An intersectional analysis of sociodemographic disparities in Covid-19 vaccination: A nationwide register-based study in Sweden.

BACKGROUND: Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18-64 years. METHODS: National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18-64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake. FINDINGS: By 12 October 2021, 76·0% of the Swedish population 18-64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage. INTERPRETATION: Our study, addressing the entire Swedish population aged 18-64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage. FUNDING: SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS.

Life satisfaction and coronary atherosclerosis: The SCAPIS study.

BACKGROUND: There is an increasing interest in the potential health benefits of positive psychological states, especially with regard to cardiovascular health. Life satisfaction is thought to be a constituent component of psychological well-being; however, among the few previous studies that have investigated its associations with early stages of the cardiovascular disease process, only one small study has focused on coronary atherosclerosis. The present study aimed to explore associations between life satisfaction and coronary artery disease. METHODS: The study used cross-sectional data from SCAPIS Malmö (n = 6251 randomly selected men and women, aged 50-64 years), including assessment of life satisfaction and coronary artery calcification. Adjustments were made for sociodemographic factors, depression, and cardiovascular risk factors as assessed with the SCORE instrument. RESULTS: Higher levels of life satisfaction were associated with lower odds of increased coronary artery calcification. This association persisted after adjusting for sociodemographic factors and depression, but lost significance after adjusting for cardiovascular risk factors. Sub-analyses revealed a significant dose-response relationship between higher life satisfaction and lower grade of coronary calcification in all investigated coronary artery regions. CONCLUSION: In this population-based sample, life satisfaction was associated with better coronary artery health. However, this association was largely explained by cardiovascular risk factors, indicating that life satisfaction is linked to coronary atherosclerosis through a decreased load of cardiovascular risk factors.

Health locus of control and mortality: a population-based prospective cohort study.

OBJECTIVES: The objective of the study was to estimate associations between health locus of control (HLC) and mortality. STUDY DESIGN & METHODS: The public health survey in Scania 2008 was linked to the Swedish cause of death register. In this study of 10,757 men and 12,322 women aged 18-80 years, 421 men and 235 women died during the 5.3-year follow-up. Survival analyses were conducted. RESULTS: Respondents with only some or no internal HLC had significantly higher hazard rate ratios (HRRs) compared with respondents with high HLC. For women, the HRRs of those with low HLC did not significantly differ from the reference group after final adjustments for health-related behaviours. CONCLUSIONS: HLC is a predictor of mortality, and this association is to an important extent mediated by health-related behaviours.

Sexual identity and low leisure-time physical activity: a population-based study.

OBJECTIVES: To investigate associations between sexual identity and low leisure-time physical activity (LTPA). STUDY DESIGN: Cross-sectional study. METHODS: The 2012 public health survey was conducted with a postal questionnaire in southern Sweden with 28,029 respondents, aged 18-80 years. Analyses were conducted with logistic regressions. RESULTS: The prevalence of low LTPA among men and women were as follows: 13.9% and 12.3% among heterosexuals, 26.1% and 18.5% among bisexuals, 19.5% and 15.6% among homosexuals, 26.6% and 18.5% among others. Bisexual men and women and other men had higher odds ratio of low LTPA than heterosexuals in the final models, whereas gay and lesbian participants did not differ. CONCLUSIONS: The results should guide health promotion and prevention.

Negative life events predict weight gain in a 13-year follow-up of an adult Swedish population.

BACKGROUND: Increasing psychosocial stress may underlie contemporary obesity trends. We investigate cross-sectional and prospective associations between negative life events (NLEs) and anthropometric indicators, and whether these are explained by lifestyle, depression and sleeping problems. METHODS: Participants in the Swedish INTERGENE cohort answered questions about ten types of NLE, and indicated whether they occurred during the last year or earlier (2001-04, n = 2706). Body mass index (BMI) and waist-to-hip ratio (WHR) were measured at baseline, and at follow-up (2014-16, n = 974). Numbers of recent and distant NLE were related to anthropometric variables using linear models including age, sex, and education, and further adjusted for lifestyle, and psychological problems. Prospective models were adjusted for baseline anthropometric values. RESULTS: Participants reported on average 3.6 types of NLEs, of which 70% were experienced more than one year ago. At baseline, distant but not recent NLEs were associated with higher values of both BMI and WHR. These associations were explained in part by lifestyle and depression assessed at baseline. Recent but not distant NLEs predicted gain in BMI, 0.19 (0.07, 0.30) kg/m2, and WHR, 0.005 (0.002, 0.007), per event and independent of baseline covariates. The largest associations were seen for job insecurity and financial worries, with 0.35 (0.17, 0.52) kg/m2 increase in BMI corresponding to approximately 1.2 kg per event, in both sexes. CONCLUSION: We observed positive associations between NLEs and weight gain over 13 years including signs of latency and recovery regarding adverse weight development.

Negative emotional states and negative life events: Consequences for cardiovascular health in a general population.

OBJECTIVE: The contemporary increase in psychological distress observed in many countries is, by itself, a public health issue of great concern. The present study aims to investigate associations between self-reported negative emotional states and negative life events, and cardiovascular disease (CVD). METHODS: Prospective cohort study based on the Swedish INTERGENE cohort comprising 3614 men and women, aged 25 to 75. Baseline examinations during 2001-2004 included self-rating depression and anxiety scales, life stress, as well as a wide range of physiological and behavioral parameters, which allowed for relevant adjustments. Cox proportion hazard was used to predict incident CVD, CVD mortality as well as all-cause mortality. RESULTS: The results showed a dose-response relationship between depressiveness, anxiety and negative life events on the one hand, and increased risk of CVD. Most of these associations persisted in the fully adjusted models. Furthermore, the youngest age group (25-44 years) generally showed the highest prevalence of psychosocial distress, and also had the highest risks of incident CVD with regard to depression and anxiety. CONCLUSION: The associations between psychological distress and later life cardiovascular disease calls for enhanced public health efforts aiming at ameliorating psychological health, not least in younger age groups.

Sexual orientation and poor psychological health: a population-based study.

OBJECTIVES: The purpose of this study was to analyse associations between sexual orientation and poor psychological health. STUDY DESIGN: This was a cross-sectional study. METHODS: The 2012 public health survey in Scania, Southern Sweden, is a cross-sectional population-based study with 28,029 participants aged 18-80 years. Logistic regression analyses were performed. RESULTS: The prevalence of poor psychological health (measured using the General Health Questionnaire [GHQ]-12) was 16.3% among men and 22.4% among women. Bisexual men and women had significantly higher odds ratios of poor psychological health throughout the multiple analyses than heterosexual individuals. In contrast, the odds ratios of poor psychological health among gay men and lesbian women were not significantly higher. CONCLUSIONS: Respondents with bisexual orientation have increased risk of poor psychological health.

Marital status and 5-year mortality: A population-based prospective cohort study.

OBJECTIVES: The aim was to investigate the association between baseline marital status and mortality using survival (Cox-regression) analysis. STUDY DESIGN: This is a prospective cohort study. METHODS: The public health survey by Scania in 2008 was linked to the Swedish cause of death register. This prospective cohort study includes 12,245 men and 14,969 women aged 18-80 years, and 538 men and 362 women of them died during the 5.3-year follow-up. RESULTS: Unmarried, divorced, and widowed men had significantly higher hazard rate ratios (HRRs) of all-cause mortality than married/cohabitating men. For women, the HRRs of these groups did not significantly differ from those of the married/cohabitating reference group. CONCLUSIONS: The results are in accordance with a previous study that only compared those living alone with those cohabitating.

Economic stress in childhood and suicide thoughts and suicide attempts: a population-based study among adults.

OBJECTIVES: To investigate associations between economic stress in childhood and suicide thoughts and attempts. STUDY DESIGN: The 2012 public health survey in Scania, Sweden, is a cross-sectional postal questionnaire study including 28,029 participants, aged 18-80 years. METHODS: Associations were analyzed in logistic regressions. RESULTS: A 12.1% prevalence of men and 15.5% of women had ever experienced suicide thoughts, while 3.2% of men and 5.3% of women had experienced suicide attempt. Roughly 24% had experienced less severe and 8% severe economic problems in childhood. Significant associations between economic stress in childhood and suicide thoughts and attempts remained throughout the age-adjusted and multiple adjusted analyses. CONCLUSIONS: Economic stress in childhood is associated with self-reported suicide thoughts and suicide attempts in an adult general population.

Addictive behaviors, social and psychosocial factors, and electronic cigarette use among adolescents: a population-based study.

OBJECTIVES: The aim was to investigate associations between e-cigarette use and social and psychosocial factors and cigarette smoking, alcohol consumption, and narcotics use among adolescents attending 9th grade in primary school and 2nd grade in secondary school. STUDY DESIGN: Cross-sectional study. METHODS: The public health survey among adolescents in Scania in 2016 includes pupils in grades 9 and 2. The associations between e-cigarette use and lifestyle, social and psychosocial factors, and trust were investigated with logistic regressions. RESULTS: In 9th grade, 32% of male pupils and 27% of female pupils had ever used e-cigarettes, and in 2nd grade, 43% of males and 31% of females had ever used e-cigarettes. E-cigarette use was significantly associated with current smoking, snus (a moist powder tobacco product originating in Sweden) use, water pipe use, intensive alcohol consumption, and narcotics and also with psychosocial conditions related to home and parents, peers, and school. CONCLUSIONS: The prevalence of ever e-cigarette use was high among adolescents attending both grades. E-cigarette use was most strongly associated with health-related lifestyles. It was also associated with psychosocial factors such as study difficulties, school stress, problems talking with parents, and generalized trust.

Risk factors for the progression of carotid intima-media thickness over a 16-year follow-up period: the Malmö Diet and Cancer Study.

OBJECTIVE: To evaluate the progression of carotid intima-media thickness (IMT) in the common carotid artery (CCA) and the bifurcation over a mean follow-up of 16 years in relation to cardiovascular risk factors. METHODS: The study population included 3426 middle-aged Swedish men and women participating in the 1991-1994 (baseline) and the 2007-2012 (re-examination) investigation of the cardiovascular cohort of the Malmö Diet and Cancer Study (MDCS). RESULTS: There were differences in risk factor patterns in arterial segments in that diabetes and male sex were associated with the progression of IMT in the bifurcation, but not in the CCA, and high-density lipoprotein cholesterol (HDL) was associated with the progression of IMT in the CCA, but not in the bifurcation. Favourable changes in systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL) and HDL during follow-up decreased the IMT progression rate in the CCA. There was a cumulative relationship between traditional cardiovascular risk factors (i.e., regular smoking, LDL/HDL-ratio ≥ 3, hypertension) and IMT progression rates. The odds ratio (OR) of high IMT CCA progression rate (>75th percentile) was 1.0 (reference), 1.4 (95% CI: 1.1, 1.7), 1.7 (95% CI: 1.3, 2.2) and 2.1 (95% CI: 1.4, 3.1), respectively, for individuals with none, one, two, and three risk factors. CONCLUSION: There were differences in the associations between risk factors and progression rate in different arterial segments. Favourable changes in SBP and lipids during the follow-up period were associated with reduced IMT progression rates in the CCA.

Children in family foster care have greater health risks and less involvement in Child Health Services.

AIM: This study investigated the impact of being in family foster care on selected health determinants and participation in Child Health Services (CHS). METHODS: Two groups of 100 children, born between 1992 and 2008, were studied using data from Swedish Child Health Services for the preschool period up to the age of six. The first group had been in family foster care, and the controls, matched for age, sex and geographic location, had not. Descriptive statistics were used to describe differences in health determinants and participation in Child Health Services between the two groups. RESULTS: The foster care group had higher health risks, with lower rates of breastfeeding and higher levels of parental smoking. They were less likely to have received immunisations and attended key nurse or physician visits and speech and vision screening. Missing data for the phenylketonuria test were more common in children in family foster care. CONCLUSION: Children in family foster care were exposed to more health risks than the control children and had lower participation in the universal child health programme during the preschool period. These results call for secure access to high-quality preventive health care for this particularly vulnerable group of children.

Dynamics of interacting information waves in networks.

To better understand the inner workings of information spreading, network researchers often use simple models to capture the spreading dynamics. But most models only highlight the effect of local interactions on the global spreading of a single information wave, and ignore the effects of interactions between multiple waves. Here we take into account the effect of multiple interacting waves by using an agent-based model in which the interaction between information waves is based on their novelty. We analyzed the global effects of such interactions and found that information that actually reaches nodes reaches them faster. This effect is caused by selection between information waves: lagging waves die out and only leading waves survive. As a result, and in contrast to models with noninteracting information dynamics, the access to information decays with the distance from the source. Moreover, when we analyzed the model on various synthetic and real spatial road networks, we found that the decay rate also depends on the path redundancy and the effective dimension of the system. In general, the decay of the information wave frequency as a function of distance from the source follows a power-law distribution with an exponent between -0.2 for a two-dimensional system with high path redundancy and -0.5 for a tree-like system with no path redundancy. We found that the real spatial networks provide an infrastructure for information spreading that lies in between these two extremes. Finally, to better understand the mechanics behind the scaling results, we provide analytical calculations of the scaling for a one-dimensional system.

Common carotid intima-media thickness does not add to Framingham risk score in individuals with diabetes mellitus: the USE-IMT initiative.

AIMS/HYPOTHESIS: The aim of this work was to investigate whether measurement of the mean common carotid intima-media thickness (CIMT) improves cardiovascular risk prediction in individuals with diabetes. METHODS: We performed a subanalysis among 4,220 individuals with diabetes in a large ongoing individual participant data meta-analysis involving 56,194 subjects from 17 population-based cohorts worldwide. We first refitted the risk factors of the Framingham heart risk score on the individuals without previous cardiovascular disease (baseline model) and then expanded this model with the mean common CIMT (CIMT model). The absolute 10 year risk for developing a myocardial infarction or stroke was estimated from both models. In individuals with diabetes we compared discrimination and calibration of the two models. Reclassification of individuals with diabetes was based on allocation to another cardiovascular risk category when mean common CIMT was added. RESULTS: During a median follow-up of 8.7 years, 684 first-time cardiovascular events occurred among the population with diabetes. The C statistic was 0.67 for the Framingham model and 0.68 for the CIMT model. The absolute 10 year risk for developing a myocardial infarction or stroke was 16% in both models. There was no net reclassification improvement with the addition of mean common CIMT (1.7%; 95% CI -1.8, 3.8). There were no differences in the results between men and women. CONCLUSIONS/INTERPRETATION: There is no improvement in risk prediction in individuals with diabetes when measurement of the mean common CIMT is added to the Framingham risk score. Therefore, this measurement is not recommended for improving individual cardiovascular risk stratification in individuals with diabetes.

Ranking and clustering of nodes in networks with smart teleportation.

Random teleportation is a necessary evil for ranking and clustering directed networks based on random walks. Teleportation enables ergodic solutions, but the solutions must necessarily depend on the exact implementation and parametrization of the teleportation. For example, in the commonly used PageRank algorithm, the teleportation rate must trade off a heavily biased solution with a uniform solution. Here we show that teleportation to links rather than nodes enables a much smoother trade-off and effectively more robust results. We also show that, by not recording the teleportation steps of the random walker, we can further reduce the effect of teleportation with dramatic effects on clustering.

Marital status, social capital and health locus of control: a population-based study.

OBJECTIVES: To investigate the association between marital status and lack of internal health locus of control (HLC), taking economic stress and trust into account. STUDY DESIGN: Cross-sectional study. METHODS: The public health survey Skåne 2008 is a postal questionnaire study (55% participation rate). A random sample was invited to participate, and 28,198 individuals aged 18-80 years agreed. Logistic regression models were used to discern associations between marital status and lack of internal HLC. The multiple regression analyses included age, country of birth, education, economic stress and 'horizontal' trust. RESULTS: In total, 33.7% of the men and 31.8% of the women lacked internal HLC. After age-adjustments, the unmarried and divorced men and the widowed women displayed significantly higher odds ratios of lack of internal HLC. The significantly higher odds ratios only remained for unmarried men throughout the multiple analyses. In contrast, divorced women had significantly lower odds ratios of lack of internal HLC than married women after adjustments for economic stress. CONCLUSIONS: Health promotion regarding HLC and related behaviours should consider men and women who are not cohabiting. Health promotion should particularly consider unmarried men due to their higher propensity to lack internal HLC. The economic conditions and exposure to economic stress among widowed and divorced women should also be highlighted.

The association of education with long-term weight change in the EPIC-PANACEA cohort.

BACKGROUND/OBJECTIVES: Cross-sectionally, educational attainment is strongly associated with the prevalence of obesity, but this association is less clear for weight change during adult life. The objective of this study is to examine the association between educational attainment and weight change during adult life in the European Prospective Investigation into Cancer and Nutrition (EPIC). SUBJECTS/METHODS: EPIC is a cohort study with 361,467 participants and up to 10 years of follow-up. Educational attainment was categorized according to the highest obtained school level (primary school or less, vocational secondary training, other secondary education and university). Multivariate mixed-effects linear regression models were used to study education in relation to weight at age 20 years (self-reported), to annual change in weight between age 20 years and measured weight at recruitment, and to annual change in weight during follow-up time. RESULTS: Higher educational attainment was associated with on average a lower body mass index (BMI) at age 20 years and a lower increase in weight up to recruitment (highest vs lowest educational attainment in men: -60 g per year (95% confidence interval (CI) -80; -40), women -110 g per year (95% CI -130; -80)). Although during follow-up after recruitment an increase in body weight was observed in all educational levels, gain was lowest in men and women with a university degree (high vs low education -120 g per year (95% CI -150; -90) and -70 g per year (95% CI -90; -60), respectively). CONCLUSIONS: Existing differences in BMI between higher and lower educated individuals at early adulthood became more pronounced during lifetime, which possibly impacts on obesity-related chronic disease risk in persons with lower educational attainment.

Reinforced communication and social navigation: remember your friends and remember yourself.

In social systems, people communicate with each other and form groups based on their interests. The pattern of interactions, the network, and the ideas that flow on the network naturally evolve together. Researchers use simple models to capture the feedback between changing network patterns and ideas on the network, but little is understood about the role of past events in the feedback process. Here, we introduce a simple agent-based model to study the coupling between peoples' ideas and social networks, and better understand the role of history in dynamic social networks. We measure how information about ideas can be recovered from information about network structure and, the other way around, how information about network structure can be recovered from information about ideas. We find that it is, in general, easier to recover ideas from the network structure than vice versa.

Psychotropic drugs and falling accidents among the elderly: a nested case control study in the whole population of Scania, Sweden.

STUDY OBJECTIVE: The objective of this study was to investigate the associations between medication with psychotropic drugs and falling accidents in the whole population aged 65 years and older in the county of Scania, Sweden. DESIGN: A population based nested case control study was performed. SUBJECTS: Cases were persons registered in the Region Healthcare database after a falling accident during the year 2006 (n=10 482). One control was matched to each case based on age, sex, date of the falling accident, living area and propensity score (based on prevalent disease). MAIN RESULTS: Using psychotropic drugs within 3 months before the fall was associated with a more than doubled odds for a falling accident among both men (2.14, 95% CI 1.87 to 2.44) and women (2.21, 95% CI 2.04 to 2.39). The use of psychotropic drugs during the week before the accident occurred was associated with an even higher odds for a falling accident among both men (OR=5.61; 95% CI 2.54 to 12.41) and women (OR=3.40; 95% CI 2.24 to 5.17). A similar pattern of association was seen for specific groups of psychotropic drugs: opioids, antidepressants and anxiolytics/hypnotics/sedatives. CONCLUSIONS: The use of psychotropic drugs increased the odds for a falling accident among persons 65 years and older. Generally, patients using psychotropic drugs seemed to have the highest odds for falling accidents immediately after initiating therapy. Since these medications are extensively used among the elderly, the increased risk for falls associated with these kinds of drugs is an important public health problem that could be tackled by a more rational medication use.

Time walkers and spatial dynamics of aging information.

The distribution of information is essential for a living system's ability to coordinate and adapt. Random walkers are often used to model this distribution process and, in doing so, one effectively assumes that information maintains its relevance over time. But the value of information in social and biological systems often decays and must continuously be updated. To capture the spatial dynamics of aging information, we introduce time walkers. A time walker moves like a random walker, but interacts with traces left by other walkers, some representing older information, some newer. The traces form a navigable information landscape which we visualize as a river network. We quantify the dynamical properties of time walkers, and the quality of the information left behind, on a two-dimensional lattice. We show that searching in this landscape is superior to random searching.