Health and social outcomes among children in low-income families and families receiving social assistance--a Swedish national cohort study.

We examined health and social outcomes among children related to parental disposable income and receipt of social assistance. Swedish national registry data were used in a longitudinal design. We estimated relative risks and odds ratios for health and social outcomes in Poisson and logistic regressions among 1.2 million children between 1993 and 2002, and adjusted for factors that might affect the associations. Children in families receiving long-term social assistance showed considerably less satisfactory future prospects regarding health-related outcomes--all-cause mortality, suicide attempt, alcohol and drug misuse. Also, and to an even greater extent, the children experienced low educational attainment and social assistance in young adulthood compared with the rest of the population, and also in comparison with other low-income families. Low income was also associated with risk increases, but to a lesser extent. After taking into account the greater proportion of social-assistance recipients in low-income groups, attenuated risk increases remained only regarding future prospects of low education and social assistance. Regarding both low income and months receiving social assistance there was a gradient, at least in the age-adjusted analyses; there were greater risk increases among long-term recipients and among those with low incomes, and lower risk increases among short-term recipients and among those with high incomes. The results indicate that growing up in a family on long-term social assistance is a robust risk marker for compromised long-term development. A policy whereby children and parents receiving long-term assistance are offered access to evidence-based prevention programs in the areas of health, education and skills training appears to be important.

Inpatient/outpatient health care costs and remaining years of life--effect of decreasing mortality on future acute health care demand.

The article introduces a method that may be used to estimate how demographic changes may affect future demand for inpatient/outpatient health care. The method is useful in order to refine estimation of demographic influence on demand in the process of health human resources planning. Empirical evidence focuses on the connection between health care costs and remaining years of life. We estimate the demographically determined rise in inpatient/outpatient health care demand in Sweden in the period 2000-2030. The increase arrived at, by means of our method, is circa 37% lower than estimates done with a simple demographical extrapolation, which does not take the decreasing mortality pattern into account.

The effect of change in educational composition on population ageing.

Official Swedish demographic projections have systematically underestimated the number of older people. One explanation behind the underestimation may be found in the fact that the demographic projections are not taking into account socio-economic mortality differentials. We performed alternative demographic scenarios based on assumptions of unchanged and continuing declining mortality, with and without taking into account socio-economic gradients in mortality. According to a scenario based on assumption on declining mortality rates per age group, sex and educational level, the number of older persons (65+) in Sweden will increase by 62% during the period 2000-2035. This can be compared to an increase by 54% in a scenario that does not take into account future structural differences in educational levels and the latest trends in socio-economic inequality in life expectancy (the method used by statistical offices). The socio-economic structure of the older population is significantly changing over the years. We project that by year 2035, only 20% of women 80 years and older will have a low educational level, compared to about 75-80% today. The change in socio-economic structure is similar for the older men. Standard demographic projections that do not take into account socio-economic mortality differentials, risk underestimating the number of older people and hiding dramatic changes in population composition. Taking into account socio-economic mortality differentials results in alternative projections giving us new information regarding the future size and socio-economic composition of the older population. We recommend use of this information in health care and long-term care human resources planning or when assessing financial sustainability of health care, long-term care and pension systems in the future.

Population ageing in Sweden: the effect of change in educational composition on the future number of older people suffering severe ill-health.

We investigate how expected changes in the educational level composition of the older population may affect future prevalence of severe ill-health among older people in Sweden. Previous research has indicated that the number of older people, given educational differentials in mortality and expected changes in educational composition during the next decades, may increase more than expected following official population projections in Sweden. Eight alternative scenario projections for the possible development in the number of people with severe ill-health in Sweden between 2000 and 2035 are presented. Scenario projections, where both morbidity and mortality inequalities by educational level are taken into account, are compared with scenarios in which only age and gender are modelled. The projections are made with both constant and decreasing mortality. The calculations show that the expected increases in severe ill-health as a result from the ageing of the population in the period 2000-2035 might, to a large extent, be counteracted by the increase in the educational level of the Swedish population. We recommend therefore that in projections of the prevalence of ill-health, in addition to the ageing of the population, also changes in educational level should be taken into account.

Future demand for formal long-term care in Sweden.

Ageing population will have a significant effect on demand for human resources in health care and social care for the older people. Here we are presenting, using different scenarios, how projected demographic development may influence the demand for formal long-term care (LTC) for the people older than 65 years in Sweden 2000-2030. Our method uses information on utilisation of current services per gender and age group, demographic projections of number of older people per gender and age group and assumptions on health status changes per gender and age group. Our assumptions on health status changes were based on estimates from Swedish National Survey of Living Conditions, covering 32,502 observations during the period 1975-1999. The assumption that trends in severe ill-health in Sweden between 1975 and 1999 will continue (meaning expected improvements in age/gender-specific health and functional ability among the older people) results in the projected increase in the demand by year 2030 being almost halved, compared with an estimate that is based on unchanged age/gender-specific health and functional ability. The assessment of future demand for LTC for the people older than 65 years should involve extrapolations based on expected changes in health status, as well as the question how decreasing mortality incorporated into population forecasts is to be associated with future trends on severe morbidity/disability.