Inequality and COVID-19 in Sweden: Relative risks of nine bad life events, by four social gradients, in pandemic vs. prepandemic years.

The COVID-19 pandemic struck societies directly and indirectly, not just challenging population health but disrupting many aspects of life. Different effects of the spreading virus-and the measures to fight it-are reported and discussed in different scientific fora, with hard-to-compare methods and metrics from different traditions. While the pandemic struck some groups more than others, it is difficult to assess the comprehensive impact on social inequalities. This paper gauges social inequalities using individual-level administrative data for Sweden's entire population. We describe and analyze the relative risks for different social groups in four dimensions-gender, education, income, and world region of birth-to experience three types of COVID-19 incidence, as well as six additional negative life outcomes that reflect general health, access to medical care, and economic strain. During the pandemic, the overall population faced severe morbidity and mortality from COVID-19 and saw higher all-cause mortality, income losses and unemployment risks, as well as reduced access to medical care. These burdens fell more heavily on individuals with low income or education and on immigrants. Although these vulnerable groups experienced larger absolute risks of suffering the direct and indirect consequences of the pandemic, the relative risks in pandemic years (2020 and 2021) were conspicuously similar to those in prepandemic years (2016 to 2019).

Birth order and health disparities throughout the life course.

BACKGROUND: Research has shown ample evidence of how birth order affects health; however, these studies focus on specific health outcomes and ages. OBJECTIVE: We provide a comprehensive picture of the effects of birth order on health disparities over the life course. METHOD: We study the effects of birth order from birth to age 70 on hospitalizations, visits to open care facilities and mortality using Swedish register data from 1987 to 2016. We identify the effects by comparing siblings within the same family. RESULTS: We find that firstborns have worse health at birth. In adolescence, the birth-order effects switch direction, and younger siblings are more likely to be hospitalized and visit open care facilities. From early age younger siblings receive more care for injuries, in adolescence for drug and alcohol abuse, and from middle age for diseases of the circulatory system compared to older siblings. Younger siblings also stay longer in hospital. Age 0-2, younger siblings are more likely to be hospitalized for infections, diseases of the respiratory system, eyes and ears, whereas the pattern is the opposite for children age 3-6. Firstborns are more likely to receive care for depression and ADHD in childhood and endocrine diseases after age 50. INTERPRETATION: Birth order affects health over the life-cycle and this is likely due to biological factors as well as parental behavior and the family environment. Firstborns have worse health at birth, but in adolescence the effects switch direction due to health issues related to younger siblings engaging in more risky behavior. For small children, having siblings at home increases the risk of being hospitalized for infections, diseases of the respiratory system, eyes and ears. The adverse conditions in utero for firstborns may be the cause of increased risk of metabolic syndromes such as obesity and diabetes later in life.

Interpregnancy interval and maternal and neonatal morbidity: a nationwide cohort study.

This study aimed to assess the association between interpregnancy interval (IPI)-the time from childbirth to conception of the next pregnancy-and maternal and neonatal morbidity. The World Health Organization (WHO) currently recommends an IPI of at least 24 months after a live birth to reduce adverse birth outcomes. However, assessing the relationship between IPI and perinatal outcome is complicated by confounding factors. We conducted a nationwide population-based cohort study using Swedish registry data, allowing for adjustment of maternal characteristics and health at first birth. The study population consisted of all women with a singleton, live, and vaginal first birth with a second singleton birth within five years during 1997-2017, covering 327,912 women and 655,824 neonates. IPI was grouped into six-month intervals with 24-29 months as the reference. The association between IPI and morbidity was examined using multivariate logistic regression. For women having a vaginal delivery at their first birth, intervals < 24-29 months were associated with decreased maternal morbidity and unaffected neonatal morbidity. Intervals > 24-29 months were associated with increased maternal and neonatal morbidity. Our findings question the relevance of WHO's recommendation of an IPI of at least 24 months in a high-income country.