden, as measured by a composite index such as the UPA score, is wide. A two-fold variation at municipality level was also found in premature mortality. There was a significant association between high rates of mortality and social deprivation.